As the debate on the EU referendum continues to heat up, the future of the NHS has unsurprisingly emerged as one of the key battlegrounds.
Labour MPS like Alan Johnson have said that leaving the EU would risk “frightening consequences for staffing, waiting times and levels of service care”.
By contrast, right wing campaigners for Brexit argue that leaving the EU could secure the health service, reducing the burden on the NHS caused by immigration from Europe.
Both camps rely heavily upon fearmongering – a strategy frequently adopted by people with nothing to say, or something to hide. In separating fact from fiction on the EU referendum and its effects on the NHS, therefore, it is useful to examine the credentials of some of those involved.
The NHS and Right Wing Euroscepticism
Perhaps the archetypal Leave campaigners in recent years have been those associated with UKIP (although historically Brexit has been a position most associated with the political left).
On his weekly phone-in show on LBC Radio, UKIP leader Nigel Farage expressed concern that continued membership in the EU would “allow giant American corporations to bid for contracts within the National Health Service”.
He added: “There are many people that fear that this could be the privatisation of the National Health Service through the back door.”
Anyone following British politics will know that Farage – an ex-commodity broker – is a slippery character, but his hand wringing over the NHS is laughable even by his own standards.
On his 2012 Common Sense Tour, Farage announced:
“I think we’re going to have to think about healthcare very, very differently. I think we are going to have to move to an insurance-based system of healthcare.
“Frankly, I would feel more comfortable that my money would return value if I was able to do that through the market place of an insurance company than just us trustingly giving £100bn a year to central government and expecting them to organise the healthcare service from cradle to grave for us.”
In keeping with his leader’s sentiments, Douglas Carswell, the single elected UKIP MP, has campaigned continuously for an “open market” in healthcare contracts.
Similar disingenuousness can be seen in the Brexit campaign group Vote Leave, which is backed by the Justice Secretary Michael Gove and London Mayor Boris Johnson. The campaign is currently appealing to NHS staff to support leaving the EU on the basis that a vote to remain would destroy the NHS.
One spokesperson for the group stated that “[i]f we Vote Leave we can stop handing over £350m a week to the EU and can instead spend our money on our priorities like the NHS.”
And yet, in 2005 Gove co-authored a book entitled Direct Democracy: An Agenda for a New Model Party which states unequivocally:
“Our ambition should be to break down the barriers between private and public provision, in effect denationalising the provision of health care in Britain, so extending to all the choices currently available only to the minority who opt for private provision.” (p.77)
More recently, in 2012 Gove also voted in favour of the Health and Social Care Act, which provided a legal framework for fragmenting and privatising the NHS.
Another prominent figure within the Tory-dominated leave group is Gisela Stewart MP. Stewart’s media strategy has been to stoke up anti-immigrant sentiment by ascribing the NHS crisis to “health tourism”, which, she states, costs the government £700million a year.
Stewart is unexceptional within the ranks of the Tories, however: deflecting criticism from central government by scapegoating immigrants is nothing new, even if it seems doubly callous given the context of the current refugee crisis – caused by wars our elected officials, including Stewart, support.
What makes Stewart stand out from the crowd is that she is in fact an elected representative of the Labour Party.
Hands up who’s surprised?
It is hardly news that the right wing Brexit vote is totally lacking in credibility. After all, the main grievance of this group is not the negative effects that the EU has on the NHS, but on the sovereignty of nation states.
The majority of right wing Eurosceptics in parliament are simply beleaguered patriots, longing for a return to the days of Empire. Although membership in the EU went some way toward achieving this through the creation of a vast trading bloc capable of rivalling the USSR and the US, Britain’s subordinate role (to France and Germany) continues to be the source of much EU hostility.
Another factor which feeds the ghoul of right wing Euroscepticism is the existence of extremely profitable corporate monopolies across the EU trading bloc. Those big businesses that are marginalised by these corporations have become embittered and have, subsequently, joined the campaign to leave the EU so as to undemocratic establish cartels of their own.
The NHS and Right Wing Remain Campaigners
So much for the right wing Brexit campaigns (did we really expect any better from them?), but what we really need to be concerned about is the make-up of the remain groups.
