Frequently reported differences in health outcomes are generally ascribed to factors beyond the control of the health service, such as unhealthy lifestyles or poor living conditions. However, research has disclosed that there is a difference in the level of service received by poorer communities.
Though the NHS’s funding formula is designed to provide more money to the neediest areas, an FT article reported last week that – according to data analysed by the Nuffield Trust for the Financial Times – some poorer communities being “left behind” when accessing GP services.
Sarah Neville, Global Pharmaceuticals Editor, summarising the data, reports that rich and poor people in England receive different standards of care from the UK’s universal free health service.
Despite the higher burden of ill health in lower socio-economic groups, there are markedly fewer GPs per head in poorer areas of England than in richer areas
There was an average of 1,869 patients on GP lists for each doctor in the most affluent clinical commissioning groups, compared with 2,125 in the most deprived, according to Nuffield researchers. One in seven people in the poorest areas was unable to get a GP appointment, compared with one in 10 in the richest areas.
As GPs act as the crucial “gatekeeper” to other health services, a delay in seeing a doctor can lead to delays in securing other appropriate treatment. Emergency admissions were nearly 30% higher in the most deprived fifth of CCGs, compared with the least deprived fifth, which could point to delays in securing — or seeking — the right treatment. (See references to Sandwell here)
Nigel Edwards, chief executive of the Nuffield Trust, said that the new analysis showed there were “concerning discrepancies between the standards of care rich and poor receive from some NHS services”.
NHS England, “more medical treatment isn’t by itself the only answer”:
“ (T)he NHS long-term plan will be setting out new action to tackle inequalities including in access to primary care. But with the root cause of ill health lying in factors such as diet, smoking and exercise, income security, housing, air pollution and social connection, more medical treatment isn’t by itself the only answer.”
Ms Neville concludes that the findings raise questions about how well the 70-year-old National Health Service is meeting its founding principles of equity. They increase pressure on the NHS to outline plans to reduce health inequalities when it publishes its long-awaited spending plan next month.
George Monbiot recently pointed out that the Commons report on the Carillion fiasco is one of the most damning assessments of corporate behaviour parliament has ever published. It trounces the company’s executives and board and laments the weakness of the regulators.
But, as Prem Sikka said in his April article, it scarcely touches the structural causes that make gluttony a perennial feature of corporate life.
Both agree that the problem begins with an issue the report does not once mention: the extreme nature of limited liability. Sikka points out that this system, under which executives are only financially accountable for the value of their investment, has also benefited frauds and led to the self-enrichment of executives at the expense of workers, consumers, creditors, pensioners and citizens.
Monbiot adds that the current model of limited liability allowed the directors and executives of Carillion to rack up a pension deficit of £2.6 billion, leaving the 27,000 members of its schemes to be rescued by the state fund (which is financed by a levy on your pension – if you have one). The owners of the company were permitted to walk away from the £2 billion owed to its suppliers and subcontractors. (Left: the former Carillion chief executive Keith Cochrane in Westminster after appearing before the Commons work and pensions select committee)
Monbiot continues: “There is no way that fossil fuel companies could pay for the climate breakdown they cause. There is no way that car companies could meet the health costs of air pollution. Their business models rely on dumping their costs on other people. Were they not protected by the extreme form of limited liability that prevails today, they would be obliged to switch to clean technologies”.
So what is to be done?
Prem Sikka (right) proposes that the bearers of unlimited risks and liabilities should be given rights to control the day-to-day governance and direction of companies.
He advocates including employees and citizen/consumers on company boards – because both ultimately have to bear the financial, health, social and psychological costs associated with environmental damage, pollution, poor products, industrial accidents, loss of jobs, pensions and savings. Through seats on company boards, they could secure a fairer distribution of income, challenge discrimination, curb asset-stripping and influence investment, training and innovation.
Across the 28 European Union countries (plus Norway), most have a statutory requirement for employee representation on company boards – unlike the UK, Belgium, Bulgaria, Cyprus, Estonia, Italy, Latvia, Malta and Romania.
George Monbiot proposes a radical reassessment of limited liability.
