Theresa May has come under intense criticism in the last week, with former Education Secretary Justine Greening resigning rather than change departments in a muted cabinet reshuffle, and new Office for Students board member Toby Young stepping down just days after being backed by May herself. However, one clear winner was Jeremy Hunt MP, who not only managed to persuade the Prime Minister not to move him from Health Secretary, but actually increased his remit to include Social Care.
Jeremy Hunt is hardly popular – in 2016 he was voted the most disliked politician of any party – and the NHS is going through a crisis that has seen some officials complain of “third world” conditions. Critics and supporters of May have respectively claimed that this decision confirms her precariousness or points to Hunt’s powers of persuasion.
But it may just be that Jeremy Hunt is simply lucky. Anne Milton MP had been set to take over the role until it emerged that her husband was a director at Virgin Care, a private health company which recently sued the NHS, a county council and six clinical commissioning groups after not winning a contract. Despite maintaining that the procurement process was entirely correct, it was cheaper for the NHS to settle the legal dispute through an undisclosed settlement likely to be worth millions.
After press speculation that Milton was the frontrunner, her Wikipedia page was mysteriously edited – anonymously – from the Houses of Parliament, and her husband’s role at Virgin Care obscured. Could dragging these events into the spotlight have been thought a press nightmare too far for the Prime Minister?
Privatisation of the UK’s public services has been a contentious topic since the first Margaret Thatcher government sold off British Petroleum in 1979. Thatcher went on to privatise over 50 nationally-owned companies or services, fulfilling an ideology of total reliance on market forces while conveniently demolishing unions and the ability for left-wing worker organisations to effectively organise. By the time the Tories lost power to New Labour in 1997, privatisation had become such a widespread global drive that, despite largely stopping unpopular sell-offs, Blair’s government ended up creating Private Finance Initiatives, contracting private firms to provide public sector services in the NHS, schools and London Underground.
Since the Conservatives regained power in 2010 in coalition with the Liberal Democrats, they have consistently represented the 2008 global financial crisis as a result of public sector spending, rather than financial deregulation and subsequent banking practices. The UK has again entered a period of major privatisation, with key examples including Royal Mail (whose sale has come under fire for being undervalued by close to £1bn), East Coast Rail (which, at the time, had been returning £220m to the taxpayer annually), prisons and detention centres (despite widespread failures in prisoner and staff welfare) and even some schools.
Every iteration of this creeping privatisation ruffles the feathers of the British public to some extent, and it is clear that despite 40 years of neoliberal government, most citizens want the majority of services to be run in the public sector. However, while most of the government’s recent privatisations have been condemned by large sections of the public and even occasionally protested, potential privatisation of the NHS has been an absolute red line since Thatcher first proposed it in 1982.
Privatisation by stealth
In 2005, Jeremy Hunt co-authored a policy book calling for the NHS to be replaced with US-style private insurance, and less than a year ago gave a talk at the Patient Safety Movement Summit in the US on ‘the close links between the UK and US health sectors’. Outright privatisation of the NHS would be political suicide, but the service continues to be quietly carved up and pushed towards the private sector, and this has accelerated dramatically under the Conservatives.
The main vehicle for this change was the Health & Social Care Act, implemented in 2012. Ostensibly designed to ‘liberate the NHS’ through ‘putting patients at the heart’, the Act has in fact paved the way for the incursion of private companies into the health service.
£60-80bn of commissioning was transferred to clinical commissioning groups (CCGs), which have been dogged by corruption scandals involving payments from drug companies, findings that a quarter of members have links to private healthcare companies and 56% of executives choosing to pay themselves more than the recommended salary range. Meanwhile, fewer than half of GPs surveyed believed that they had the ability to affect decisions, despite this being the supposed reasoning behind introducing CCGs.
The 2012 Act also amended one of the founding pillars of the NHS in allowing private sector providers far more access to deliver services. Care contracts must now be tendered to any willing provider including private companies, enabling them to undercut public providers on price for the most profitable contracts while leaving expensive operations for the NHS to perform with public money.
Corruption allegations have again mounted as private health firms win contracts despite cheaper bids being placed by the NHS – such as in 2015, when Alliance Medical (who pay Conservative MP Malcolm Rifkind £60,000 per year to sit on their board) received a contract to operate a £3m publicly-funded PET-CT scanner after being outbid by £7m. There have also been allegations of ‘privatising profits while nationalising risks’. In 2014, 30 NHS patients who had received cataract surgery from a private company suffered complications including blindness following ‘rushed procedures’, but the firm was able to pass financial responsibility back to the NHS.
Keeping privatisation under the rug
By 2014, private companies were winning around 50% of NHS contracts, which chair of council at the British Medical Association, Dr Mark Porter, said “proved that ministers had not told the truth…the pushing through of the Health & Social Care Act, an act that the government denied loud and long would lead to privatisation, has done exactly that”.
Just days before Theresa May’s cabinet shakeup, new data revealed that this figure has jumped to 70%, including the seven highest value contracts – and that Virgin Care has become the dominant private provider in the NHS market with over 400 contracts worth a combined £1bn. To add insult to injury, recent exposés on tax-dodging have reminded the public that Virgin Care pays no corporation tax in the UK, and it is registered in the British Virgin Islands, a known tax haven.
Jeremy Hunt has plenty of links to private healthcare, has demonstrably failed to improve NHS conditions for staff or patients and has a proven track record of facilitating the privatisation of the health service. However, it seems that he may have survived this reshuffle purely because of a potential media ‘perfect storm’ if he had been replaced by Anne Milton MP, with a new privatisation row set to begin as Carillion collapses.
Her links to Virgin Care may have seemed reasonably tenuous, but the intrigue of an attempt to obscure these links on a Parliament computer – and the spotlight it would have shone on the accelerating influence of private companies in the NHS, including those who pay no taxes – would surely have made tantalising headlines. With her position as fragile as ever, it seems Theresa May made the decision to keep Jeremy Hunt as captain not down to his persuasive skills or record as Health Secretary, but to avoid rocking an already unstable boat.