As I wrote at the beginning of this week’s series on the NHS, my first political experience happened when I was two or three, when Mum took me to a rally to defend the hospital where I was born. Since 1992, that maternity ward, along with other services like pediatric services and critical care, has been under threat.
Half the times we had a babysitter when I was young, it was because Mum was attending meetings of the Banbury Health Emergency campaign. I have very clear memories of being desperate for her to come home—impossibly late to me, like ten o’clock in the evening—and being so excited when she did. She always sat down in the kitchen and ate ham and tomato on a Ryvita, and I would join in. I wonder now if that was her entire dinner.
To conclude our week of interviews with experts on what the NHS, and its slow dismantling by governments of both parties, can teach single payer advocates in the U.S., we have a very special interview: my mum, Sue Edgar. She was Secretary from 1992 to 1993 and Press Officer between 1993 and 1998 at Banbury Health Emergency, and spent much of my childhood campaigning to keep all services at our local hospital open.
Libby Watson: So. How did this all start?
Mum: In 1992 the Tory government started requiring ‘efficiency payments’ and additional ‘value for money payments’ from Health Authorities (HAs). At that time HAs held the budgets of all local hospitals. As a result (they claimed) the HA had an independent review of services done.
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Libby: What were “efficiency payments”? They sound bad.
Mum: Right, so efficiency payments were required of every HA as a percentage cut in the overall annual budget. The government could say ‘we want 2 percent,’ and that’s what the HA had to give them.
Many of us now believe, as we did then, that the government MEANT to introduce a fall in standards. We called it ‘softening it up for privatisation.’ The NHS is a sacred cow: No government can be seen to attack it, because for obvious reasons the British people love, value and rely on the NHS.
So these subterfuges, like softening up, underfunding, ‘value for money payments,’ reviews of services, quality control measure and so on have to be gone through in order to fool some of the people enough of the time to get the job done, the job being sell-off. It started in 92, here and probably everywhere else, and it’s still going on.
Libby: Got it. So what was your role in the response to that decision?
Mum: We started with a public meeting. When the HA announced its intention to review and possibly cut services, a few Labour activists rang each other up and formed a committee. It’s what we do best. Other political groups joined us, so we became ‘cross-party’—an important factor in keeping support in a high-Tory locality. Local journalists got interested and helped us publicise a huge public march—5,000+ people in a city of 40,000.
Mum: We made national news and a lot of local coverage. This frightened the politicians—local and national.
Libby: I BET
Mum: And I think this is important. You can win the argument as much as you like, and we did that many times—because the bad guys’ argument was “you’re shit,” and a nine-year old could see through it. But you can still lose the battle. You have to have something else and we found that the something else was publicity.
I remember having contempt poured down on me by some committee-sitting high-up who said. ‘You haven’t even got a structure! You’re just a street organiser! Where is your mandate?” and I said ‘Oh, I haven’t got a mandate. I’ve got leaflets and fifteen journalists waiting to hear how this meeting went.”
Libby: HELL YEAH MUM
YOU CLOBBERED HIM MUM
Mum: But it’s true. They are TERRIFIED of publicity. And marches. Big demos, cross publics, angry mobs.
Libby: That seems to be the key —the knowledge that they must be seen to be defending the NHS, even if they’re actually dismantling it. They have to pretend it’s intended to make the NHS or the hospital stronger.
Mum: Yes EXACTLY. And if your call their bluff and they can’t avoid people SEEING them having it called, they melt.I think things are tougher now, though. They are more barefaced.
Libby: Right. Before we get onto the Tories nowadays, though: In 1997 Labour won the General Election, though Banbury was still Tory. I remember how happy you were; we got presents! A Hercules PE kit bag! But what happened to the Horton under Labour? Were they better, worse, or just different?
Mum: At first they were better. So much better. They killed me by saying that they were going to abide by Tory spending plans, but they kind of didn’t. They snuck money into the NHS, and as soon as they’d got some momentum they openly funneled billions in. Then they stopped.
Libby: So they had sort of the opposite track from the Tories at first—they had to pretend they were more budget-conscious than they really were?
Mum: Yes, they constantly had to pretend to be Torier Than Thou. And we had to privatise everything. All public services were to be opened up for ‘external investment.’
Libby: That seems to be the big change—where the Tories were just cutting funding, Labour was selling it off. Did that start under the Tories at all?
