Workers Daily Internet Edition Year 2003 No. 70

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Who Should Seize the Initiative in the NHS?

Don't be fooled by the rhetoric: this is about privatisation

By Allyson Pollock *, Wednesday May 7, 2003, The Guardian

At its launch, Alan Milburn described the foundation hospitals bill as "true to our traditions of solidarity, community and fairness". The Labour party chairman, Ian McCartney, even called it leftwing. But this did not satisfy Labour stalwarts: 130 backbench Labour MPs signed a motion opposing the bill because of fears about privatisation, an anxiety echoed by many outside parliament, including the British Medical Association and the Royal College of Nursing.

So now the media are being fed another story. The foundation proposal, we are being told, is only rhetoric; in reality, the reform changes nothing very much. Foundation hospitals will not be businesses but not-for-profit "mutuals", NHS pay rates will apply and private practice will be capped. New Labour is simply tweaking some hoary NHS institutions while spinning the changes to undermine the Conservatives.

This is untrue, as a close reading of the health and social care bill demonstrates. Foundation hospitals are not bound by the bill to nationally agreed pay rates and they can subcontract clinical services to private firms, where NHS rates need not apply.

Under the proposed legislation NHS hospital trusts and private sector bodies can apply to become "public benefit corporations" or foundation trusts - a new form of mutual company that does not have shareholders on the board. However, this is simply a fig leaf for privatisation below board level. The bill allows any private sector body - from Bupa to Boots - to apply to be a foundation trust and run NHS services. Furthermore, the board can contract out clinical services directly to the private sector - in which case shareholders of those private companies will make a claim on scarce NHS resources.

Foundation hospitals will have increased responsibility for generating surpluses to cover the costs of new investments in services. Each trust will operate like a private business with limited liability, a board of directors and ownership of its assets - as well as freedom to sell any of them with the permission of an unelected independent regulator. Thus foundation status will take hospitals out of the public accountability loop. Crucial decisions about what is provided where, when, and how will not lie with the local community, the department of health or parliament.

Because there is so much potential for privatisation, Milburn has stressed that the bill contains an equity guarantee safeguarding the principles of universality and free services at the point of delivery. But the bill does not once refer to equity and the sole public duty of a foundation trust is to exercise its functions "efficiently, effectively and economically".

It is the notorious section 17 that thoroughly undermines the claim that foundation hospitals will keep services in the NHS with local accountability and control. It is here that foundation hospitals are given unlimited powers to enter into joint ventures with the private sector, either through raising private finance or through contracting with private companies for the provision of clinical services.

The department of health is lining up the private sector to take over so-called "failing hospitals". Companies such as Bupa and those already involved in PPPs are waiting in the wings; fiercely predatory American corporations such as Kaiser and United Healthcare are also hovering. These firms specialise in patient charges and private health insurance, and restrict access to care. Their presence will blur the boundary between what is free care and what is paid for.

Foundation status is part of a broader pattern of health service privatisation under New Labour. The government's commitment to private clinical services is already explicit. It has invited Boots to apply for contracts in eye surgery and has recently contracted with United Healthcare to advise NHS trusts on the provision of services for older people.

But profits erode clinical care. Take the controversial PFI initiative, under which more than 50 NHS hospitals are being handed over to companies such as Jarvis, Tarmac, Siemens, Rentokil, and Initial to run. Across all the first 15 British PFI hospitals, the number of hospital beds has been reduced by a third.

Before 1948, access to healthcare was on the basis of what the local community and the individual could afford. The result was that 50% of the population had no access to healthcare. Nye Bevan's vision of the NHS was one of "freedom from fear" of the costs of healthcare, and for more than 40 years politicians from all parties have defended this achievement. Today MPs will vote on a bill, which, if passed, will effectively privatise NHS hospitals. Let's hope that politicians will once again cast aside their political differences and unite to vote against the further break-up of the NHS.

* Professor Allyson Pollock is head of health policy at University College London.

