When it comes to policy on the NHS, I am proud to be a member of the Pirate Party; we have been clear about our commitment to the NHS, and clear what we think could be done to make it better.
I should be clear; the party has said that it wants to bring outsourced services back into the NHS:
"We all trust the NHS with our lives. In return for that trust, the NHS should ensure that it is using the funds apportioned to it as effectively as possible, even when an effective service isn't the cheapest option."
"All the skills to deliver healthcare from start to finish, from cleaning to surgery and from transport to transplants, should be available within the NHS."
But it doesn't explicitly state that the service shouldn't be privatised either. After all, our policy was formulated in the period before the Health and Social Care Act 2012 when the issues simply weren't as clear cut as they are now. The relevant statement from our Manifesto reads:
“… There should be no compulsion to outsource services if they can be more effectively or cheaply provided in house. Doctors must not be burdened with administration. They must be allowed to focus on patients. There must be complete transparency about the decision making for our health service; the risk register must be published. If we are going to have a cost effective health service available to all, then it must no longer be a blank cheque for big pharmaceutical companies.”
I know we need to go further than a lack of compulsion to outsource and advocate directly both for a rolling back of the privatisation from the last few years and the repealing of the legislation that enables it. I want to make a very clear commitment to a National Health Service that is in public hands and ensure that we all 'own' something that we all rely on so heavily.
There are arguments made all the time as to why privatisation is beneficial. The more cynical, and those led entirely by a fundamental belief in free market solutions for everything, simply see the potential economic gains as being too great to pass up. After all, in the US, health care spending makes up a significant portion of GDP, one that has been rising providing profit and opportunity for companies and investors. The impact on patients? Well, that's collateral damage - you should be working harder, or better insured.
Slightly less extreme voices including many in the Conservative Party, the Liberal Democrats and latterly UKIP, suggest that we can both have our cake and eat it. We can privatise bits of the NHS, save taxpayers money and invigorate the economy, whilst building a market that improves outcomes and gives patients more choice. In practice that doesn't seem to work unless you also work hard to screw up public provision, but at least it's a little less alarming than the pure economic argument.
I'd disagree with both.
I think that it is absolutely vital that the NHS provides care free, at the point of delivery, on the basis of need.
I'd argue that we haven't spent the money we should have on the NHS. Based on both what other countries spend, and what we as a country demand from our health system, we should spend more. If we do, we will have a service that outstrips all its rivals, more so than it does at present in its weakened, underfunded state.
But why not allow a bit of privatisation, some arbitrary percentage, maybe 4.4% or 2%..?
Once you privatise something, it becomes very hard to renationalise, even without threats like the The Transatlantic Trade and Investment Partnership or rules on state involvement in private industry. Importantly, it also becomes much harder to hold private companies to account, and at the end of the day taxpayers are still holding the bag if anything goes wrong.
When a Health Minister is answering questions about a problem, service delivery or some other failure, I don't want them to be able to point at some unaccountable private company and shrug their shoulders. We have seen what happens when private firms fail to deliver - in fact we see it again and again, because even after a major failure, they are awarded new contracts.
I don't want to hear that the government has been sued and must now pay millions in lost revenue to some multinational that feels a change in policy has harmed its bottom line, or because the government had to wrestle away some profitable arm of its business to ensure that a proper service is delivered.
If I want to scrutinise how the NHS is spending money, where there are problems, where too much, or too little money is being spent, I don't want to be told that I am not entitled to know about it because there are commercial interests involved.
So, I want an NHS that not only provides the best possible care to those who need it, when they need it, at no cost when they do, paid for through taxation. I want an NHS that is fully nationalised, with suppliers, GPs and other ancillary providers (the drug companies and device manufacturers that the NHS sources medicines and equipment from) open to scrutiny.
Of course, any change to the NHS should be carefully considered, as someone said last time we had an election 'No top-down NHS reorganisations'. It isn't simply a case of waving a magic wand, and we shouldn't turn the service upside down to get back to where we should be. We have to engage with and listen to health workers to see how we can get to a fully public NHS with as little disruption to both patients and staff.
I hope to convince this party that I am right, and submit the small change that moves us from wanting an NHS where there is no compulsion to outsource services if they can be more effectively or cheaply provided in house to specifying that services should be delivered in house, from a publicly owned service.
I think that along side our other flagship health policies, like changing the approach to pharmaceutical patents, which should both reduce the costs whilst improving the availability of medicines and dealing with drugs as a health issue, we can can all be clear about where we stand. I'd also ask our General Election candidates to join me in making it clear that they stand behind a National Health Service that is not only available to all of us, but belongs to us all too.