[A-List] UK corporate state: unhealthy accumulation

[Michael Keaney]

There are two ways of looking at the British government's policy of
foundation hospitals within the NHS. Firstly, as a clever way of
circumventing impending GATS regulations which "force" the state to put out
to tender all directly-administered services and thereafter regulate the
franchise-holder according to "transparent" performance criteria. Secondly,
as a way of engineering the ultimate privatisation of the NHS via the
stepping stone of "mutualisation", as has already been conjectured here. See

http://archives.econ.utah.edu/archives/a-list/2002w46/msg00098.htm

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Keep your nerve: this is the rebirth of popular socialism

NHS foundation trusts aren't elitism, but localised public ownership

Ian McCartney
Monday December 2, 2002
The Guardian

For the past 20 years the debate about our public services has been
characterised by the left defending the status quo and the right arguing for
reform. Many people have become so wedded to this that even when reform
comes from the traditional left, they automatically dismiss it as rightwing
and oppose it.

At the last general election in 2001 the centre-left in Britain gained a
historic victory by persuading millions of citizens that sustained long-term
investment in public service infrastructure and public sector staff should
come before tax cuts and privatisation. It was only, however, a battle that
we won - not the war. Popular socialism is still in its infancy and we need
to do more, both intellectually and by practical demonstration, to sustain
this victory of ideals.

Let's take the example of NHS foundation hospitals. Quite simply, these are
a new form of public ownership. They lock the public resources of the
hospital into ownership by the citizen in the community: owned by the
community, for the community, serving the community.

If the NHS foundation trust is a local district general hospital, the
members will be drawn from local residents and patients. This will secure,
for the first time, strong local ownership and a real connection between
local people and their hospital. If the NHS foundation trust is a regional
or national hospital then it will make more sense for membership to be drawn
from patients from across the region or country. In both cases, people will
be eligible to become members of the organisation and, as members, will
actually own the hospital and all assets. It is this ownership that makes
this particular reform of public services so much a part of Labour's
traditional values.

It is a concept that both the Conservative party and the Liberal Democrats
find it hard to disagree with. It is also a demonstration that the left, for
the first time in two decades, has succeeded in moving the debate about who
should own public assets away from Thatcher's popular capitalism. But it is,
of course, a direct challenge to the traditional left's belief that public
assets should all be owned centrally and managed by the state. This was in
its time a laudable aim and gave birth to the modern welfare state. However,
its weakness is that history has shown us that elected centre-right
governments immediately degrade public assets by massive underinvestment,
and follow this up with phase two by selling off the assets for private
gain.

If we truly believe in the value of public services for building a better
country, then, as well as re-investing and modernising them now so that they
deliver citizen-centred services, we need to take steps - both politically
and organisationally - to protect public assets from future rightwing
attack. This is exactly what foundation trusts will do. Local communities
will elect the members of the stakeholder council, who will set the policy
and direction of the hospital. The staff of the hospital will also be
members, with a right to elect their own representatives. The management
team will be responsible for the day-to-day running of the hospital.

Unlike building societies, the owners of NHS foundation trusts will not be
able to sell these assets to the private sector; they will have to remain in
public ownership. If there is to be any future merger or change of
ownership, this could only happen with another NHS foundation trust. There
will be no carpetbaggers in this new form of public ownership.

Those with some knowledge of the history of working-class people in this
country will recognise that a localised form of ownership has an important
role in our politics. Mutual organisations have been an essential part of
our history. The idea of local mutual public ownership is a significant part
of the left's tradition, and it would be seen as very strange to find the
left rejecting it as elitism.

But why, if local community ownership is such a good idea, are we developing
it only for the best-performing hospitals? The main problem with old-style
public ownership is that it was based on the philosophy that one size should
fit all. Our aim must be to build a diverse range of organisations since
now, in the 21st century, we have very diverse communities. We must create
public organisations that will serve and celebrate that diversity. The days
of imposing the same system on everybody must be past.

We need to work with staff and local communities. The NHS has been
bedevilled by national reorganisations. When local people have not bought
into this reorganisation, history shows that they do it reluctantly and at a
slow pace. As a consequence, it interferes with the core business of
providing health services. We will be working with willing organisations.

We are developing the first wave of NHS foundation trusts from the NHS's
existing best hospitals. These hospitals cannot be described as "elitist" in
any real sense of the word. Only the weirdest of political commentators
could describe hospitals in Sunderland and Hackney, which serve some of the
more deprived areas of the country, in this way.

At the moment, some hospitals perform better than others. It is no surprise
to the public that the existing uniform system of managing hospitals has
created outcomes that are much better in some places than others. Some
hospitals need a lot of assistance to improve their delivery, and there are
already a number of ways of providing that help and support. There are no
artificial limits on who can become a foundation trust. There will be no
two-tier NHS. Therefore, it seems a good idea to start with those who not
only want to do this but have demonstrated the capacity to achieve it.

In the business of politics, I expect people to challenge and search for
hidden motives. But, branding every reform as an assault on the values of
public service or an attempt to sell off the service to the highest bidder
is to belittle the very radicalism of our past. The Bevans, the Morrisons,
the Attlees et al - as the architects of the first comprehensive welfare
state in the world - took enormous risks to create a model of public
ownership. We are creating a different and newer model, one in which the
public will know that they, and not Whitehall, own the country's public
assets.

This is public ownership which means exactly that: owned by the public. As
the socialist MP for Makerfield, I am impatient to see the day when we can
have the ultimate victory of popular socialism over popular capitalism. Hold
your nerve, comrades - we're on a journey worth travelling.

· Ian McCartney is vice-chair of Labour's National Policy Forum, a member of
the party's national executive committee and minister of state at the
Department for Work and Pensions