See also the briefing paper on the Health and Social Care (Community Health and Standards) Bill by Allyson Pollock and David Price of the Public Health Policy Unit, University College London: http://www.ucl.ac.uk/spp/download/health_policy/foundation.pdf

Also see the discussion document, "Foundation hospitals and the NHS Plan": http://www.ucl.ac.uk/spp/download/health_policy/Foundation_hospitals_NHS_Plan.doc

The past and future of the NHS: New Labour and foundation hospitals

John Mohan *

Executive Summary

The government's current policies on hospital provision rest on a partial critique of previous attempts at planning health care. New Labour alleges that the National Health Service's monolithic, top-down structures have failed to deliver an equitable service, and argues that the recuperation of what is claimed to be a neglected mutualist tradition in British socialism can rectify the democratic deficit in health care.
Developments under the NHS cannot be characterised simply as a top-down bureaucracy in the current fashion of government spokespersons. For this fails to acknowledge the real achievements of central planning in improving the distribution of resources. And it is arguable that the failures of top-down hospital policy were due as much to external circumstances as to technical weaknesses in the ability to plan services.
The inter-war period, characterised as a mixed economy of welfare, should not be celebrated as a positive example of localism, and its health-care system should not be celebrated as a positive example of mutualism. New Labour's proposals may indeed merely reproduce the shortcomings of the unrepresentative governing bodies of pre-NHS hospitals.
The establishment of foundation hospitals is being pursued for largely pragmatic and electoral reasons, with the attendant (but not publicly acknowledged) risk of fragmenting and dividing the service, and of reproducing features which the supervisory and regulatory state of the 1930s was unable to deal with satisfactorily.

Introduction

New Labour has had to come to terms with the party's previous history. Nationalised and centralised institutions such as the National Health Service (NHS), once praised as crowning glories of previous Labour administrations are now seen as problematic for the party. Many of New Labour's policies are as much about distancing themselves from 'old' Labour as about distancing themselves from the Tories. Here I want to argue, with respect to the introduction of NHS 'foundation trusts', that Labour is selectively reinterpreting history to justify policy measures which are driven by pragmatic and ideological considerations, and which have the potential to fragment the NHS. This entails the construction of a mythical past which has two central elements. Firstly, it denigrates centralism and state planning, allowing the government to insist that only competition and choice can drive forward improvements in the NHS. Secondly, there are proposals to return hospitals to the autonomous status which they enjoyed prior to 1948. These arguments rely on invocation of a mutualist and localist past, in which hospitals were somehow more responsive to the wishes of the local community. These policies might have short-term electoral advantage but they have the potential to impact adversely on access to health care. This is because the establishment of autonomous foundation trusts will remove or weaken some important mechanisms for planning and cross-subsidy within the NHS.

Key to the proposals are the following elements. Trusts will be constituted as autonomous entities, accountable only to a board drawn from a membership comprising local residents, patients, and employees, and operating under a license issued by an independent regulator, rather than reporting to the Government through the Minister of Health. They will have enhanced borrowing powers subject only to the NHS's overall spending limit. Some of their assets will be 'protected' (those assets deemed essential, by the regulator, for the provision of health care) while others will not, and they will be able to engage in borrowing against income streams from the latter. Finally, there will be much greater scope for patients to choose the hospital in which they are treated and, although all trusts will eventually be awarded 'foundation' status, in an interim period of up to 5 years their new status will give the first-movers significant advantages in attracting patients.

This paper comments first on the validity of Labour's critique of the history of the NHS as a command bureaucracy. Second, it disputes the argument that the policy represents a reincarnation of an earlier mutualist tradition, points to the inadequacies of the pre-NHS system and questions the extent to which it permitted genuine community control. The final section considers some of the problems which may arise from the establishment of foundation trusts.

The NHS as a command bureaucracy?

Some might think that Labour are trespassing on ground staked out by right-wing think tanks and the Conservatives. For parallels were drawn in 1989 between the collapse of the state bureaucracies of Eastern Europe, and the urgent need for reform in the NHS. Malcolm Rifkind, for example, suggested that when the NHS was established it was believed that:

the best way to administer resources was through a form of rigid, centralised planning.... the assumption was that there should be nationalisation and ....that that would achieve the best use of resources. That view was shared in eastern and western Europe as well... a structure established 40 years ago does not necessarily make sense in dramatically changed circumstances...in this country and elsewhere we have seen a growing disillusionment with central planning and control...

In startlingly similar terms, Alan Milburn asserted over a decade later that the 1945 settlement was the 'social equivalent of mass production'. The NHS had been founded in a 'world where everyone was given the same rations', so that a minimal form of equity for the population was produced at the expense of choice for the individual.

