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Public and private healthcare

Dear HIP

I have worked as a doctor for 35 years and have done additional private medical work for the past 25 years. For the past 21 years I have been Consultant Dermatologist at the Conquest Hospital. Here is my contribution to your current NHS debate (Free at the Point of Delivery in HIP 234).

Healthcare is a uniquely human arrangement that reflects our ability to communicate and cooperate to the benefit of our group and is therefore at the heart of a civilised society. I am not aware of an equivalent in the animal kingdom. Healthcare is built on altruism and the instinctive urge to help the suffering. It thus balances our selfish instinct, and seems to make us stronger as a community. Only if it does work to the benefit of the overall whole of society does it actually make sense. Therefore it’s a ‘group thing’. And that is how the NHS was created, in an attempt to make us all healthier and eliminate disease. 

Has its goal been achieved? I think it is obvious that it has not. Will privatisation be able to fix this? Certainly not, in my view.

Firstly, there is the well-established correlation between health and wealth. The poorest are the sickest. Good luck with trying to build a business model around caring for the poorest of the country in order to make a profit. 

Secondly, practising good medicine requires a lot of empathy and compassion, something that is difficult to quantify and charge for. In fact, the most compassionate healthcare staff would probably be willing to work for next to nothing.

Thirdly, we see in countries where private medicine flourishes or where medical work is paid per service that this leads to harmful overtreatment and inflated costs.

Does private medicine have a role? Yes, it can pick up work that goes over and above what a public healthcare service should deliver. So, what should the public service deliver?

The most important answer to this £200 billion (the annual UK healthcare budget) question is in my view: not everything! We have to accept limits and acknowledge that the original concept of the NHS has failed. We are not healthier than we were 75 years ago. In fact we are much unhealthier. Possibly, in part, because we have become complacent and relied on the expectation that the NHS can sort all our problems out. This is a form of entitlement which corrodes the very basis of a public healthcare system.

Healthcare, and the debate around it, is now dragging the group (our country) down. It no longer seems to make us stronger. Unfortunately this means we need to ask for an increased personal (not financial) contribution from ‘the ill’, essentially becoming less helpful for a while and saying “no” more often. It strikes me as strange that, in an age of individuality, we assume that health is a system issue, free from individual responsibility. 

If it can be demonstrated that individual responsibility is improving, then healthcare workers will be the first to jump in to assist further and help to the very best of our abilities – and without trying to become wealthy in the process.

Dr Jan von der Werth

Northeye: The Lib Dem view

Dear HIP

We refer to your report   in HIP 234. 

The Home Office now presides over an asylum application backlog of some 175,000 cases and counting – that’s four times the population of Bexhill. This astonishing number underlines both the scale of the issue and the magnitude of the Government’s failure – a failure which looks set to deprive the people of Bexhill of an allocated brown field development site for 140 much-needed houses and sports facilities. 

The current Government has granted itself powers against which there is little or no recourse: It can override local planning powers and controls, as it is doing with respect to Northeye; it can award building contracts to whomsoever it desires, and it has even curtailed our rights to protest. Despite the sop to local business offered by Huw Merriman MP, how many local companies will realistically navigate the Home Office procurement process and profit from the rebuild? 

But there are wider issues too. The Government’s recently passed Illegal Migration Act determines that any man, woman or child arriving on our shores by irregular means is automatically deemed ‘illegal’. This is despite the fact that 70% of claims to the year to June 2023 resulted in a grant of protection by the UK. In other words, the vast majority of the people running from countries like Iraq, Iran, Afghanistan or Syria are deemed by the Home Office itself to be entirely legitimate claimants – i.e. ‘legal’, not ‘illegal’. Under the Government’s cynical Illegal Migration Act, however, their rights shall be summarily denied contrary to international law and contrary to our legal obligations under the UN Refugee Convention. So, who’s really acting ‘illegally’? 

But lofty talk of human rights often feels remote from immediate local concerns. Anxieties, expressed in good faith, about the pace, scale and impact of migration should not be a cause of shame, but it’s worth recalling that desperate people have not caused the Home Office backlog, nor the consequent need for costly hotels, barges and detention camps like Northeye. The present situation is entirely the result of the Home Office failure to process applications. Indeed, the effect of the Illegal Migration Act will inevitably be to create more ‘illegals’, the majority of whom cannot be returned as the Government has barely any agreements in place and cannot, since Brexit, rely on the Dublin Agreement. So, how many more Northeyes will we have to build if the Government’s ‘not for turning’? 

Liberal Democrats don’t underestimate the challenges, but we do propose pragmatic solutions. We have called for the repeal of the Illegal Migration legislation, the establishment of legal routes to deter small boat crossings, and an extension of the Ukrainian resettlement scheme to include people from other nations. We also advocate permitting asylum seekers to work, thereby removing the cost of their housing from the Exchequer. We also urge faster processing of asylum claims, and the abandonment of the costly and failed Rwanda scheme. 

The combination of these commonsense measures would do more to save taxpayers’ money, remove the need for Northeye, and undermine the people smugglers’ economic model, than would the Government’s continued policy of inhumane detention, legally dubious legislation and morally questionable rhetoric. 

Martin Griffiths, Chair, Hastings & Rye Liberal Democrats 

Leave it to the private sector

Dear HIP,

 I was shocked to read your report Hotel Costs Soar But Council Committed in HIP 234. Why do the Council think they can successfully develop a hotel? Where is their expertise in such schemes? Judging by the brief details available they clearly have not got a clue. Yes, things change, and especially costs, but they have not doubled. The decision was only taken in 2019 and some of the increases were fully predictable. The initial cost estimate must have been wrong. 

