Time for Oliver Letwin to come out of the shadows

Two days ago, the Mirror newspaper "revealed" that Oliver Letwin wrote the blueprint for the privatisation of the NHS. Except this has been known by plenty of people for quite some time now. The Mirror made no mention of a book on privatising everything that he wrote back in 1988. It was called Privatising The World: A Study of International Privatisation in Theory and Practice and it has had enormous influence on Conservative party policy ever since.

But who the hell is Oliver Letwin and why should anyone care about him and his 28-year-old book?

Oliver Letwin usually only appears in the public eye when he fucks up. He, like many of his colleagues on both sides of the House of Commons, has been caught up like the vile hypocrites many of them are, in expenses scandals. And he is probably best remembered for being the colossal bellend who threw important papers in a London park bin. It turned out they were letters from his constituents. Apparently, in the minds of his apologists, this somehow made it OK, not quite as bad as tossing official business out with the rubbish.

And, pitifully, apart from a few dissenters, his constituents didn't seem to mind their views being treated with such utter contempt by the man they pay to represent them, because he is still, like a smug and brattish barnacle, their MP. He has been the MP for West Dorset for 19 years, a seat which has been held continuously by the Conservative Party since 1885.

Because he is such a gaffe-prone car crash of a man, he is not trotted out during election campaigns, he does not appear much on telly, and the fact he has written a book, even though it has been a blueprint for Tory policy for more than 20 years, is certainly kept quiet on purpose.

And Letwin was back in the news the other week because he did something embarrassing and made a non-apology apology. He revealed his contempt for black people in a memo when he was a policy adviser to Margaret Thatcher in 1985, saying that assistance for black communities would help the "disco and drug trade" and Rastafarian crafts. Frankly, Oliver, you may as well legalise the drugs so people can make money there as well as encouraging disco and Rastafarian craft businesses, if you are truly the free market libertarian you claim to be.

Except that for Letwin and many of his colleagues in this current wretched government, they are only interested in money-making opportunities for themselves and Conservative Party donors. There is certainly an ideological drive towards this government's drive towards privatising everything but we are also being governed by a party whose MPs are up to their eyeballs in vested interests and serve the needs of their party donors rather than their constituents.

Letwin's 1988 book, Privatising The World: A Study of International Privatisation in Theory and Practice has an interesting title, to be sure. "Theory" rather than "practice" is the operative word for Letwin when it comes to his career. From childhood until he was 26, he was at Eton and then Cambridge University. Academically, he is clearly no fool. Morally, he is a vacuum.

After Cambridge, despite zero experience in the real world, he joined Margaret Thatcher's policy unit. He has also been a bank director, written a few other things, and from 1997 onwards, he has been a constantly promoted MP, albeit one who is not given much media prominence by the party. This is clearly deliberate.

In particular, Letwin has advocated for the privatisation of the NHS. But this is not happening in any blatantly obvious way. It's not even happening in a vaguely competent way. If that were the case, we'd be on a clear path towards the mixed public-private system of Australia - it's not a perfect system, it is currently being messed around with by the current Australian government, but it does not generally leave people in terrible debt, as happens in the US.

It is happening in a way that is far more insidious than that and the incompetence is deliberate. The Health and Social Care Act 2012 paved the way for Clinical Commissioning Groups across the country to make decisions for their local areas. Local people making local decisions sounds great in theory, but in practice, we have CCGs in many parts of the country stacked with members with vested interests in private healthcare and it is not uncommon for them to commission these companies.

Additionally, the administration of the private tenders for the NHS marketplace is one of the biggest cost pressures on the health system. It is difficult to get an exact figure on how much the added bureaucracy costs but estimates vary between £5 billion and £20 billion per year. The other big cost pressure is PFI debt which, unless all the contracts are renegotiated or declared null and void through some excellent lawyering, will probably never be paid off.  In short, PFI (private finance initiative) debts on construction work for hospitals mean British taxpayers are getting such crap deals as one hospital for the price of nine. The billions and billions of pounds that PFI and the marketised NHS cost the system means the "health tourists", women undergoing IVF, and New Year's Eve drunks, and anyone else that the Daily Mail, the Sun, and Daily Express uses as scapegoats, are drops in the financial ocean.

Even when incompetent (but Tory-donating) companies such as G4S get NHS contracts and do things such as kill patients in "never" events, they tend to keep the contracts, even though in the private sector, that kind of thing might well lead to a contract being torn up. Virgin has been running vast chunks of Croydon University Hospital very poorly too, but this has not been the front page news it should be either. A woman died in agony at Croydon after being triaged by a receptionist.