If one is searching for examples of the command-and-control systems in the history of the NHS, the Hospital Plan of 1962 would appear to fit the bill. The aim was to create regional hierarchies, centred around District General Hospitals (typically containing 600-800 beds) to provide a range of general acute medical and surgical services to communities with populations of 100,000-150,000. More-specialised services would be available in the teaching hospitals at the apex of the hierarchy. The assumption was that a considerable increase in capital investment would greatly enhance hospital efficiency and also effect revenue savings.

Perhaps for the first time there was an attempt to identify and prioritise hospital investment programmes. Communities which lacked provision knew what they were going to get and roughly when they were going to get it (albeit decades away, in some cases). But on closer examination the extent to which this was a hierarchical, bureaucratic and rational exercise is debatable. The Plan was not a top-down blueprint, but the result of the aggregation of proposals of varying quality from various Regional Hospital Boards. Despite the efforts of the Ministry to achieve consistency, in many cases comments on regional strategies show that they were making the best of a bad job. Enoch Powell's comment, as the Minister responsible for launching the Plan, that the government was now planning the hospital service on a 'scale not possible this side of the Iron Curtain', must therefore be taken with a large pinch of salt (though no-one should doubt Powell's commitment: he minuted that he would even be prepared to 'close hospitals symbolically' to demonstrate Ministerial commitment to the project!). Nor was a uniform template simply imposed across the country. Instead, there were extensive discussions on hospital design with management committees and doctors. Some might argue that this meant that professional aspirations were given too much deference, but the consequence was that there remained scope for local variability and flexibility.

Of course, planning also assumes a capacity for execution, but severe implementation problems ensued. The Plan had raised hopes that the decrepit hospital stock would be upgraded, but the economy was faltering and the construction industry proved inadequate. The former restricted the resources available for hospital construction while the latter prevented their effective use, but this does not make a case for 'state failure'. We need, perhaps, to separate failures of policies from changes in the circumstances affecting their implementation. For all the complaints about the Plan and the attendant frustrations, it did guarantee some new hospital construction in locations where it had previously been almost non-existent. But the problems of implementing it led politicians swiftly to disavow it, and insiders contend the Plan was dead within three years of being launched. Symbolically, a published revision in 1966 was titled 'the Hospital Building Programme'- the word 'Plan' being quietly dropped. The oil crisis of 1973 brutally terminated the programme's expansion, expenditure not recovering to its 1972 level until the mid-1980s. The response was a more localist emphasis on policy with a greater retention of physical assets rather than new building, a softer line on hospital closures, a scaling-back of the official view of appropriate hospital size, and efforts to promote standardisation of hospital design and construction. This certainly cannot be regarded as a blueprint or coherent policy, and there were further variations on this theme during the 1980s as the Conservatives placed greater emphasis on estate rationalisation and reinvestment of proceeds of land sales as a way of funding capital developments.

All this suggests that a period of hierarchical, top-down planning in hospital provision was at most short-lived. It is worth recalling that there were good reasons why such a planning exercise was launched and specifically why it took the form it did, namely, District General Hospitals serving a defined catchment. This made possible the integrated planning of services for a defined population, not just in terms of making hospital beds available, but also in terms of developing parallel community-based services (even though provision of the latter was variable). But elements of localism, markets, and partnerships with local communities never really went away. Caricatures of the NHS as a command bureaucracy are surely vitiated if we recall that the key decisions about committing resources are made - and, by and large, have always been made - by individual doctors. Moreover the distribution of hospital medical staff has always been shaped, at least in part, by market forces, in the form of opportunities for private practice. Commentators on the post-1991 era in the NHS have, moreover, emphasised the extent to which the 'market' era was in fact characterised by management of the market or even what Donald Light called 'dictated competition, which was perhaps a contradiction in theory, but not in politics'. It is in fact the New Labour government that has adopted highly centralist policies, exemplified by its rigid specification of targets.

The more important point of principle concerning New Labour's policies is where it places them on the ideological spectrum of contemporary health care policy debate. For their references to the pre-reform NHS as a command bureaucracy are being used to justify pro-market policies which in certain respects go even further than those of the Conservative successors to Enoch Powell. Ironically, the Hospital Plan endorsed by Powell accepted restrictions on patient choice in a way that New Labour's proposals do not. For they are proposing that hospital services should be driven by the expressed preferences of patients and at the same time removing controls on hospital borrowing powers. Thus they risk losing their grip on the key levers by which the government can steer the development of hospital services.

