Value and Capitalist Economics in the NHS

The chief executive of the NHS, Sir David Nicholson was questioned last week by MPs about his role in the Mid Staffordshire NHS Foundation Trust scandal. On his way to the top he drifted through many posts including several months in charge of Shropshire and Staffordshire Strategic Health Authority, which was the body responsible for overseeing the troubled Trust.

In the period between 2005 and 2008 patients were regularly neglected, hungry and thirsty, left in soaked and soiled beds and not given medical treatment. It is estimated that in this period between 400 and 1200 unnecessary deaths occurred. Enquiry findings were published in February 2013 and detailed the “unimaginable” distress and suffering of patients.

A Public Enquiry chaired by Robert Francis QC found damning evidence that the focus of the managers was on their business systems and on controlling costs, not on the care of patients.

Nicholson told MPs on the Commons Health Committee that “patients were not the centre of the system”. He made a telling admission that this had been so “across the NHS as a whole.”

Since the release of the Francis Enquiry report, various other hospitals have been highlighted as having death rates above the expected – much larger than average. Of course one can always ask whether the expected levels of mortality are acceptable; recently published international comparisons show that these UK averages are not.

Over 150 years ago, Karl Marx explained that while capitalist economists concentrated on the variation of prices of commodities, they did not explain the average around which these prices clustered. He showed that this average was the value of the commodity, determined by how much labour went into its production.

In terms of the National Health Service, we can see that the unacceptable state of British mortality rates has much to do with the cuts in the number of staff involved in front line healthcare delivery, and the unproductive, wasteful expenditure on privatisation, private finance initiatives, marketing and contracting, legal costs and endless reorganisations.

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