But it doesn't matter to Letwin et al because these fuck-ups, even when a private company is at fault, all serve to whet the public appetite for cuts, closures of essential services and entire hospitals, and selling stuff off, usually to private companies who make vast donations to the Conservative Party.

This government quite literally does not care if people live or die as long as they can continue with their agenda.

And other privatisations are completely cack-handed. Atos has done an abysmal and expensive job of fitness-for-work assessments for the Department of Work and Pensions, for example. All this should be a gift for Labour. But it seems "kinder politics" may be getting in the way. After Letwin's racist gaffe was revealed a few weeks ago, the only real resistance from Labour was to trot out Diane Abbott, MP for Hackney North and Stoke Newington, to make a few comments and that was it.

If Labour is at all serious about winning the middle ground back - and winning the middle ground means winning elections - an attack dog approach to Oliver Letwin is essential. Instead of embarrassing, backfiring stunts like throwing Mao's Little Red Book around the House of Commons, Privatising The World needs to be thrown at the government benches. The major news channels and newspapers should request interviews with Oliver Letwin and tell the readers and viewers if he refuses to be interviewed/is not given permission from Tory spin doctors to be interviewed.

We need to see more of Oliver Letwin's Alfred E. Neumann-like face in the media, as a constant reminder of what this government is really up to.






Photography by Peter Griffin

On the phone with the Hotel Hospital

"Hello, is that the PremierLodge Hospital Hotel?"

"Yes, it is. How can I help you?"

"Good! I am the Lead Nurse at the hospital up the road and I understand you are now open for patients."

"Right you are, Sister!"

"Er, can I speak to the manager please?"

"The manager has gone home for the day. We just operate on a skeleton staff overnight."

"I see. I have a few cases that I'd like to bring in. They are taking up valuable beds, we are full to capacity, but I'm not sure they're quite ready to go home yet."

"Right."

"I mean, it'd be great if we still had the old convalescent homes but they seem to have gone the way of leeches and trepanning and, well, we all know how hard it is to get a doctor to make a house call these days..."

"What?"

"Oh, never mind, I am babbling now, reminiscing about days gone by. Are all the staff there trained medical professionals?"

"No, but everyone has undergone the week-long PremierLodge induction course. Our certificates are on the wall in the break room."

"Right. But everything has been cleaned to hospital standards?"

"We have cleaners..."

"Good, jolly good, that's a start. Do the patients get fed at the same time or do they just use room service?"

"Oh, we have a special offer on this week for room service. All patients can get a free half-bottle of wine with every main meal ordered!"

"Wine? I was looking to bring in Mr Jenkins, he is recovering from a stomach ulcer, and Mrs Santori, who had a baby a couple of days ago. I'm not sure either of them are up to a glass of wine at the moment."

"There's a selection of food in the vending machines down the hallway."

"Vending machines? Special offers? Hang on, what is the deal with paying for food? I mean, I know these hotels are meant to save the NHS a fortune but who bills who? Do we pay the hotels to cater? Does the hotel bill the hospital or the local trust? Er, don't tell me the patients get billed?"

"Uh, there has been talk of billing the patients for food. They already have to pay for the telly, phones, soap and extra pillows, blankets and towels..."

"I see. What if one of the patients needs emergency care?"

"The doctor will come back in the morning and do rounds then. Costs a fortune to keep one in overnight on the off chance someone might take a turn for the worse. We're a business, not a charity, y'know."

"OK..."

"But it's cool, visitors can come at any time. It's better than those poxy hospital visiting hours."

"Visiting hours are there to ensure patients get adequate rest."

"But the patients get bored."

"I'm pretty sure Mr Jenkins is too busy dealing with post-operative pain and Mrs Santori is pretty focused on her new baby at the moment. I'm not sure I want to send either of them somewhere where members of the public can wander up and down the corridors at all hours."

"Oh, it's OK - we use G4S for our security here. Anyway, it's all part of the PremierLodge mission statement..."

"The what?"

"Our mission statement. 'PremierLodge Hospital Hotels aim to provide outstanding patient outcomes in a cost-effective, fun medical environment' - it's on the plaque in the foyer."

"Good grief. Is it a medical facility or the set of Grey's Anatomy? Is there a Dr McDreamy on hand?"

"No, but that's a great idea. Might draw in some more clients if we can get a doctor who looks like Patrick Dempsey on staff. We don't want to lose more business to the Infirmary Inn down the road. I'll suggest that at the next staff meeting. Noted!"

"I think I'll just keep Mr Jenkins in for an extra night and send Mrs Santori home tomorrow. If all else fails, they can call an ambulance after they're discharged, I suppose."

"Just remind them that PremierLodge's call centres will be managing 999 calls from now on - 45p a minute, higher from mobiles..."