Many people are understandably repulsed by the anti-immigrant rhetoric of right wing Euroscepticism, but we need to ask ourselves why so many appalling politicians, individuals, and organisations have lined up alongside the EU.
Are the likes of David Cameron, George Osborne, Nicky Morgan, Theresa May, and Stephen Crabb really any better that those currently campaigning for “Out”?
The fact that the Tory Health Secretary Jeremy Hunt – probably one of the most hated men in the country right now, and undoubtedly the man with the most frequently mispronounced name – has come out in favour of remaining with the EU should arouse suspicion.
In an article published in The Observer late last month, Hunt explains:
“Those who want to leave need to explain how they could protect the NHS from this economic shock… No savings can compensate for the economic volatility that would follow a vote to leave… Our doctors and nurses have never worked harder… Against that backdrop, Brexiteers need to be honest that a period of economic uncertainty and volatility poses a real challenge to the NHS.”
For most Britons, this staunch defence of the NHS should come as something of a surprise. Hunt been a regular face in the news media over the last year, and not because of his commitment to health workers.
On the back of a specious Tory manifesto promise, Hunt has been spearheading a programme for a new “7-day NHS.” In reality, this has meant an assault on the terms and conditions of the 55,000 Junior Doctors currently in Britain.
The proposed contract would see “sociable” working hours extended to 10pm, and also to include Saturday. If the government is successful in imposing this contract, it would set a dangerous precedent for other workers in the NHS, and could even lead to the collapse of the health service altogether.
Significantly, Hunt was another co-author of Direct Democracy.
Enter Sir Richard Branson, tax-dodging billionaire owner of Virgin Healthcare. Branson too has spoken out against Brexit, warning that “it would be a very, very, very, very sad day if British people voted to leave [and] it would be very, very damaging for Great Britain.”
Since entering the health market in 2010, Virgin Care has gathered over £1billion worth of contracts within the NHS.
Most recently, Virgin Care was awarded a £126million contract to take over four hospitals in Kent. Unsurprisingly, this deal was pushed through by – drum roll – Jeremy Hunt.
If Branson wants to stay in the EU, it is certainly not for the love of a publicly owned health service.
The piecemeal sale of the NHS is nothing new, however, with origins going back to the 1990s and the use of Private Finance Initiatives (PFIs) to fund “public projects with private capital.” PFIs were originally introduced by the Tories under John Major, but the use of the scheme was expanded into the NHS by Tony Blair’s New Labour.
Blair, the pioneer of NHS PFIs, is also unambiguous on the EU referendum, stating triumphantly that it is Britain’s “destiny to lead in Europe”. With characteristic charm, Blair even goes on to suggest that the public cannot be trusted to make the “sensible choice” on the EU.
No one trusts Blair these days. Even he himself admits that his endorsement can do more damage than good . But what of the other so-called Labour “moderates”?
In a letter to The Guardian, former Labour Health Secretaries, MPs Patricia Hewitt, Alan Milburn, Andy Burnham, and Alan Johnson, express concern over the consequences of Brexit for the NHS: “[t]he economic damage wreaked by leaving Europe will have devastating knock-on effects, including in the health service.”
And yet, Hewitt now earns more than £100,000 as a consultant for Boots, one of the biggest pharmaceutical chains in the world, and as a “special adviser” to private equity company Cinven, which bought 25 of Bupa’s UK hospitals for £1.4 billion in 2007.
Similarly, following his resignation as Secretary of State for Health in 2003, Milburn took a post for £30,000 a year as an advisor to Bridgepoint Capital, a venture capital firm heavily involved in financing private health care firms moving into the NHS, including Alliance Medical, Match Group, Medica, and the Robinia Care Group.
It seems that former Labour health ministers have done particularly well out of private health care since leaving office.
Johnson for his part is currently leading the Labour In group, and is perhaps most well-known for voting for the invasion of Iraq in 2003 and, despite the horrors which have since followed in the Middle East and the severe damage wrought on the NHS by PFI contracts, persistently calling for a return to the “aspirational Blair years.”
Johnson was also one of the key figures who oversaw the distribution of shares in Royal Mail to employees, which laid the groundwork for its eventual privatisation in 2013. More recently in 2015, Johnson was one of the MPs who refused to oppose the Tories’ controversial Welfare Bill.
