Here’s a Christmas cracker riddle for you:
Question – What is the difference between the British fishing industry and the NHS?
Answer – No difference – they are both the bait for trade agreements – fishing in 1972, and the NHS at some future date when the government will be so desperate for economic growth that the NHS will be offered up to US corporate healthcare interests.
The more you think about it, the greater the similarity. The fishing fleet and the NHS are both national icons, two of the few things that make us proud to be British and are thought to be the envy of the world.
In its heyday, the fishing fleet provided a major part of the nation’s protein, was the mainstay of the economy along the east coast, and provided dangerous but often well-paid work for generations of men.
It was severely damaged in the UK’s agreement to enter the Common Market (as it was then), with rights to fish within what had previously been British waters shared with other European countries, and trawlers being allocated a quota of fish they were entitled to catch.
A fishing frenzy followed, with over-fishing reducing stocks in key fishing grounds like the North Sea. Increased competition for a more limited catch led to a huge loss of traditional fishing capacity, with many small enterprises selling out their quotas to the highest bidder and going for an easier life – the slipper skippers.
Despite the passage of time and the fact that those fishermen who stayed in business did so by selling a large proportion of their fish into European markets, the fishing community organised itself to campaign hard for a leave result in the referendum.
In 1972 they had suffered a historic injustice, being the bait the UK offered up to gain entry. Injustice enters the soul, and stays there through the generations, and so fishermen – whose catch will be subject to a 40% tariff in the EU if there is no deal – argued strongly to leave.
The UK does not have many enticing pieces of bait left, but the NHS, with £135bn to be spent in 2021, has potentially rich pickings for US private health care interests. Since 2012 it has been structured as a market rather than a planned public service, with commissioners required to put services out to tender.
This process has not gone smoothly, with many contracted out services failing because the price control exerted within the NHS made it difficult to make money. Despite that, there is now major penetration of NHS budgets by private interests.
For example, Virgin Health have contracts for 30% of England’s community health services, and almost 50% of the revenue of private hospitals now comes from NHS patients who are paid for out of the public purse. The cavalier approach of policy makers to patient safety in private hospitals (see the report by the Centre for Health and the Public Interest). But much of this privatisation goes on by stealth, with government ministers and senior NHS officials consistently denying the reality of the penetration of the NHS by the market.
What compels them into denial is the persistence of the collective values of the NHS in the public’s mind. Protecting the NHS is a highly salient issue, and one reason why this government has sought to detoxify its stewardship record by pumping in extra money to start flowing in time for a 2022 general election.
But faced with the kind of economic decline that a no-deal Brexit promises, and needing to tempt the US to be a trade partner, the NHS could have the same role at the fishing industry as the bait that opens those opportunities.
There are two problems with this strategy. The first is that the EU itself, through the Transatlantic Trade and Investment Partnership – the trade deal it is still trying to conclude with the EU – has already used the NHS as bait.
The British government could have kept the NHS out of the trade deal, as the French government did with its cultural industries, but they chose not to since the neoliberal philosophy behind the trade deal was very much in line with their own.
Although the deal appears to have fallen apart, it almost certainly whetted the appetite of US healthcare interests who will no doubt use their lobbying power to put a deal with the UK back on the agenda.
The second problem is about the attractiveness of the UK’s health provision. Experience in the last few years has shown that the private sector cannot work within the existing model and make a profit. The public sector in health is cheaper.
The answer is to change the model, making it possible to close some hospitals, capitalise on assets, restrict the range of services offered on the NHS while simultaneously marketing private provision, dilute the proportion of professionally qualified staff providing the service so that unit costs go down (although quality and outcomes go down at the same time).
These are all policies currently being undertaken by senior staff in the NHS, and they could do much more if required. All it needs is for the political calculation to change from the present attempt to detoxify threats to the core values of the NHS in the hope of reducing its salience, to the likely desperation of a government after Brexit to find positive sources of economic growth.
By Sue Richards, co-chair of the Centre for Health and the Public Interest. She was a professor in the School of Public Policy at the University of Birmingham.