Mutualism before 1948?

Labour have claimed that they are merely drawing on neglected traditions in socialist thought which are consistent with their aspirations. There is a recognition of the achievements of the post-war settlement, but this is combined with an insistence that governments must not become prisoners of it. With characteristic 'third way' rhetorical antithesis, it is asserted that changed socio-economic circumstances require alternatives to 'monolithic health care provision' (i.e. the public sector) on the one hand and shareholder-led-for-profit providers on the other. Thus Ian McCartney and Peter Hain describe the proposals for foundation hospitals as emanating from a cooperative and mutualist tradition. There are also proposals from think tanks, which climb on board the same bandwagon. For example Mutuo state that 3118 independent hospitals, many of which were 'steeped in the not-for-profit traditions of mutuality', were nationalised in 1948.

In fact the actual number of voluntary hospitals nationalised was nearer 1100, the majority of the rest having been provided by local authorities or by central government via the wartime Emergency Medical Service. It is also questionable whether many of the pre-NHS voluntary hospitals could be regarded as cooperative and mutualist enterprises. With a few exceptions democracy and consumer control were not strong features of these hospitals. In historical terms, Labour is suggesting that community control can work, much as it did in the pre-NHS era. But if we look back at that period we find large-scale community participation in raising funds for hospitals (via mass contribution schemes) accompanied by tokenistic representation on governing bodies. Moreover, any serious assessment of the pre-NHS era would have to acknowledge the enormous variations in provision and finance, such that there were five-fold variations in patients' chances of obtaining treatment in a voluntary hospital, depending on where they lived! Assertions, by Arthur Seldon for instance that the NHS 'simply mounted the already-galloping horse of voluntarism' are simply not credible: that horse lacked steering mechanisms and had not found its way into all parts of the country.

Designing representative and democratic structures for organisations operating in the British NHS is complicated because there is no obvious way of delimiting the territory served by a hospital, nor is it easy to determine who the electorate should be. A succession of administrative reforms have failed to solve this problem. Had health care remained the responsibility of local government, and had local government been reorganised around relatively large spatial units, incorporating both urban areas and their hinterlands, there might have been grounds for a direct integration of health care and local government. But there are very large counterfactuals here and a key reason for nationalisation in the health service related to professional antipathy to local government control. For their part, the new proposals may only serve to stimulate loyalty to individual health care institutions, such as hospitals. A persistent problem in the pre-NHS era was that of persuading hospitals to sink their differences and work together rather than developing in an autarkic manner. Strengthening loyalties to individual institutions does not seem sensible at a time when the aim of intelligent policy ought to be about integration of services. Establishing trusts covering integrated hospital and community services might have been one way forward, but probably looked too much like the discredited health authorities which existed until 1991. Alternatively, democratisation could be extended to Primary Care Trusts, the bodies responsible for commissioning NHS care, which serve relatively coherent geographical areas, albeit ones which are not coterminous with local authorities.

Moreover, the proposals for foundation trusts do not, in fact, resolve the democratic deficit. They allow for a self-nominating membership, which may be unrepresentative of the population served by a trust, to elect its governing body. One is reminded of the early days of the voluntary hospitals, the governing bodies of which comprised individuals who were wealthy enough to pay to see doctors privately, rather than attending hospital as a patient. Indeed, the precise arrangements for democratic involvement under the new scheme have been left to the discretion of individual foundation hospitals. For example, their trusts will be free to decide how they attract members and conduct elections to their board. This can only be designed to introduce further diversity of accountability and governance into the nation's health services and raises the question of what sort of national health service is intended by New Labour. Of course, one answer to that might be that the service never has been 'national', but if one is providing broadly the same type and level of services across the board, it would seem reasonable to expect some consistency in their governance.