The Council’s total incompetence at property development was displayed only a few weeks ago when they announced the sale of 12/13 York Buildings. After spending over £1m converting the upper parts for social housing they decide the building was not suitable for such a use. Why did they come to that conclusion only after they had spent our money?

While the Council play at being property developer, where is our Local Plan? With the various flows of investment into our town, where is the much-needed co-ordinating Plan? The Council should not gamble our money on speculative schemes. Let the private sector take those risks. They have the knowledge and experience for such projects, and if they get it wrong then they take the consequences. Please, Council, get on with the jobs you should be doing, such as publishing the Local Plan.

Graham Seaton

“The Government is expending a lot of energy to prepare for ‘no deal’ but I have not seen the same level of intensity go into our talks with the European Union, who have asked us to present alternative arrangements to the Irish backstop.

“The updates I have been grateful to receive from [the Prime minister’s] office have not, regretfully, provided me with the reassurances I sought.

“I must also address the assault on decency and democracy that took place last week when you [Johnson] sacked 21 talented, loyal One Nation Conservatives.

“This short-sighted culling of my colleagues has stripped the party of broad-minded and dedicated Conservative MPs. I cannot support this act of political vandalism.”

The next MP for Hastings and Rye

Hastings and Rye Labour parliamentary candidate, Peter Chowney, said, “I’m pleased that Amber Rudd has realised what many of us knew already: that the Tories are in utter disarray, and that Boris Johnson is not fit to be an MP, let alone Prime Minister.

“She once said that Boris Johnson was the life and soul of the party, but you wouldn’t want him to give you a lift home. Now she’s firmly slammed the door on him and decided to walk away, avoiding the car crash this government has turned into.

“I look forward to other prominent Conservatives, both nationally and locally, taking the same honourable route.”

Local Lib Dem parliamentary candidate, Nick Perry, said: “Amber Rudd’s resignation provides further evidence that Boris Johnson’s Conservative Party is now a Trojan horse for the Brexit Party. With the Conservatives and Labour in the hands of political hardliners, the Liberal Democrats will continue to welcome voters who want an open, tolerant and socially progressive party, committed to economic competence and stopping Brexit altogether.” 

Soames it ever was

In a Twitter exclusive, Jim Pickard, chief political correspondent for the Financial Times, tweeted: “I can reveal that Amber Rudd is going to stand as an independent at the next election – but not in Hastings & Rye”. 

Packard started a poll asking where Rudd might stand in an upcoming election, suggesting Putney, Kensington, Uxbridge, and The Rhondda. Rudd has since ruled out Uxbridge. 

The resignation article in The Times insinuated that Rudd might move ‘up the road’ to Mid Sussex, Nicholas Soames’s seat. Soames, who incidentally is Winston Churchill’s grandson, has recently had the Conservative whip withdrawn after voting against the government on the Benn bill and has been rumoured to be vacating his safe Conservative seat. This move to Mid Sussex seat has been predicted since Rudd’s majority was reduced to less than 346 in the 2017 general election. 

One Johnson pulls out, the other doesn’t 

This resignation may be a moral stance or a shrewd political calculation, depending on your sympathies. Twenty-three Conservative MPs have lost the party whip under Johnson’s leadership, including Soames, Rudd and Jo Johnson, Boris’s brother who also recently surrendered the party whip. A lot will depend on when they will have the whip restored. It seems unlikely in the extreme that Rudd will not return to the fold after this unusual period of open acrimony within the party. If the whip is returned before the next election and the seat becomes available, Mid Sussex can look forward to a new MP. It’s within an hour of London and she can see that they’ll win. If not, Rudd says that she’ll run as an ‘independent Conservative’. 

Given some of the policies and practices that Rudd has been able to tolerate, this move is unlikely to be a noble resignation. As Home Secretary, Rudd was a key architect in creating the ‘hostile environment’; she refused to acknowledge or implement the Dubb’s amendment which should have given thousands of child-refugees safe sanctuary in the UK; she gave the famous ‘Rivers of Rudd’ speech at the 2016 Conservative party conference in which she suggested that the majority of Britain’s problems could be solved by being tough on immigrants; she lied about the Windrush scandal and was eventually hounded out of office by the press. As Work and Pensions Secretary, Rudd oversaw the roll out of Universal Credit, a system that has caused extreme suffering, rent arrears and homelessness for the most vulnerable in society and was part of a government that considered raising the pension age to 75. Rudd campaigned enthusiastically to remain in the EU but was happy to sit in a cabinet that was prepared to prorogue parliament in order to see through a no-deal Brexit. The party whip being withdrawn from fellow MPs seems a strange place to draw a line in the sand. 

The next leader of the opposition?

Rudd’s move away from government can be interpreted as a bet against the current Johnson administration from someone at the centre of its innermost circle. When she returns to cabinet this resignation will put her in a strong position for a top job. 

Rudd would make a better leader than Johnson, he could never have been a successful Prime minister because he is a fool. His role is to make people laugh. Johnson reeks of British public-school exceptionalism, where effort is an affront to a born entitlement, he has only ever wielded power through proximity. Now that there are no higher authorities to hide behind, his jokes are falling flat, the gaffs no longer funny, the lack of effort and research, dangerous. If Rudd’s bet pays off, we may be looking at the collapse of the current government and a new leader of the Conservative party before Christmas. 

Hastings may have seen the back of Amber Rudd but the world has yet to see the end of her ambition.