Image courtesy of www.kozzi.com

Lies, statistics and Band-Aid solutions to big problems

Statistics are marvellous. But they are very easy to misinterpret. The media loves to play on this - it is so easy to pull a supposedly shocking stat out of the bag, lazily run it as fact without any nuanced analysis to peddle an agenda, and wait for the inevitable outrage and website clicks. And when it comes to healthcare, scary numbers make for easily manufactured outrage.

The scary healthcare number that has been freaking everyone out of late is the "1,200 unnecessary deaths" in Mid Staffordshire hospitals. The researchers at the excellent website, fullfact.org have analysed this big number very carefully and found that while nothing will bring back dead loved ones and Mid-Staffs has some big problems to sort out, the 1,200 figure should be examined more closely.

The 1,200 number actually refers to 1,197 "observed deaths" over 10 years, minus the "expected deaths" between 2005 and 2008 (171 in 2005-6, 187 in 2006-7 and 134 in 2007-8 - a total of 492 deaths). A south-west London NHS trust paper defines expected deaths as "death following on from a period of illness that has been identified as terminal and where no active intervention to prolong life is ongoing."

It all stems from the Francis Report, commissioned in 2009 to investigate "higher than average" mortality rates for emergency admissions at the two hospitals managed by the Mid Staffordshire NHS Foundation Trust. The 1,200 number did not appear in the final report - it was removed from the report because there were concerns that it would be misunderstood, but it was leaked to the press.

The report included Standard Mortality Ratios for each hospital between 2005 and 2008 for patients admitted as emergency cases and these varied between 127 and 145, against a national average of 100 - the number of deaths was 27-45% higher than the baseline figure. Obviously, this isn't a great result for the two hospitals but witnesses who testified for the report cited problems with data collection so the accuracy is wobbly to begin with.

But in this dizzying sea of numbers and the accompanying hysteria centred on one NHS trust, we're not getting any closer to any solutions. And instead of looking at ways to improve the NHS, the 1,200 figure has become a stick with which to beat the NHS in much the same way that the Jimmy Savile case has become a stick with which to beat the BBC.

David Cameron has blamed Labour for creating a target-setting culture in the nation's hospitals. If he was so concerned about this, why didn't he set about reversing this culture when he came into office? The timing of the release of the report was perfect for Cameron's government to take a stand.

The Francis Report was commissioned by Andy Burnham, the former Health Secretary under the Gordon Brown's Labour Government, in June 2010, after an initial inquiry in 2009. By the time the initial inquiry report was finished, it was February 2010. David Cameron became Prime Minister in May 2010 - did he really expect Labour to have sorted it all out in two months with an election campaign going on? By the time Cameron took office, there would be no excuse for the shiny new Health Secretary, in the form of Andrew Lansley, not to be aware of problems at Mid-Staffs, and by the time the final report was released, after hearing from 164 witnesses and receiving 87 witness statements and 39 provisional statements, Jeremy Hunt was Health Secretary. The final report is addressed to homeopathy-loving Hunt in February this year.

When asked why he didn't sack Sir David Nicholson, the NHS chief executive, Cameron said that Sir David had apologised. Well, that's just fine and dandy then! How about looking into emergency department procedures and data collection at the two hospitals? Hell, what about looking at the reasons why patients were being admitted via the emergency department to determine if preventative measures might help reduce admissions in the first place? Or is some joined-up thinking, which may involve multiple stakeholders and government departments, all too much for this government? Simply apologising is a pathetic response.

People will always die in hospitals. No hospital will ever have a 0% mortality rate. But there is always room for improvement and investment. Sacking Sir David and making a fresh start from the top down would not be a bad thing.

Sadly, however, in the current climate, all we're getting is buck-passing, a spectacularly unsuitable Health Secretary in Jeremy Hunt, sneaking threats to women's reproductive rights, multiple A&E and maternity units at risk across the country, three children's heart surgery units closing down, eight walk-in NHS clinics slated to close in Birmingham and Solihull alone, and multiple health services put out to tender to private companies with little protest from anyone much. Oh, and there's the small matter of 141 Lords and 66 MPs having either recent past or present vested interests in private healthcare - that'd be the people that we have to entrust with casting votes on the future of British healthcare.

My condolences go out to anyone who feels they unnecessarily lost a loved one at Mid Staffs, but if the privatisation by stealth and ongoing slashing of health services continues, the whole nation will mourning the slow, painful, needless death of the NHS.

UPDATE

In news just at hand, David Cameron has indulged in a spot of nurse-bashing at today's Prime Minister's questions brawl. Oh, good. That will motivate nurses at Mid-Staffs and around the nation...



Image courtesy of www.kozzi.com