Independence, incentives and regulation

If we think about the potential future development of the hospital system and what it might look like under these new decentralised proposals, are there any further lessons from history? In terms of planning the disposition of hospital services there is an argument that the combination of the borrowing powers available to foundation trusts, plus the expanded scope for patients to choose their hospital, creates dilemmas which are novel for the NHS but which do have parallels with the inter-war years. The future of the NHS will be as a mixed economy; the government clearly being indifferent as to whether provision of services is by the public or private sectors, as long as the services are provided. A crucial difference is that hospital finance will be underwritten in a way which was inconceivable in the pre-NHS period. However, relaxing restrictions on the borrowing powers of foundation trusts would seem to lead inexorably in the direction of a more commercialized service, because trusts will be thinking primarily in terms of how they resource repayment of loans. This will lead to competition between trusts to capture market share. The parallel with the inter-war years concerns how one articulates a collective interest.

In the 1930s, many of what we would now regard as deficiencies were regarded as strengths. It was acknowledged that no hospital 'system', as such, existed, but this resulted from 'local patriotism' which was 'not without its advantages' according to Ministry of Health officials. There was a degree of Ministerial agnosticism about variations in the quantity and quality of hospital services. The Ministry had next to no dealings with the voluntary hospitals (and had no way of influencing their development) while surveys of local-authority activity in health care had revealed 'variations in the standards achieved'. However, according to the Ministry of Health's annual report, the Minister had no desire to limit the activities of local authorities to 'the maintenance of a mechanical efficiency'. Of course, this was a rather self-serving argument which could be used to justify the hands-off stance of the Ministry. Thus, no attempt was to be made to impose a national blueprint. Attempts to improve access to services largely took the form of exhortations to greater collaboration. These failed to overcome deep-seated problems of articulating a collective interest; even in locations experiencing severe economic depression, where necessity might have been the mother of invention, voluntary hospitals refused to collaborate. And there were no powers available to the Ministry which enabled it to guarantee the provision of services in communities lacking them. Nevertheless, voluntarism was celebrated as being deeply-rooted in the national character, and part of the reluctance to countenance greater intervention (during wartime discussions, for example) had to do with the desire to preserve the positive aspects of voluntarism. Even here, however, informed opinion within the voluntary sector recognised that, in rebutting the advance of state intervention, 'more was needed than this negative argument.... that uniformity does not give the best service'.

Under the new proposals such problems could recur in a modified form. The trajectory of health-systems development is going to be determined by the pattern of investment in buildings until society reaches a utopian condition of prevention or self-management of illness. As that still seems a long way off, a national service needs control over the pattern of service provision. The top-down planning initiatives criticised by Milburn at least had the advantage of spelling out priorities. Under these new proposals, instead, individual trusts will strike their own bargains with banks for the financing of capital development, and the only constraint will be that borrowing must be contained with the NHS's spending limit. Capital development in the NHS will therefore be skewed towards foundation trusts and, even though the intention is that all NHS trusts will ultimately attain this status, in an interim period this must give an advantage to those at the front of the queue.

In the absence of close ministerial supervision of capital development Labour places faith in the role of a new independent 'regulator'. Rather than imposing a top-down blueprint for the pattern of service provision the object will be to ensure that 'reasonable demand' for NHS services is met. The regulator will issue licenses which will specify the services which are to be offered to the NHS by providers (whether in the public or private sectors). In issuing the licenses the regulator will have to take account of existing provision in the locality: this could be regarded as a sensible way of avoiding duplication (there was no way of doing this in the 1930s), or as a way of guaranteeing local monopoly not without its parallels from the maligned era of planning. Either way, what is not specified is how and where 'reasonable demand' is to be met. At least the 1962 Hospital Plan specified the range of services which were to be available for communities of a specified size, but there are no such specifications in the bill introducing foundation trusts and presumably the implication is that demand could be judged to have been met even though it involves much longer travel for patients. Nor is it clear what powers there are to guarantee the provision of services in communities which lack them. Presumably the government hopes that the welcome additional resources being pumped into the service will call forth a response in terms of extra capacity, but one can foresee circumstances in which surplus capacity in distant parts of the country is used to meet 'reasonable demand'. This might be regarded as a sensible use of resources but - like the patients crossing the Channel for treatment - it is only possible if one accepts much greater travel on the part of patients.

