Yet another redundancy and the obsession with privatisation

A friend of mine has just been made redundant. Two years before he could have taken his pension.

He worked for the local Council for many years, but then his department was hived off to the private sector, to an outsourcing company which offered to provide the same service. Two years on, the company has decided to rid itself of most of the staff it took over. So my friend is unemployed, at a time in life when it isn’t always easy to find a job, and his pension isn’t fully paid up.

You may wonder why I tell this story. It’s far from uncommon. Why focus on one case?

Put it down to the old Stalin principle, that one death is a tragedy, a million a statistic. Talking to a man who’s putting a brave face on misfortune makes the pain far more palpable, far more poignant than just hearing about the tens or hundreds of thousands of others who’ve suffered the same fate.

It’s happening all over the public sector. The NHS, for instance. Government policy is clear: any service that can possibly be put out to tender, must be. It used to be cleaning and catering, but these days it’s diagnostic services, therapeutic services, anything that can be delineated and handed over.

Emblematic of failed privatisaion:
Serco and out-of-hours service in Cornwall

And how well has it worked? It seems to me that the poster boy here is Serco, one of the big boys of the outsourcing business in the UK. It had to cut short its contract to provide out-of-hours healthcare services in Cornwall because it couldn't fix problems that led to a barrage of complaints about quality; it also cancelled its arrangement to provide clinical services to Braintree Community Trust. Then in August it announced it was pulling out of the clinical services market entirely, as it was losing far too much money trying to run them. 

Think about what’s going on here. The company ran a lousy service that failed to meet patients' needs. But even at that level it couldn’t make the clinical services business pay. Not that such considerations stopped senior executives paying themselves generously: in 2011, the Chief Executive collected £1.86 million and the Finance Director £948,000.

Now that’s healthcare, and my friend was in local government. But the same considerations apply. Private companies don’t have a glowing track record of managing services any more effectively than the public sector; as often as not, it’s because in pursuit of a profit, they cut staff to the lowest levels they can manage, whether or not that allows them to meet requirements.

That thinking’s cost my friend his job.

Poor service. Dissatisfied service users. Employees’ careers destroyed through no fault of their own. And yet, no great profits to delight shareholders. Though wonderful pay to executives to prove they can’t deliver them.

Those are the results of today’s blind fixation with privatisation in the Western world. Yet the victims are far more numerous than the beneficiaries, and we all have votes. Why do we leave in office the people who pursue this distorted dream instead of showing them the door?

Meanwhile my friend’s out of work and looking for another couple of years to shore up his pension. All I can do is swallow my anger and wish him well. And put out a few feelers to see if anyone I know is recruiting.

Without much hope of success, in this Brave New World that is ConDem Britain.

David Cameron's bright idea: privatising the NHS

It’s curious to be sitting in the Accident and Emergency Department of our local (NHS) hospital, waiting for someone to see my wife for a sports injury she received this morning.

No one has asked us to provide evidence of ability to pay. The treatment will be delivered based only on the state of her health, the extent of her injury, and not her financial status.

No one stands to profit financially from her care. I’ve just heard a nurse explaining to an East European couple that they would not be receiving antibiotics. There is no financial incentive to prescribe any particular medication, and so it’s possible to get strict about what drugs are handed ou.

Sadly, Britain seems to be trying to move away from this admirable model, with doctors warning that the principle of service being free at the point of care is unlikely to survive more than another ten years if there’s no let up in the pressure on the NHS. It’s hard to overstate how shameful that is: the notion that when we’re ill or hurt, we can count on care immediately whoever we are and whatever our social position, is precious. It seems extraordinary that anyone can seriously question it or want to do away with it.

This isn’t to say that a health service has to be based on it. The United States, for instance, takes the opposite approach: there is no presumption of treatment without payment. I’m always impressed by the number of Americans I’ve known who assure me that the system is the world’s best, whereas it’s my feeling that it’s simply the world’s most expensive.

US Healthcare leads the world.
At least in expenditure

Far too much of the US population has no cover at all, a lamentable state of affairs Obamacare is only beginning to address, and a great many more have no adequate cover; highly expensive care is often provided, but it’s often entirely inappropriate: costly hospital treatment for conditions which could have been dealt with far more cheaply by a GP if one had been available earlier; and no follow-up after hospitalisation, so there’s a high risk that the underlying condition will continue to get worse and the patient will be back in hospital before long.

Considering how much it costs, that’s a damning indictment of the US system.

Which leads me to wonder why it is that some in Britain, most deplorably many in government, are so keen to see us move in that direction. And yet they do. Increasing numbers of services are being put out to tender to private companies. Currently £5.8 billion worth, a 14% increase over last year. And yet there’s no evidence that they’re provided either better or more cheaply than by the NHS itself: one of the biggest privatisation companies, Serco, was involved in a major scandal when it was forced out of its contract to provide out-of-hours GP services in Cornwall. And then just a week ago, it announced that it was going to see out the contracts it still has left and then withdraw from the UK market for healthcare services. It has racked up multi-million pound losses, and has had enough.

So privatised services aren’t particularly good. They aren’t particularly cheap. And they don’t even generate much of a profit for their providers.

Not that they don’t try to make one. When Care UK took over services to people with severe learning difficulties in Doncaster and absorbed a group of employees from the NHS, their first move was to cut wages by up to 35%, leading to a long-running strike. If profits don’t come, it certainly isn’t for want of trying. 

Why are they so hard to achieve? Because the NHS runs a tight ship: Britain may not have the world’s best health service, but many studies have found that it has the most cost-effective. In the profligate environment of the US, healthcare service companies can make a fortune, but over here it’s a lot more difficult.

