The NHS when profits come first

It begins with the matter of social enterprise and the seemingly endless argument about definition.

Four years ago in 2010, Health Secretary Andrew Lansley declared that social enterprise was initerpreted too narrowly. At the time I asked what others defined as social business. For Muhammad Yunus it's this: 

"A social business is defined as a non-loss, non-dividend company dedicated to meeting social needs; such as ensuring affordable healthcare for all, promoting better nutrition for children, creating employment for the unemployed, moving towards a safer environment, enhancing the process of women empowerment and providing safe drinking water."

"In social business, the investor gets the investment money back over time, but never receives dividend beyond that amount. All profits of the social business go towards improving the product or service provided, and increasing its reach."

In our own 'Marshall Plan' paper from 2006, we'd said:

"Profits can be directly applied to help resolve a broad range of social problems: poverty relief, improving childcare, seeding scientific research for nationwide economic advancement, improving communications infrastructure and accessibility, for examples – the target objectives of this particular project plan. The same financial discipline required of any conventional for-profit business can be applied to projects with the primary aim of improving socioeconomic conditions. Profitability provides money needed to be self-sustaining for the purpose of achieving social and economic objectives such as benefit of a nation’s poorest, neediest people. In which case, the enterprise is a social enterprise.' "

10 years ago, British government were called on for support: :

"Traditional capitalism is an insufficient economic model allowing monetary outcomes as the bottom line with little regard to social needs. Bottom line must be taken one step further by at least some companies, past profit, to people. How profits are used is equally as important as creation of profits. Where profits can be brought to bear by willing individuals and companies to social benefit, so much the better. Moreover, this activity must be recognized and supported at government policy level as a badly needed, essential, and entirely legitimate enterprise activity.”

Today we may observe the consequences of failing to deliver, creating a void into which corporations do not hesitate to step. 

 

 

"The cheapest but best health care system in the world can only suffer when profits come first", says Will Hutton in his recent Guardian piece about NHS privatisation.

He relates the experience of leukaemia in his family and a growing awareneness of those who collaborate for the greater good.

"The Anthony Nolan Trust has more than half-a-million volunteers who give their bone marrow and blood for free; the bigger the pool, the better the chance of a match, and thus of survival. They are unsung heroes and heroines, the best of humanity.

These donors are animated by the same value system as the NHS. The nurses who inspect stools and the consultants who mastermind the cocktail of drugs are united by the drive to cure, to give health and life. They are givers and sharers. They know humanity demands solidarity, empathy and looking out for each other – or else, who are you?

Of course they are imperfect and sometimes make mistakes. The sums have to add up, as they do in any organisation, but they add up to serve this larger purpose. You give your bone marrow for free to a service that provides health for free, funded by commonly created resources. Life-threatening disease is a lottery. Before this existential truth we stand together. Profit maximisation cannot be the value system at the heart of our healthcare system. "

Last year, I wrote of my own experience of leukaemia and profit maximisation. Lack of access to health care had cost a friend and colleague his life, as he battled with the profit maximisers on behalf of vulnerable children.

The converse of putting profits ahead of people, people ahead of profits is where we'd begun, by arguing the case that business could disregard shareholder primacy and operate entirely for a social purpose.  It was for the Guardian 3 years ago that I wrote about business which puts people first:  It was of no interest to the original recipients, editors David Mills and Jo Confino. 

"The P-CED model was adapted to an existing software development business in the UK and from 2004, began operating in the supply chain of several major corporations, government departments and NHS trusts. This is where we’ve always seen the role of social enterprise in healthcare, in providing a competitive commercial service which creates additional social value."

As a supplier to Manchester Evening News, we were also a "stakeholder" to Guardian Media Group. MEN as a profit maximiser in their own right had simply stopped paying our support invoices, while the Guardian launched a hub promoting social enterprise. As Polly Toynbee, also in the Guardian says of John Lewis - they don't extend their virtuous approach to the supply chain. 

"Why celebrate the store's business model when its famed generosity doesn't extend to its outsourced and low-paid cleaners?"

The trend in social enterprise with regard to healthcare has been a focus on "rolling out" public services and due to the inability to support grassroots organisations with investment has in my view created a void into which the profit maximisers have stepped  I suspect that this was the deliberate act of a neoliberal government which disregarded the potential of efficiencies and social impact in the supply chain.    .