Conclusions

The government's justification for its proposals rests on the apparent failure of the NHS, over many years, to tackle health inequalities, but is the way to do this really to enhance the scope for the articulate and well-off to exercise choice, and simultaneously to reduce integration between hospitals and other elements of the health service? Historically, after all, health standards have improved most as a result of public health and economic policies, rather than as a result of health services. A serious attack on health inequalities would involve macro-economic policies which prioritised relatively secure and well-paid employment and a more redistributive welfare state than is currently on offer. Within the health service the foundation trust proposals run counter to a long history of attempts to integrate hospital and community services and this is why commentators view the proposals as a pragmatic attempt to bind the middle classes into the public sector by offering them scope to exercise choice and, in a worst-case scenario, as a Trojan Horse for the creeping privatisation of the service, rather than elements of a coherent policy for improving health standards.

In defending his proposals for nationalisation, Aneurin Bevan, Minister of Health in the post-war Labour government, insisted that 'the self-contained, independent local hospital is nowadays a complete anachronism'. The implication was that the development of health services required a modern, integrated organisation with appropriate links between hospitals and primary and community services. New Labour is rejecting part of this - the belief that such integration is to be established through a centralised administrative structure - and instead creating autonomous trusts in the belief that incentive structures can be designed which will ensure that they pursue collective interests. Inter-war criticisms of hospitals 'pursuing the prosperity of the infirmary rather than the service of the city' stand as warnings of the difficulties of ensuring that such collaboration takes place. If, like the Minister of Health in the 1930s, the government is sanguine about 'variations in the standards achieved', then they should say honestly how much variability they are prepared to tolerate.

June 2003

Further Reading

Gorsky, M., Powell, M., and Mohan, J. (2002), 'British hospitals and the public sphere: contribution and participation before the NHS', in Sturdy, S. ed., Medicine and the public sphere in Britain, 1600-2000, London, Routledge, pp123-145.

Hunt, P. (2002), 'Governance in health care', in Making healthcare mutual: a publicly-funded, locally-accountable NHS, London, Mutuo, p5.

Lawlor, S. (2001), Second opinion? Moving the NHS monopoly to a mixed system London, Politeia.

Light, D. (1997), 'From managed competition to managed cooperation: theory and lessons from the British experience', The Milbank Quarterly, 75, pp297-341.

Mohan, J. (2002), Planning, markets and hospitals, London, Routledge.

Mohan, J. (2003), 'Voluntarism, municipalism and welfare: the geography of hospital utilisation in England in 1938', Transactions, Institute of British Geographers, 28, pp57-74.

Paton, C. (1997), 'The politics and economics of health care reform: Britain in comparative context', in Altenstetter, C. and Bjorkman, J. eds. (1997), Health policy reform, national variations and globalisation, London, Macmillan, pp203-235.

* John Mohan is Professor of Geography, University of Portsmouth. He is the author of Planning, markets and hospitals (Routledge, 2002) and A National Health Service? (Macmillan, 1995), as well as of numerous articles on historical and contemporary geographies of health and welfare services.

The Hour of Truth Concerning the "Nuclear Issue", Security and Peace on the Korean Peninsula:

The US Is Cornered as a Result of the DPRK’s Proposal for a "Global Solution"!

Lead article in the June 2003 Bulletin of CILRECO, the International Liaison Committee for Reunification and Peace in Korea

The misleading campaign of Bush and his administration against the DPRK, a sovereign state and a full member of the United Nations, rudely described as a "pariah state" and a member of the "axis of evil", has been further reinforced lately, as the DPRK is now also accused of being a "nuclear threat to the world".

CILRECO has proved over and over again, backing it up with concrete evidence, what is the origin of the "nuclear crisis" provoked on the Korean Peninsula by the hostile power policy of the US towards socialist Korea, the policy whose objective is to strangle that country economically and eliminate its regime, in order to block the independent reunification of the country, maintain American domination over south Korea, and accomplish its hegemonic ambitions in Asia and in the world.

CILRECO has denounced this media campaign, orchestrated by the White House, pointing out that its goal is to justify a "pre-emptive attack" on the DPRK, which has officially been included in its strategic plans for quite some time, all the while trying to obtain the support of the international community to this imperialistic policy.

Again, quite recently, during their war against Iraq, the Americans, the "world policeman", repeatedly referred to north Korea as the next target in their "crusade against terrorism" and their struggle against the "proliferation of weapons of mass destruction".

As we all know, these same fallacious pretexts were used by the Bush administration to justify the invasion of Iraq, carried out in violation of international law, and in defiance of the almost unanimous opposition of UN members and the people world-wide.

