The Reform Scotland proposals to merge parts of the public sector into big units is anti-deomcratic and seems intentionally designed to make the public sector especially susceptible to profiteering by the financial sector. We need to be more alert to the real intention of this agenda.
I am really hesitant to appear to get into inter-think-tank-bitching. Generally I think it is good for democracy to have people creating thinking and ideas from all parts of the political spectrum and I’m not sure how helpful it is for think tanks to get into a feedback loop between themselves.
That said, the proposals from Reform Scotland on ‘putting patients first’ requires some close scrutiny. At this point I’m not awfully interested in the detail or on arguments about whether this creates more choice or not. I want to explore an underlying theme which ties this piece of work to a couple of other proposals that have come from Reform – and elsewhere. The theme is ‘hidden space’ – the process of creating parts of the public sector which are positioned such that neither top-down nor bottom-up scrutiny is particularly effective. The problem seems to me that this is a strategy for creating unaccountable ‘leaks’ in the public sector which are much easier to exploit commercially than if there is clear visibility.
Let me rehearse the case study of this, which is the NHS reforms in England. The argument is that it would be better for healthcare to be driven and guided by those closest to patients, which is why centralised bodies are being weakened or removed and the task instead being devolved down to GPs. Despite all the talk of ’empowerment’ and ‘choice’, the primary outcome is to make the NHS ungovernable. There is simply no way that GPs as currently configured can continue to deliver the general medical service they do and also make complex decisions about commissioning of specialist healthcare (such as cancer treatment). The reason ‘ungovernability’ is so attractive is that inevitably someone will need to step in to fix the problem. And that will be commercial healthcare companies. The pressure on GPs to hand over decision-making to Secro or similar will become enormous. The goal is to push the decision-making process far enough down from the scrutiny of central government that it won’t be seen as a national news story but high enough up from any real democratic accountability that no-0ne can stop it. It’s the difference between ‘NHS privatised’ and ‘tiny bit of NHS in small town privatised this week’.
I detected the same thing from Reform’s proposals to make local authorities in Scotland much bigger than they are. As we have made very clear with our report on local democracy, Scottish local government is already staggeringly big in Scotland and local democracy is so weak it is next to meaningless in many places. What benefit of making local government even less local then? Well, at the moment if most local authorities want to privatise their services there would be at least a degree of local scrutiny – local papers still cover local authorities because the scale still fits. But if they become regional authorities, who is watching? The local media can’t cover that scale (in many cases at least) and the nationals won’t cover the country properly. It seems to me that the primary aim of larger local authorities is to create a space where senior public sector managers and commercial interests like Serco can get together and run services without the inconvenience of democracy getting in the way. It creates a hidden space which allows the private sector to profiteer from a public sector that has put the brakes on this kind of profiteering at a national level.
Likewise Scottish Water – we recently published a paper (which really should have got more media attention) which explains why equity investors are so keen to get their hands on Scottish Water. It provides them a front for a financial speculation scam which means that equity investors can make feee money at the expense of ordinary customers. This is another issue which has been high on Reform’s agenda.
And so we come back to larger and larger entities handling the details of healthcare. Since there is absolutely no chance of Serco getting the Scottish Parliament to follow the lead of the UK parliament and giving the financial decisions over the NHS to people more or less unable to make those decisions, this might be seen as a ‘best compromise’ option. The larger the groups of GPs, the easier it is for private interests to nobble them without proper oversight.
This entire agenda is presented as about customers’ rights and customers’ choice. It is time we woke up to the fact that this is the Trojan Horse that has been used for three decades to dismantle the public sector in favour of financial speculators. Do we really feel like we’ve got more choice in our electricity supplier than before, or do we just feel more screwed-over when we see the profits being made on our back? From there, local services and the NHS are next.
I keep mentioning Serco (more here if you don’t know about it) because Serco funds Reform. And Reform certainly has close links with the financial sector that would benefit from these kinds of policies.
The only thing that is reassuring is that these proposals have no more chance of getting through the democratic process in Scotland than does direct privatisation of the NHS, London-style. The status of Scottish Water is not going to be changed, local authorities are not going to be merged into super-authorities and the GPs are not going to be joined up into consortia. In each case the reason is largely procedural rather than political – in each case the disruption is too large.
But it is perhaps time there was more discussion of this agenda not in terms of practicality but in terms of ethos and purpose. Big-but-not-too-big is a corporate political philosophy that has nothing to do with ‘customers’, ‘users’ or ‘citizens’ and everything to do with financial speculation. We need to be aware why ‘hidden space’ is so attractive and we need to fight it head-on. It is anti-democratic and anti-democratic is terribly attractive to Big Finance.