He points out that a recent paper by the US law professor Michael Simkovic proposes that companies should pay a fee for this indemnity, calibrated to the level of risk they impose on society. He adds, significantly, that as numerous leaks show, companies tend to be far more aware of the risks they inflict than either governments or the rest of society. Various estimates put the cost that businesses dump on society at somewhere between 4% and 20% of GDP
His own ‘tentative’ and ingenious proposal is that any manager earning more than a certain amount – say £200,000 – would have half their total remuneration placed in an escrow account, which is controlled not by the company but by an external agency. The deferred half of their income would not become payable until the agency judged that the company had met the targets it set on pension provision, workers’ pay, the treatment of suppliers and contractors and wider social and environmental performance. This judgement should draw on mandatory social and environmental reporting, assessed by independent auditors.
If they miss their targets, the executives would lose part or all of the deferred sum. In other words, they would pay for any disasters they impose on others. To ensure it isn’t captured by corporate interests, the agency would be funded by the income it confiscates.
Monbiot then says “I know that, at best, they address only part of the problem” and asks, “Are these the right solutions?
- support them,
- oppose them
- or suggest better ideas.
He ends: “Should corporations in their current form exist at all? Is capitalism compatible with life on earth?”
The corporate world continues its vitriolic but insubstantial attacks on the Labour Party leader whose approach threatens their unreasonably affluent lifestyles. Will increasingly media-sceptical people who seek the common good be affected by them?
In brief, the reference is to arms traders, big pharma, construction giants, energy companies owned by foreign governments, food speculators, the private ill-health industry and a range of polluting interests. Examples of the damaging political-corporate nexus are given here – a few of many recorded on our database:
Arms trade: Steve Beauchampé – “A peacenik may lay down with some unsavoury characters. Better that than selling them weapons”.
The media highlights Corbyn’s handshakes and meetings, but not recent British governments’ collusion in repressive activities, issuing permits to supply weapons to dictators. In the 80s, when lobbying Conservative MP John Taylor about such arms exports, he said to the writer, word for word: “If we don’t do it, someone else will”. Meaning if we don’t help other countries to attack their citizens, others will. How low can we sink!
Reader Theresa drew our attention to an article highlighting the fact that the Specialised Healthcare Alliance (SHCA), a lobbying company working for some of the world’s biggest drugs and medical equipment firms, had written the draft report for NHS England, a government quango. This was when the latest attempt at mass-medication – this time with statins – was in the news.
Most construction entries related to the PFI debacle, but in 2009 it was reported that more than 100 construction companies – including Balfour Beatty, Kier Group and Carillion – had been involved in a price-fixing conspiracy and had to compensate local authority victims who had been excluded from billions of pounds of public works contracts. The Office of Fair Trading imposed £130m of fines on 103 companies. Price-fixing that had left the public and councils to “pick up the tab”.
In Utility Week News, barrister Roger Barnard, former head of regulatory law at EDF Energy, wondered whether any government is able to safeguard the nation’s energy security interests against the potential for political intervention under a commercial guise, whether by Gazprom, OPEC, or a sovereign wealth fund. He added: “Despite what the regulators say, ownership matters”. The Office of Fair Trading was closed before it could update its little publicised 2010 report which recorded that 40% of infrastructure assets in the energy, water, transport, and communication sectors were already owned by foreign investors.
A Lancashire farmer believes that supermarkets – powerful lobbyists and valued party funders – are driving out production of staple British food supplies and compromising our food security. She sees big business seeking to make a fortune from feeding the wealthy in distant foreign countries where the poor and the environment are both exploited. These ‘greedy giants’ are exploiting the poor across the world and putting at risk the livelihoods of hard working British farmers, their families and their communities. She adds that large businesses are gradually asset-stripping everything of value from our communities to make profits which are then invested abroad in places like China and Thailand.
Government resistance to funding long-term out of work illness/disability benefits followed the publication of a monograph by the authors funded by America’s ‘corporate giant’ Unum Provident Insurance which influenced the policy of successive governments. After various freedom of information requests, the DWP published the mortality figures of the claimants who had died in 11 months in 2011 whilst claiming Employment and Support Allowance, with 10,600 people dying in total and 1300 people dying after being removed from the guaranteed monthly benefit, placed into the work related activity group regardless of diagnosis, forced to prepare for work and then died trying. Following the public outrage once the figures were published, the DWP have consistently refused to publish updated death totals. Information touched on in this 2015 article has been incorporated into a ResearchGate report identifying the influence of Unum Provident over successive UK governments since 1992, the influence of a former government Chief Medical Officer and the use of the Work Capability Assessments conducted by the private sector – described as state crime by proxy, justified as welfare reform.
