Symbolic really: on the day that Margaret Thatcher’s death was announced, we get a letter informing us that ‘following a robust procurement process’ the GP practice at our local health centre has been acquired by a private company, SSP Health Ltd.
It’s part of a massive move by a company that is rapidly taking over GP practices across the North West. In one fell swoop, SSP Health will now manage 22 GP practices in Merseyside. Last November, in the Liverpool Echo, Paul Summers, northwest organiser for Unison, was quoted as saying: ‘We are very disappointed with this decision. The problem is that they are in it for the purpose of making a profit, which we believe is incompatible with delivering the best possible patient care. Staff and the public will be concerned about the future of these practices’. Sam Semoff, from Keep Our NHS Public Merseyside, added: ‘We are very much opposed to any services going into the private sector’.
Recently, NHS Unlimited? Who runs our GP services?, a study of GP services put out to tender by the NHS which was carried out by the NHS Support Federation, had these words of warning about the process of GP procurement:
We believe that the extent of the commercialisation of GP services has been substantially understated. From our study we found 23 commercial companies that have multiple contracts and between them run a total of 227 GP surgeries and health centres. These are all private or public companies that have expressed publicly an interest in commercial expansion and have a corporate structure. Until now many of these expanding companies have been described as GP-led companies. We have found this to be misleading as it suggests that they have a non commercial focus and are managed by GPs, when in fact many of these companies have a profit making intent and a traditional corporate management structure. We found 18 examples of private companies that were started by groups of GPs but are now in the process of business expansion.
A small number of companies have a sizeable portfolio of NHS contracts. There are 9 companies with 10 or more contracts to run GP health centres or surgeries. Chilvers McCrea, described as a GP led company runs 35 surgeries across the country. Care UK and Assura (currently selling to Virgin), both public companies, have the largest number of contracts to run the large health centres with 11 and 12 each. Local GP practices are finding it hard to afford to bid for contracts according to anecdotal evidence, which could lead local GP practices to be squeezed out as the NHS market matures. [...]
Public scrutiny of these new providers of NHS services is very difficult. Their business strategies and approach to generating profit does impact upon the quality of the service and yet this information is often not collected by government or not made available by the companies themselves. Information about the contracts between providers and the NHS are not easily accessible. The public are often excluded from involvement in choosing a provider and the tendering process is not open to scrutiny. The complex structure of ownership makes it difficult to track who controls the service and where public money is going. Employing less GPs and more nurses is one cost cutting strategy of the profit motivated providers. The proportion of nurses is going up sharply and they outnumber GPs in many of the supposedly GP led health centres. [...]
Profit is crucial for any companies, but for those companies with shareholders, profits have to be evident sooner rather than later as a rule. Investors can be placated for only so long with an optimistic business plan, eventually if no significant profit is forthcoming shareholder pressure on the company often leads to changes in business strategy and the divestment of loss-making business interests. Once the NHS was immune to such pressures from shareholders for quick profits and the uncertainties of the stock market, but now privatization means that the NHS can no longer avoid such pressures.
An investigation by Keep Our NHS Public found that a principal shareholder in SSP Health is also a director of 20 active companies including property and private medicine. The campaign also discovered a link to Capita, suggesting that SSP Health’s takeover of surgeries may strengthen Capita’s influence on what health services are commissioned in future. Capita is the largest ‘business process outsourcing’ company in the UK, a creation of Blair’s New Labour hubris (see Why it gets called Crapita). There’s almost no branch of local or central government that has not been outsourced to Capita – health care, housing, Criminal Records Bureau, you name it. In January, The Guardian explained why vulnerable residents fear a Crapita (as it has been named by Private Eye) takeover of Barnet Council Services.