In the Forest of Dean where I live, the rollout of healthcare to social enterprise had floundered due to the dishonesty of those involved, who had obtained council tax funds by being "economical with the trurh" about approval from the PCT.

Then the PCT itself was in the crosshairs, a Community Interest Company' was to be backed by a £10 million bond. This kind of money just isn't available to authentic social enterprises and as already demonstrated in the Forest of Dean, a CiC business model is no assurance of ethical behaviour. In the case of Gloucestershire PCT the CIC model had been used to justify an exemption from EU procurement law. 

Ten years ago, in the interview which marked the introduction of 'people over profit' as a business to the UK our founder said this about profit maximisation:

"Essentially, P-CED challenges conventional capitalism as an insufficient economic paradigm, as evidenced by billions of people in the world living in poverty in capitalist countries and otherwise. Under the conventional scheme, capitalism - enterprise for profit - has certainly transformed much of the world and created a new breed of people in capitalist societies, the middle class. That is a good thing. But, capitalism seems to have developed as far as it can to produce this new class of fairly comfortable people between rich and poor, at least in the West where it has flourished for quite some time.

The problem is that profit and money still tend to accumulate in the hands of comparatively few people. Money, symbolically representing wealth and ownership of material assets, is not an infinite resource. When it accumulates in enormous quantities in the hands of a few people, that means other people are going to be denied. If everyone in the world has enough to live a decent life and not in poverty, then there is no great problem with some people having far more than they need. But, that's not the case, and there are no rules in the previous capitalist system to fix that. Profit and numbers have no conscience, and anything done in their name has been accepted as an unavoidable aspect of capitalism.

I disagree. In 1996, I simply set up a hypothetical 'what if' proposition. What if some businesses decided to change their practices, or institute themselves as new enterprises completely, for the sole purpose of generating profits as usual and then using those profits to help people who have little or nothing?"

In 1996 it began with a treatise which reasoned:

"Manipulation of numbers, represented by currency/money, allows writing “new” money as needed.  There is no tangible asset, or anchor.  There are only numbers, managed by whomever might maneuver into position to do so.  Economics came to be based on numbers, rather than real human beings."

"Economics, and indeed human civilization, can only be measured and calibrated in terms of human beings.  Everything in economics has to be adjusted for people, first, and abandoning the illusory numerical analyses that inevitably put numbers ahead of people, capitalism ahead of democracy, and degradation ahead of compassion.

Each of us who have a choice can choose what we want to do to help or not.  It is free-will, our choice, as human beings."

Virgin is one of the businesses which has inserted itself in our healthcare system and in 2009, their founder Sir Richard Branson was speaking at an event then known as the Ukrainian Lunch, where he called on business to focus more on social problems. We were a business focussed on social problems in Ukraine and I wrote to Virgn Unite who'd been soliciting project ideas  

"This is what we’ve been doing in Ukraine for 7 years to reach the point that our efforts have persuaded government to adopt changes to childcare policy. We’re a small business rendering 100% profit to do something about the plight of orphans and street children in Ukraine."

Both Blair and Branson have connections with oligarch Viktor Pinchuk who hosts the Davos event  Blair was the PM who made social enterprise government policy.  Between them, in spite of the 'Marshall Plan' for Ukraine, they seem clueless about how to address the problem of inequality which provoked an uprising and has since become an international crisis. ,

'This is a long-term permanently sustainable program, the basis for "people-centered" economic development. Core focus is always on people and their needs, with neediest people having first priority – as contrasted with the eternal chase for financial profit and numbers where people, social benefit, and human well-being are often and routinely overlooked or ignored altogether. This is in keeping with the fundamental objectives of Marshall Plan: policy aimed at hunger, poverty, desperation and chaos. This is a bottom-up approach, starting with Ukraine's poorest and most desperate citizens, rather than a "top-down" approach that might not ever benefit them. They cannot wait, particularly children. Impedance by anyone or any group of people constitutes precisely what the original Marshall Plan was dedicated to opposing. Those who suffer most, and those in greatest need, must be helped first -- not secondarily, along the way or by the way. '