Mum: The Tories introduced PFI—the Private Finance Initiative—on a small scale, but it was in the Blair years that it really took hold and escalated. So even while the NHS was being adequately funded, under Labour, it was being attacked administratively so that bits of it could be sold to private companies. At first it was just small things—cleaners, porters, hospital food—then bigger things like commissioning, administration, peripheral services like phlebotomy. By now it’s entire services, like Virgin running paediatrics in Devon.
Libby: On the Horton specifically, what did Labour do? And when did the idea of downsizing the maternity ward come in?
Mum: The threat to core services never went away. After the ‘92 battle, Paediatrics was threatened the following year, and the three core services of Paediatrics, A&E (Accident and Emergency) and Maternity were threatened. Each time, we won. Then a few years later, under Labour, another Review. Then another—again pinpointing the three core services. Each time, we won and some mandarin somewhere decreed that the services should be kept here in perpetuity. Each time, there was a different reason for them coming back to have another pop. The current unpleasantness is just more of the same, but this time done by the Tories again.
I have had to conclude that all governments are the same.
Libby: Right. It implies there’s something bigger than party or even ideology at play here.
(In 1998, the Horton was put under the control of the Oxford hospital trust by the Labour government.)
Mum: Yes. I think—well obviously—it’s NEOLIBERALISM BABY
Libby: HONK HONK.
So, then the final chapter, the Tories since 2010. What have they done in Banbury and more broadly? And they’re kind of succeeding now, right?
Mum: The Austerity label really gave them permission to do whatever they liked. Their thinking obviously was that they only had to say the magic words—LABOUR DUNNIT and THEY CRASHED THE ECONOMY—and everyone would immediately understand that the broken public services and abject poverty they were consigning us to were Labour’s fault and not theirs.
But I think they have done what Tories always do in the end. They’ve underestimated the electorate. They love to snigger about how it’s impossible to do this, but they do it every time. People have noticed what they’ve done and how they lied.
In Banbury, they left it alone for a few years, apart from some VERY silent adjustments, then the Commissioning Group (Health Authority in old speak, but these are now all business people, not public servants) in cahoots with the management of the Oxford hospital are demanding that the three core services be removed to Oxford.
It’s been a perfect illustration of how it was really just a difference in style between Blair’s Labour and the Tories, not of substance. The economic template was always the same—sell bits off, underfund, watch it wither. Then announce the private sector as the great saviour who would keep it going. Then watch said private sector asset-strip it, belch and move on.
Libby: So why do you think the Tories have been successful this time around in getting the core services moved, for example, when the government wasn’t in the past?
Mum: Interesting question. I really do think it’s partly the mood of austerity, or the confidence it gives to people wanting to cut things. There’s a huge excuse, if you just mutter something about austerity. Also I think that news, information, opinion, content etc, are so devalued that it’s hard to make yourself heard in any important way. I think democracy itself has big problems—everything now is just another petition on FB, and it’s all just someone virtue-signaling or, yeah, maybe, worth clicking on—and half an hour later it’s gone, displaced by another thing of reduced interest.
However, persistent people are trying every legal trick and patiently conducting a continuing campaign... maybe it’ll pay off. Because with every day more people have more hope and are more pissed off with the crap and grubbiness. Have we reached peak grubbiness? I hope so. The decision to move maternity and the other core services is going to legal review, which means a judge has to say whether it is legal.
Libby: Last question: You’ve lived, briefly, under the US system as well as the British system. Which is better?
Mum: WITHOUT DOUBT the NHS system. I can’t begin to imagine coping in the US now. Especially as Trump keeps only-just failing to introduce truly hellish changes. I can’t imagine being in a place where people routinely go bankrupt because they are ill. I can’t marry that up with the nice, kind, funny, subtle, generous people I’ve met and loved. How is it tolerated? I just don’t understand. People living in terror of illness—not because of the pain or the humiliation or the fear itself, but because of the FINANCE?
And then there’s the practicality. The U.S. per-capita cost of healthcare is many orders of magnitude more than the U.K.’s, and its health outcomes are massively worse. Wtf? Why do that?
Libby: So you don’t think Americans need to fear queues and waiting lists?
Mum: Fuck no. They need to LOOK FORWARD TO QUEUING.... No. They just need to elect a government that will undertake to adequately fund a health system. That isn’t scary, and it’s perfectly possible. It’s actually easier than a complex system where lots of wolves are fighting over the piece of profitable meat. And as you’ve found, even with the NHS in its currently reduced state, you wait longer in America, for often worse treatment.