Workers' Weekly On-Line
Volume 48 Number 7, March 17, 2018 ARCHIVE HOME JBCENTRE SUBSCRIBE
Commentary on Brexit and the NHS:

Say No to the Neo-liberal Health Agenda in Britain, the EU and Globally

Over the last year the effect of Brexit on the NHS has been reported on in Parliament and in the monopoly dominated media as claim and counter claim by those in both camps. The idea that Brexit will harm the NHS whilst a Remain agenda will not, or vice versa, is promoted in these claims and counter-claims especially on the funding of the NHS. In this way these claims around Brexit, or the Remain agenda, are being used to create misinformation, confusion and division. But worse than that and more dangerous for health workers and for the working class and people: it is an attempt to line people up in a chauvinist way behind the British or the EU monopoly interests. The fact is that the rights of all are under attack from all the neo-liberal interests of these factions that are fighting it out for dominance over Britain, the EU and the global economy.

Much has been reported on Theresa May's minority government Brexit stance, whilst the government has continued behind the scenes to impose the massive public sector budget cuts. In particular it continues to drive its health commissioner NHS England to "think the unthinkable" and continue to impose cuts to the NHS. This is forcing through withdrawals of "non-urgent" treatments, closure of hospitals and their services and encouraging the private sector involvement and privatisation of the NHS for which government new funding is mainly directed. In this way, contracts worth billions of pounds are being awarded to Virgin Care and US-based UnitedHealthcare. This is clearly one of the government's aims for the NHS as far as Brexit is concerned.

But in addition, as part of the EU of the monopolies, Britain has been and will continue to be a major enforcer of the pro-privatisation environment for health services in other European countries. Britain as part of the EU and the European Social Fund (ESF) investor-state dispute settlement (ISDS) has already made clear precedents with private companies using ISDS mechanisms to successfully seek colossal sums of money from governments that have attempted to reverse previous healthcare privatisation policies. One of many examples was in 2008 when a Dutch insurer Achmea (formerly Eureko) sued Slovakia via its bilateral investment treaty with the Netherlands because the Slovak government had required health insurers to operate on a not-for-profit basis.[1] Following this the British government was a prime supporter of the EU Transatlantic Trade and Investment Partnership (TTIP), deal with the US which would have removed member states protection from public health care and other public services. Whilst TTIP has reportedly been halted in the EU since 2017 the British government has expressed its desire to agree a similar deal with the US through Brexit and Theresa May has several times indicated that US health giants will be part of that deal.

Also, in spite of the British government's Brexit intention to restrict the flow of people from Europe, it will continue to champion and welcome the privatisation of the NHS by EU corporations. For example, in Northumberland, NHS England is putting in place its Five Year Forward View model of the NHS with its strategic partnerships, including an EU company Ribera Salud. Northumbria's three major hospitals have had their acute and emergency services closed or downgraded to one Trauma Hospital at Cramlington, covering the huge area of Northumberland including the large urban areas around Ashington and North Tyneside. Now the Northumbria Foundation Group website trumpets a "Strategic Partnership" with Ribera Salud, which started in 2016. Ribera Salud [2] is the Spanish public/private partnership (or Accountable Care Organisation) that pioneered a form of Private Finance Initiative that covers not just buildings but "integrated" health care delivered by hospitals, GPs and community services for the whole population in designated areas. Ribera Salud has already failed in other ventures.[3]

The reality is that in the negotiations with the EU over Brexit, control of the outcome is not with the people. The necessity is not to become fazed by the claims and counter-claims on Brexit, or divided by it, but continue as thousands of health workers are doing to build the resistance movement and fight together for the right to health care. The stand of health workers is say no to the neo-liberal health agenda in Britain, the EU and globally. This is part of the whole fight against the anti-social and pro-war direction of Britain and for a modern society where the working class and people are in control of their own pro-social and anti-war government.

[1]On March 6, 2018, the Court of Justice of the European Union (ECJ) delivered a judgment on the Achmea case on whether an arbitration clause in a bilateral investment treaty concluded between two EU member states was compatible with EU law. The ECJ's response to that question was that the bilateral investment treaty was in violation of EU law because while an investment protection tribunal could be called upon to interpret EU law in a dispute between investors and states, its interpretation could not be effectively challenged via the court process, meaning that the ECJ's role as the final arbiter of EU law was infringed. Legal commentaries have suggested that this is the death for "Autonomous Investment Protection Tribunals". What will happen when and if Britain leaves the EU is another matter, and in any case the domination of private interests throughout the EU is bound to continue.

[1]On March 6, 2018, the Court of Justice of the European Union (ECJ) delivered a judgment on the Achmea case on whether an arbitration clause in a bilateral investment treaty concluded between two EU member states was compatible with EU law. The ECJ's response to that question was that the bilateral investment treaty was in violation of EU law because while an investment protection tribunal could be called upon to interpret EU law in a dispute between investors and states, its interpretation could not be effectively challenged via the court process, meaning that the ECJ's role as the final arbiter of EU law was infringed. Legal commentaries have suggested that this is the death for "Autonomous Investment Protection Tribunals". What will happen when and if Britain leaves the EU is another matter, and in any case the domination of private interests throughout the EU is bound to continue.

[2] Riber Salud is the health management holding company for the Special Purpose Vehicle Ribera Salud Unión Temporal de Empresas consortium. The shareholders are:
- The medical insurance company Adeslas S.A. (51%), as the technical provider of health services, with regional savings bank Agbar S.A as its majority shareholder.
- Regional savings banks Bancaja, CAM and Caixa-Carlet by means of a jointly-controlled entity - Ribera Salud S.A.- (45%), which was the financial partner for the project.
- Construction companies Dragados and Lubasa, which each took a 2% holding

[3]The Northumbria website leaves out all the evidence about what has gone wrong with the Aliza Public Private Partnership/Accountable Care System - including the fact that, as with PFI contracts in the UK:
"contracts may have been designed to mitigate risks to the private sector." (Spanish healthcare Public Private Partnerships: the 'Alzira model'. Acerete, B., Stafford, A. and Stapleton, P. (2011), Critical Perspectives on Accounting. Vol. 22, 533-549)
A study by Dr Anne Stafford of Manchester Business School, and others, assembled evidence that the financial reality is at odds with "the rhetoric, which declares this project to be a success story."
The capitation (per person) payment was set too low (204 Euros), which caused the failure of the Accountable Care System (the Ribera Salud Unión Temporal de Empresas - RSUTE - consortium).
Compensation paid out by regional government was 69.3 million Euros. The Accountable Care System consortium was re-constituted (RSUTE II) at a higher, and progressively higher, capitation amount (379 Euros in 2004 up to 639 Euros in 2012).
Under the RSUTE II consortium there were doctor shortages, a doctors' strike and continued staff dissatisfaction. According to a study carried out by the Universities of Zaragoza/Manchester and Manchester Business School, there were allegations that the consortium 'cherry picked' the most profitable medical and surgical specialities. At the same time it was referring HIV and other chronic disorders to other non-RSUTE II hospitals. The annual bill for regional government was very high.

And here is Hunt's call to denationalise the NHS and "break down the barriers between private and public provision".
Source: Calderdale and Kirklees 999 Call for the NHS
https://calderdaleandkirklees999callforthenhs.wordpress.com/2017/08/18/weird-goings-on-in-northumberland-tyne-and-wear-sustainability-and-transformation-partnership/


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