Blair squeaks hospitals vote

Submitted by Anon on 26 November, 2003 - 12:00

The government won the vote on foundation hospitals in the House of Commons on 19 November by 302 votes to 285, a majority of only 17 votes. There were 62 Labour rebels.

"Choice" is one of the watchwords of the Blair government. In politics, "choice" is one of the key defining words between left and right. Ministers endlessly harping on about "choice", in the NHS and elsewhere, define the Blair government as a government of the right, not the left.
Nothing, except perhaps their keeping the anti-union laws inherited from the Tories, does it better.

Of course, everyone is in favour of "choice". The decisive questions are: whose choice? By what means is "choice" to be exercised? What, in the real world, will limit effective choice?

The rich and the well-off always have freedom of choice. The poor and the less well-off most of the time have little and often no choice. They must make do with the best they can afford, or what they have given to them.

There is no such thing as infinite choice. There is only effective choice.

For people who believe in equality and democracy the rhetoric about choice is offensive: what idiot would not choose the best? Behind the rhetoric about choice is the idea that people have different needs or at least tastes. What might suit a middle-class couple in Clerkenwell is different from what might suit a working-class single mother in Clapton.

"Reforms" such as foundation hospitals will decrease the choice open to the poor and less well-off and deprive them of the best healthcare. "Choice" here means "and the Devil take the hindmost".

"Choice" puts on the user of services the onus to seek out the best: a sort of information age social Darwinianism where those who thrive will be those who are freest to spend hours roaming the Internet finding out which hospital is best at treating a particular disease that afflicts a member of their family.

Why can't we all just be provided with the best?

Blairites - such as for example the Health Secretary, ex-Stalinist John Reid - talk about "increasing choice" but it is choice for the better-off they are increasing. In the case of the NHS, people with access to better information, people freer to travel, people more able to choose which hospital they use. Increasingly, those who have the money to choose to go private.

Under the plans, foundation hospitals will have more freedom than other NHS hospitals. They will be able to borrow cash privately and to keep money from the sale of land. They will probably be free to set their own pay and conditions for staff, undermining further national pay bargaining and conditions for NHS staff.

Foundation hospitals, although they are not-for-profit, will be more like businesses. What is to stop them neglecting less lucrative areas of work? What is to stop them becoming private in the future?

Ultimately, the government says, all hospitals in England - the plans apply only to England - should be brought up to a level where they can become foundation hospitals. In the meantime, only those trusts that obtain three stars in the government's NHS ratings are eligible.

At least in the short term, the policy will create a two-tiered health service.

Blair's whips have carried the day, helped by some MPs' reluctance to cheer the Tories revelling in their new leader. But the large swell of opposition in the House of Commons is a measure of the stirrings of Old Labour life within the political prison-house which Blair's New Labour is for anyone wanting to serve the interests of the poor and the less well-off. In introducing foundation hospitals, Blair's government serves only the rich and must be opposed!

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