However, now when Iraq is occupied by the American forces, some high-ranking officials of this administration cynically admit that the "pieces of evidence" they presented to the UN were nothing else but the fake ones fabricated by the CIA!

This scandalous manipulation of the international community by US officials, in order to disguise a true colonial occupation of Iraq, should incite the general public to think about the credibility of their accusations against the DPRK, and, further, about the real motives for their persistent, hostile power policy towards this country.

While on this subject, international public opinion could not have failed to notice that, since the three-way talks between the DPRK, the US and China, held in Beijing at the end of April, the campaign on the "North Korean nuclear threat" has no longer been in the headlines. What happened in Beijing that could possibly explain this sudden silence?

First of all, let us mention that the US has been systematically refusing the DPRK’s repeated proposals to organise direct talks between the two countries in order to solve the "nuclear crisis". It is quite clear that the US wanted to "internationalise" this problem in order to provoke a conflict between the DPRK and the international community and free themselves from their responsibility for this crisis.

Finally, as a result of the DPRK’s perseverance and its willingness to make concessions regarding the "form" of this dialogue, the US was forced to accept the meeting in Beijing, but they declared that the only possible solution would be for the DPRK to comply with their demands!

But events took a totally different turn: the DPRK presented to the US a proposal for a "global solution" that would not only eliminate the "worries of the two parties concerned by the solution of the nuclear problem", but would also "eliminate the danger of nuclear war and ensure peace and security on the Korean Peninsula, or even in Asia and the world".

To put it plainly, this means that everything is possible to solve the existing problems between the two countries on condition that the US declares officially (and proves it with its acts) that it abandon its insane and dangerous hostile and war-provoking policy towards the DPRK!

Therefore, now the US finds itself cornered and under scrutiny of all people who value justice, independence and peace, as a result of this extremely important proposal of the DPRK to solve different problems concerning the nuclear issue, bilateral relations, long-lasting peace in Korea, security of the entire Korean nation and global security, which would have a huge impact on international relations.

Unfortunately, so far the US has not given any response to the DPRK; it merely continues to repeat its unilateral demands that the DPRK abandon its policy of self-defence and let itself be strangled.

Fortunately for the existence of the Korean nation, for its sovereignty, for the independent reunification of the country, and for the right of all people to self-determination, the DPRK refuses to give in to American threats and blackmail, and adopts legitimate measures of self-defence and dissuasion, which it is forced to do as a result of the bellicose policy of the superpower that would like to rule over the entire world.

In this struggle, socialist Korea can count on the support and solidarity of all the forces that value justice, sovereignty, independence and peace, and call for the establishment of a different kind of international relations, that would be based on the respect of the principles of the Charter of the United Nations, and would satisfy the desire of people to be free in a world without war and with progress for all.

The 3rd Anniversary of the Adoption of the North-South Accord of June 15, 2000:

Declaration of Guy Dupré, Secretary General of CILRECO

Text sent to the international press on June 10, 2003

Three years ago, on June 15, 2000, for the first time ever in a more than 50-year-long history of the arbitrary division of Korea imposed by foreign forces and its tragic consequences that the Korean nation has been the victim of, the North and the South of Korea reached a joint Accord in order to "solve the reunification problem independently, through joint efforts of the entire nation".

This historic event for the entire Korean nation, eager to regain its national unity in a country reunited independently and peacefully, was widely acclaimed at the time by all the people of the world who value justice, sovereignty and peace, as an outstanding progress in their common struggle for the emancipation of mankind.

The Presidency of CILRECO, the organisation that has the honour to lead the international movement of support to the cause of the Korean people, rejoicing over this extremely important Accord between the two parts of divided Korea, pointed out that it had resulted from the audacious initiative of the DPRK’s leader Kim Jong Il, based on his policy of national unity in favour of the reunification, and the willingness of the south Korean president to accept the principle of the independent reunification of the country.

The Accord of June 15, 2000, was acclaimed, almost unanimously, by the international community as an important contribution to stability in the region and to global security and peace.

As soon as the North-South Accord of June 15 was made public, only the most conservative and bellicose forces from the US and south Korea tried to misrepresent its importance, expressing their intention to block the implementation of the process of reconciliation, co-operation and reunification initiated by the Accord.