Why then is the government so intent on maintaining the headlong drive towards privatisation?

There’s much debate about the nature of politics. Should it be oriented towards personalities, image, soundbites, charisma? Or instead towards ideologies, principles, fundamental philosophy?

Well, image gave us Cameron, a man whose incompetence as Prime Minister is only rivalled by his indolence. With a major crisis in Iraq he had to be called back from holiday – twice. He seems not to understand that he has a post that requires not just a full-time commitment but a lot more dedication than ordinary jobs. Dubya was like that, too, taking sixty or seventy days leave a year and working short hours. That’s the man who took us into the Iraq War, for God’s sake (and he probably thought it really was for God’s sake).

As for ideology, well that’s just what’s leading to NHS privatisation. It makes no sense: it benefits no one, not patients, not the taxpayer, not even the privatising companies. But that same Cameron has made up his mind, as a matter of principle, that it needs to be done. Against any evidence. As a matter of sheer belief.

In the debate between image and ideology, I choose neither. Competence, pragmatism and a willingness to take evidence into account, are the qualities that matter. And we need them badly, especially if we’re to save the NHS.

An old man has just been discharged in the hospital.

“Would you like a taxi home?” asked the nurse. “We’ll pay for it.”

The gesture would cost under £10. A trivial sum. But what a difference it would make to a lonely old man, worried about his health.

Money alone can’t measure the value of a health service ready to provide such care to that man. We need to hang on to it as though our lives depended on it. 

Because they do.

Privatisation: good in principle, we're told. And great for child protection

We always like our politicians to be principled. Though sometimes we forget that principles are abstract, and reality can be worth taking into account too. Detaching ourselves from reality exposes us to the danger inherent in pure principles, which is that they can be the skeleton on which ideologies hang. 

“...ideological thinking,” wrote Hannah Arendt, “becomes emancipated from the reality that we perceive with our five senses, and insists on a ‘truer’ reality concealed behind all perceptible things...”

Emancipation from reality. That’s the hallmark of ideology. Things must be this way, because that’s the principle we live by, and anything else must therefore be untrue.

Parties of the Left suffered from ideological thinking for decades. For instance, the British Labour Party became so obsessed with common ownership of the means of production that it became simply the party of nationalisation – though that meant ignoring the reality that the way the railways or gas distribution were run as nationalised industries was far from ideal, something that was obvious to their customers. The principle, nationalise the “commanding heights” of industry, trumped the reality of bureaucratic ineptitude and poorly delivered services.

Today, though, it’s the Right rather than the Left that is dominated by ideology.

It was a Thatcher/Reagan thing. Anything would be better run by the private sector than by government. And it didn’t matter how or on what basis: just get it outsourced, by hook or by crook, and hang the consequences.

The consequences were often dire. The railways pretty much hit the buffers. Labour had to renationalise part of them to get things back on an even keel – at which point they actually became rather good. Certainly better than I’d ever seen them. Expensive but good enough for me hardly ever to use the car for any trip over an hour and a half.

The railways make a powerful point. The solution we’ve reached fits no ideology. Those committed in principle to nationalisation or to privatisation both lost out: we have private train companies – and one nationalised one – running on nationalised tracks. A messy compromise, but it works. That’s reality. It doesn’t always fit any ideology.

Private train companies running services on public track
Though this private company happens to be publicly owned
Confused? That's how it is with non-ideological compromises.

The Right, however, sticks with its ideological fervour. Privatise anything that moves. Parts of the police service, parts of the prison service, increasingly large parts of the health service. Because it’s bound to be better than running those services publicly.

Except that it hasn’t been, particularly. At best, things seem little different. And at worst, they’re lousy.

• Serco won the contract to provide out-of-hours GP services in Cornwall. That contract is to end 17 months early because the company couldn’t meet its delivery commitments. Besides, some staff were found to have falsified returns to try to make it look as though targets were being hit.
• G4S won the contract to provide security at the London Olympics. It failed to put the service in place, and instead the army – the publicly-managed army – had to be called in instead and did an excellent job.
• G4S also won a contract to tag prisoners on parole. After being found to have systematically overcharged on invoices, it was forced to pay back nearly £109m.
• Now Serco faces charges of not having acted appropriately over allegations of sexual assaults on an inmate at the Yarl’s Wood immigration detention centre, which it runs and which contains particularly vulnerable people: immigrants facing deportation.

So there are some worrying concerns about these two giants of the privatisation world, and precious few spectacular successes to allay our fears.

Despite all that, Michael Gove, the Conservative Education Secretary, is proposing to put child protection services out to private tender.

Child protection is about looking after children who are deemed at risk of abuse, physical or sexual. There are few tasks that deserve to be treated more seriously. If the inmates at Yarl’s Wood are vulnerable, surely no one is more so than a child at risk. We’ve seen sickening cases in recent years of children abused and murdered because the Child Protection services failed to intervene in time.

These are the services that Gove wants to put out to tender? To a market place dominated by organisations like Serco and G4S? He feels they should be given this immensely delicate responsibility?

Curiously, one of the few services he does not propose to outsource is adoption. He was adopted himself. Has that played a role in his thinking?

The proposal is a wonderful example of ideological thinking. Privatisation, the Conservative Party has decided, is good. So we’ll privatise anything we can. And the mere reality of poor performance, or even fraud, isn’t going to deflect us from our mission.

That needs resisting. And in case anyone feels that we need to answer the principle of privatisation with another principle, this one should do: child protection is far too precious and far too fragile to allow the pursuit of profit to have any influence over how it’s delivered.

Now there’s a principle I’m prepared to go along with. Because it’s firmly rooted in reality.