An exhaustive list of dodgy Labour Remain campaigners would require considerably more space. Needless to say, the ways in which many Labour MPs are tangled up with private industry should be particularly alarming for those wishing to protect the NHS by voting to stay within the EU.
So the question is, why would these privateers, who have done so much to pass the NHS into private hands, all be campaigning to remain within the EU?
The answer is simple. It is because of the EU’s unwavering commitment to liberalisation and competition.
European integration did not, as many have romantically suggested, begin as a post-WWII peace project; rather, the EU was formed in violent opposition to Soviet Russia and the principles of state ownership on which they stood.
One of the first steps towards supranationalism in Europe was the 1951 European Coal and Steel Community, which was advocated and supported by the US to facilitate West German rearmament in the early years of the Cold War.
Since then, the EU (formerly the European Economic Community) has worked tirelessly to defeat the struggle for socialism – although strong labour movements in Western Europe meant that it was often necessary to give concessions so as to stave off the possibility of a more fundamental restructuring of society.
Today, nationalising industry is all but illegal within the EU.
Why else would the Confederation of British Industry (CBI), one of the main backers for the Tories’ brutal Health and Social Care Act, also campaign in favour of remaining within the EU?
One of the principal tools in the process of privatisation, and certainly one of the biggest threats to the NHS today, is the proposed Transatlantic Trade and Investment Partnership (TTIP).
TTIP is a multi-billion-dollar agreement between the US and the EU guaranteeing access to public services for giant corporations to make vast profits – irrespective of the destructive impact on these services. The project has been under negotiation behind closed doors since July 2013.
The European Commission (the unelected executive body of the EU) initiated “public consultations” only after a draft of its text was leaked in March 2014.
According to the European Commission website, TTIP “aims at removing trade barriers in a wide range of economic sectors to make it easier to buy and sell goods and services between the EU and the US.”
Probably the most dangerous aspect of the TTIP is the investor-state dispute settlement (ISDS), which the European Commission defines as a system that “allows an investor to directly bring a claim against the authorities of the host country in front of an international tribunal.”
This means that corporations could bring claims against governments whenever they feel that their business interests have been affected by national laws or policies. For example, the Tories’ NHS privatisation agenda would be accelerated as US private healthcare companies could demand access to run NHS services and, if denied, be entitled to legally claim against a government.
In addition to this, Richard Murphy from Tax Research UK argues that because companies like Virgin have strong US investment links, the British Government could be prevented from taking NHS contracts back into the public sector if TTIP goes ahead.
This would, in effect, “lock-in” the tax avoidance, which Virgin Care and their ilk already practice.
The fact that privateers such as Hunt, Blair, and Branson are lobbying so hard to stay within the EU and have each come out in support of TTIP should be cause for concern.
Tory ministers who campaign to remain within the EU, will look to the unelected European Commission and TTIP as a means for deflecting blame for the privatisation of the NHS…. “It would be illegal not to,” they will say.
And if the Labour Party’s recent track record is anything to go by, where it is considered better to break the poor than break the law, it is difficult to image that they would put up much of fight should TTIP be introduced.
Whether or not we stay in the EU, British workers will be faced with austerity. The same is true for the rest of Europe; it is also possible that TTIP could be introduced irrespective of the outcome of the EU referendum.
The only thing that can reliably defend against NHS privatisation is massive public and trade union opposition; the same also goes for workers’ rights, which has also been the subject of much scaremongering in the EU debate.
Positive reforms for the living conditions of the working class, such as the NHS, have been won, without exception, by the self-activity of workers. The protection and enhancement of these reforms are also, therefore, the job of the working class.
But all of this is not to say that the EU referendum is without consequence. For many, the vote will provide a stick with which to beat the establishment parties. Brexit would almost certainly lead to the downfall of David Cameron and, possibly, to a snap General Election.
Unfortunately, Jeremy Corbyn has missed an opportunity to capitalise on this by backtracking on his historic position, but there are still a good number of socialists and trade unionists who are campaigning to Leave.
So, what needs to be done to save the NHS?
My advice: leave the undemocratic EU, but remember all the while that the future of the NHS does not depend solely upon this referendum, but on whether, as Nye Bevan once said, “there are folk left with the faith to fight for it.”