So how do we feel about Thatcher? Well, here in the north we’ll probably just hum along to Elvis Costello’s vitriolic ‘Tramp the Dirt Down’:
I think I’ll be going before we fold our arms and start to weep…
Well I hope I don’t die too soon
I pray the lord my soul to save
Oh I’ll be a good boy, I’m trying so hard to behave
Because there’s one thing I know I’d like to live long enough to savour
That’s when they finally put you in the ground
I’ll stand on your grave and tramp the dirt down
This is Elvis Costello talking about the song in a TV interview in 1989:
See Seven Streets’ post today – Why Liverpool Won’t Mourn Margaret Thatcher – for reasons why Costello’s song is the one to which we raise a glass today. The piece angrily concludes:
30 years on we find ourselves unable to build our way out of a recession because we don’t have a remaining industrial base or the associated skills – all swapped for call centres and minimum-wage service-sector jobs – and the North is again to be sacrificed an the altar of ideology. Joe Anderson [Mayor] says that the effect in Liverpool of the coming cuts will be four times the national average. History repeats itself. Liverpool may have seen off Margaret Thatcher, but the effects of her tenure as Prime Minister will continue to felt across Merseyside, long beyond tonight’s parties and tomorrow’s sore heads.
Or read Ian Williams’ tart assessment Margaret Thatcher: A Flawed Legacy:
She was not nice, not popular and a person of narrow but tightly focused vision. But her flawed legacy lives on, mesmerizing, for example, Tony Blair. Apart from the pious politicians, one suspects that sackcloth and ashes will he hard to discern on the streets of London, that in pubs across the former industrial heartland of Britain, many pint glasses will be raised in tasteful celebration.
Maybe there was one blessing of those dark years. Reading Dorian Lynskey’s 33 Revolutions recently underlined how the Thatcher era saw the last great outpouring of protest song. As Lynskey observes on the Guardian website today:
Protest songs thrive on combat. Complicated policy details may cause the songwriter’s pen to freeze but larger-than-life politicians who polarise opinion enable the ink to flow. It is striking that, despite all the frustration and ferment of the punk era, nobody wrote a memorable song about Jim Callaghan. But to musicians on the left Margaret Thatcher was an irresistible super-villain who threw all the conflicts of the time into sharp relief. Penny Rimbaud of anarcho-punk radicals Crass once told me: “I think Thatcher was an absolute fairy godmother. Christ, you’re an anarchist band trying to complain about the workings of capitalist society and you get someone like Thatcher. What a joy!”
Never before had a British prime minister so explicitly identified certain sectors of society as enemies — trade unionists, socialists, liberals — and so diligently set out to crush them. Thatcher’s infamous description of Arthur Scargill’s miners as “the enemy within” (the Argentinian dictator General Galtieri being the enemy without) spoke volumes about her need for foes and this Manichean outlook cut both ways, as did the strength of her personality. The single word “Thatcher”, said with appropriate contempt, handily encapsulated everything the 1980s left opposed.
Here are five of my favourites from those times – each one a brilliant example of the form.
To end this bilious outburst, here’s a magnificent response from Morrissey, posted on Dorian Lynskey’s own blog this morning. It really captures the visceral hatred that Thatcher aroused:
Every move she made was charged by negativity; she destroyed the British manufacturing industry, she hated the miners, she hated the arts, she hated the Irish Freedom Fighters and allowed them to die, she hated the English poor and did nothing at all to help them, she hated Greenpeace and environmental protectionists, she was the only European political leader who opposed a ban on the ivory trade, she had no wit and no warmth and even her own cabinet booted her out. She gave the order to blow up The Belgrano even though it was outside of the Malvinas Exclusion Zone—and was sailing AWAY from the islands! When the young Argentinean boys aboard The Belgrano had suffered a most appalling and unjust death, Thatcher gave the thumbs-up sign for the British press.
Iron? No. Barbaric? Yes. She hated feminists even though it was largely due to the progression of the women’s movement that the British people allowed themselves to accept that a prime minister could actually be female. But because of Thatcher, there will never again be another woman in power in British politics, and rather than opening that particular door for other women, she closed it.
Thatcher will only be fondly remembered by sentimentalists who did not suffer under her leadership, but the majority of British working people have forgotten her already, and the people of Argentina will be celebrating her death. As a matter of recorded fact, Thatcher was a terror without an atom of humanity.
Perhaps the most sober assessment is found in the closing words of today’s Guardian editorial:
There should be no dancing on her grave but it is right there is no state funeral either. Her legacy is of public division, private selfishness and a cult of greed, which together shackle far more of the human spirit than they ever set free.