As a matter of fact, CILRECO launched at the time an appeal for vigilance to all peace-loving and progressive forces, pointing out that the "American imperialists and their allies will use all possible means to destroy this process of reunification, that would call into question their political, economic and military domination in the South, as well as their ambition to eliminate the DPRK and spread their domination throughout the Korean Peninsula, in order to accomplish their strategy of hegemony in Asia and in the world".

What is the situation like on the Korean Peninsula three years after the adoption of the historic Joint North-South Accord of June 15, 2000?

We have to say that this totally new situation is undeniably characterised by some spectacular progress of the North-South process under way, clearly visible in all domains, be it their bilateral relations, the accords reached between the authorities and their concrete implementation, or exchange and collaboration between all categories of population, in order to strengthen national cohesion and reunite independently.

To assess this enormous progress (that only a while ago could not even be envisaged), it is important to note that it was accomplished at the time when Bush and his administration, in collusion with the most reactionary south Korean forces, were hell-bent to destroy it, in order to prevent the application of the Accord of June 15, 2000, even if it meant risking another tragic conflict on the Korean Peninsula.

In fact, in their strategy hostile to the reunification of Korea and favourable to the elimination of the DPRK, Bush and his team chose to reinforce in all domains their hostile policy towards socialist Korea, while trying, under fallacious pretexts, to obtain the support of the international community to their dangerous power policy.

The US sabotaged the climate of détente on the Korean Peninsula, created as a result of the North-South Accord, they reinforced their embargo and economic sanctions, resorted to military provocation and serious threats of a "pre-emptive war" against the DPRK, rudely referred to as "pariah state" and a member of the "axis of evil"!

Last but not least, the US deliberately provoked the current "nuclear crisis" on the Korean Peninsula by violating its engagements from the 1994 Agreed Framework between the US and the DPRK, and now it is trying to "internationalise" this issue fleeing from its responsibility and hoping to provoke a conflict between the DPRK and the international community.

This bad "scenario" on the "North Korean nuclear threat", concocted by the US with an intention to deceive public opinion, was revealed during the Korean-American talks held in Beijing at the end of April. There, faced with audacious proposals of the DPRK for a "global solution" that would solve problems related to the nuclear issue, bilateral relations, peace and security on the Korean Peninsula, the USA remained speechless … as they themselves had nothing else to propose but for the DPRK to submit to their demands and let itself be strangled!

This insane policy of the US can only lead to a conflict in Korea, which would be a tragedy for all Koreans, from the North and from the South, but also for the American people, without even mentioning the terrible consequences for the international security and peace, exposing the entire mankind to danger.

The Bush administration very well knows that the Korean nation, with its three components, the North, the South and the Diaspora, working now hand-in-hand to ensure the application of the joint North-South Accord of June 15, 2000, will never accept to see its reunification dream shattered to pieces by unacceptable interference of the US in its internal affairs.

The US should be aware of the fact that the policy of "priority to the army", implemented by the DPRK’s leader Kim Jong Il to defend its country’s sovereignty and independence, is approved and supported by a vast majority of Koreans, both from the North and from the South, as it is perceived as a patriotic policy of defence of the nation, obviously threatened by the US with a "pre-emptive war".

They should know that this policy of "self-defence" is favourably considered and supported by the people throughout the world, who firmly condemn US threats of aggression against the DPRK, and support the just cause of the reunification of Korea by the Koreans themselves and without any foreign interference.

On the occasion of the 3rd anniversary of the historic North-South Accord of June 15, 2000, that has paved the way for the independent reunification of Korea, CILRECO would like to call on all progressive and pacifist forces and all the people who value independence and sovereignty to support the application of this Accord of the utmost importance for the Korean nation, international security and peace.

It invites them to express this demand in all forms, addressing themselves to the international community, and, most of all, to US and South Korean authorities.

CILRECO, which firmly denounces American threats of a "pre-emptive war" against the DPRK, calls on all forces that care about justice, independence and peace to mobilise to prevent this new "war of aggression" of the US, whose objective is to impose its domination throughout the world, and to demand that the US accepts to discuss the proposal for the "global solution" on the Korean Peninsula put forward by the DPRK.

The independent reunification of Korea, security and peace on the Korean Peninsula, in Asia and in the world are the issues that concern all of us!