The powerful transport lobby prevents or delays action to address air pollutants such as ground-level ozone and particulates emitted by cars, lorries and rail engines which contribute directly to global warming, linked to climate change. They emit some common air pollutants that have serious effects on human health and the environment. Children in areas exposed to air pollutants commonly suffer from pneumonia and asthma.
Victimised whistleblowers, media collusion, rewards for failure and the revolving door
- A recent whistleblower report records that Dr Raj Mattu is one of very few to be vindicated and compensated after years of suffering. The government does not implement its own allegedly strengthened whistleblower legislation to protect those who make ‘disclosures in the public interest’.
- This media article relates to the mis-reporting of the Obama-Corbyn meeting: there are 57 others on this site.
- Rewards for failure cover individual cases, most recently Lin Homer, and corporate instances: Serco and G4S were bidding for a MoD £400m 10-year deal, though they had been referred to the Serious Fraud Office for overcharging the government on electronic monitoring contracts. Another contender, Capita, according to a leaked report by research company Gartner was two years behind schedule with its MoD online recruitment computer system – yet the government had contracted to pay the company £1bn over 10 years to hire 9,000 soldiers a year for the army.
- The 74th instance of the revolving door related to Andrew Lansley’s move from his position as government health minister to the private health sector. An investigation by the Mail found that one in three civil servants who took up lucrative private sector jobs was working in the Ministry of Defence: Last year 394 civil servants applied to sell their skills to the highest bidder – and 130 were MoD personnel. Paul Gosling describes how the Big Four accountancy firms have PFI ‘under their thumbs’ and gives a detailed list of those passing from government to the accountancy industry and vice versa.
Steve Beauchampé asks if the barrage of criticism apparently aimed at Jeremy Corbyn is more about undermining the politics he stands for which are probably less far to the left than those of many in the current government are to the right. Most political commentators and opponents aren’t worried that Labour will win a General Election under him, but they are alarmed that the movement his leadership has created might one day lead to an electable left winger.
William Taylor* sends the news that Farmers For Action UK NI supported Protect Our North Coast in protest on Monday 22nd June outside the headquarters of the new Northern Ireland Causeway Coast and Glens Council offices in Coleraine.
Three Board of Directors of Canadian oil and gas drilling company Connaught Ltd, under the local guise of Rathlin Energy Ltd, including a former Northern Ireland Department of Environment Minister Dermot Nesbitt, had been summoned to a Council Workshop, presentation and question session after which Protect Our North Coast and Farmers For Action UK NI backed up by environmental consultants made their case to a sympathetic Council.
William Taylor, FFA UK NI co-ordinator, commented after the meeting that NI agriculture has been through many crises:
- foot and mouth,
- the dioxin crisis
- and recently horsegate.
He stressed that the last thing needed for the country’s clean and green image is the onslaught of oil and gas exploration leading to fracking and the destruction of picturesque environment with a huge amount of industrial traffic feeding, as much as four 150ft high 24/7 rig sites per sq mile around the North Coast, from Ballycastle to Magillian to Limavady to Garvagh to Ballymoney and drilling threats to Fermanagh and Carrickfergus.
Worst of all, according to local residents of current and previous US drilling/fracking sites are the health problems of air pollution by flaring and other airborne toxic chemicals and the effects on foetus, youngsters and grown-ups that follow. The final nail in the coffin for agriculture would be the huge risk of contaminated water tables, virtually ending the use of farm bore holes in the areas and risk to river health and native species.
In short, Northern Ireland does not need a climate-change-promoting dangerous 20-year pillage by foreign corporates who will cause and leave destruction in their wake for the sake of a dinosaur industry, as renewable energy is Northern Ireland and Europe’s future.
So say Lancastrians, facing Cuadrilla’s application to extract shale gas at Little Plumpton and Roseacre Wood on the Fylde Coast.
*William Taylor: Farmers For Action
56 Cashel Road, Macosquin, Coleraine, BT51 4NU
Tel. 028 703 43419 / 07909744624 Email firstname.lastname@example.org