What has HSBC to do with the NHS? Quite a lot in my mind.
My biggest worry is we will not learn any lessons from the financial meltdown of the past 3 years as government persists in its drive to privatise the public sector. As the ‘Peter Principle’ reminds us……why does history keep repeating itself? Because nobody ever listens.
With commentators suggesting barely 10% of total care home provision remains in state hands confidence in the ability of the free market and financial sector to provide quality care is important. However, for me it boils down to trust and respect, and the simple truth is I do not trust the private sector to deliver, and I do not believe the private sector respects me enough to ensure it will prioritise meeting my care needs, rather than making as large a profit as possible.
The recent review of care at Winterbourne View Hospital demonstrates this clearly when it suggests lack of funding was not an issue, Castlebeck Ltd had clearly put profit before care. Indeed the very foundations of Winterbourne View Hospital lay in its ability to make money for investors.
However, successive governments continue to believe free markets are able to respond to individual need more quickly and flexibly than over bureaucratic state funded systems, leading to better quality care as providers compete to attract consumers.
Faith in the free market is unshakeable in government, and in many areas of life it has proved of benefit, however, the re-branding of care as a commodity over the last 30 years has all but ignored some simple truths pointed out by the economist Adam Smith several hundred years ago; the purpose of the free market is to generate wealth for those who own the means of production, or the ‘masters of mankind’ as Smith christened them, it is not a charitable endeavour but a single minded system driven by cash not compassion, who Smith suggested had a ‘vile maxim‘ of “all for ourselves”. The ‘masters of mankind’ in Smiths time were the merchants and manufacturers who supported policy that enabled them to make more profit, they were not concerned with how such policy and their actions might impact on others. Today the ‘masters of mankind’ appear to be financial institutions; banks, insurance companies, private healthcare providers and international management consultants, such as McKinsey and Company who wrote many of the proposals contained within the Heath and Social Care Act , and stand to makes several millions from there implementation.
At a macro level those private institutions who have already taken over some areas of care provision have been found lacking, which does not bode well for extending this strategy. Take, for example, HSBC who were fined £10.5 million last year for mis-selling care bonds to older people. The Financial Services Authority found unsuitable sales had been made to 87% of customers, with the average age of those who purchased bonds being 83 years of age, many of whom having already died before the scandal came to light. Whilst £10.5 million might sound a lot its not for a company who was recently exposed as allowing the laundering of at least 7 billion dollars of drugs money through its bank and who set aside 700 million dollars to cover fines, although it was eventually fined £1.2 billion (not too harsh for the share holders as the company made approximately £12 billion in profits last year).
The selling of care related products by the private sector can leave individuals vulnerable in a variety of ways, look at the treatment of vulnerable adults in Winterbourne View and the recent review, owned by a Swiss private equity company, has the company been penalised in any meaningful way? Or look at the doubling of the number of private care homes going bankrupt leaving older people without secure housing or care provision.
Successive governments are keen to point to the failure of ‘state’ provision as an argument for the introduction of more private sector provision. True there are problems, however, rather than addressing these issues government seeks to displace them into the private sector, an under regulated private sector, where problems can conveniently disappear from view and politicians spout an empty rhetoric of disgust when an issue is exposed. For example failure within the NHS in Cornwall and Sutton and Merton in learning disability services led to private providers, such as Castlebeck Ltd, replacing NHS provision. However, issues highlighted in the subsequent inquiries in Cornwall and Sutton and Merton, around the training of staff, shift patterns, management systems and a general culture of indifference toward those who are vulnerable, were not addressed in any lasting or meaningful manner, so poor levels of care have continued, just in a different (private) setting.
It would appear when abuse occurs because of failure of ‘free market’ providers, government believes the private sector is not only to big to fail, but more worryingly, to big to jail. In essence some major private providers, whether of financial care products or personal care, seem to operate with impunity to wrong doing. If they are not held accountable and government is not held accountable, who is? Oh of course, the ‘care consumer’ who bought the product will have to take responsibility, after all it was their ‘choice’.
The truth is the ‘free market’ is anything but ‘free’. A favourite of Mrs Thatcher, economist Friedrich Hayek compared the free market to a ‘game’ where there are winners and losers suggesting trying to regulate the market in the name of social justice was a waste of time, there are winners and losers and it is not governments place to even the odds because we are all free to make choices, and should live with the consequences of those choices and not try to displace them onto others, such as government or other taxpayers. Which in many ways I support, however, the market is not free and is comparable to a casino where the ‘house’ always wins.
Lets reflect on the global economic crisis brought about by the current ‘masters of mankind’ and the displacement of said crisis on the public sector, and consequently those who use the public sector, to see how a system premised on the free market is neither free nor fair, and the biggest losers are those most vulnerable.
The current government appear to believe there is only one game in town when it comes to the future of our health and social care sector, in fact the whole of the public sector,they are wrong. Call me old fashioned but for me an active State should be about taking a lead, collective action and solidarity, setting a high bench mark for all in society, not running away and hiding behind the financial sector and an outdated ideological mantra of ‘private sector good, public sector bad’ where ‘money is the anthem of success’ like some National Anthem (Lana Del Rey).