Boobs, and the Health Privatisation That Causes Them

News has been spreading in recent weeks about potential health problems suffered by women who have received Poly Implant Prothèse (PIP) breast implants for health or augmentation purposes. The now defunct-French company is estimated to have produced two million implants over a twenty year period, with the company and its founder, Jean-Claude Mas, now at the heart of a worldwide public-health care scandal.

Governments have been quick to play down a link between leaking implants and cancer, but those with the implants have gone on record about hair loss, nausea and other symptoms. As well as risks associated with rupture and the necessary surgeries, it has emerged that the implants themselves may have been created using impure, industrial grade silicon rather than the higher grade required for medical use.

Plastic surgeon Kevin Hancock, of the Liverpool Women's Hospital, says there were concerns in the profession over a high rupture rate. "We are worried about the rupture risk because it is the rupture that brings the contents into direct contact with the body's tissues."

In the UK, we have seen a suggestion from some quarters that the risk of rupture of PIP implants is as high as 8% when compared to 1% for other implants. The French government has since taken the step of advising women with PIP implants to have them removed, despite the increased risks of further surgery. The British government has yet to take this stance, but the NHS has committed itself to covering the cost of similar operations for British women, even though 95% of patients who received the implants did so through private clinics.

Significantly, the company who supplied these products never sought to get the quality approved by independent health experts, meaning that no-one is too sure whether the products are toxic or not. Women worldwide now face an anxious wait to see if and how their health will be affected.

A statement published by the Department of Health said that it expected private firms to match the NHS offer on removal and replacement of the implants among those women with concerns. "We expect the private sector to do the same for their patients. We believe that private providers have a duty to take steps to provide appropriate after-care to patients they have treated."

Notice that the department's statement does not suggest whether this duty is a legal one (it is) or a moral one (it damn well should be). In this instance, we have seen the private sector making a fast buck at the taxpayer's expense (not to mention potentially endangering patient lives) while the public sector will once again be left to pick up the pieces.

Meanwhile, if anyone is ever looking for an example of where the use of private firms to deliver healthcare has resulted in boobs, they now have a ready made example.

Nationalisation May Be Cheaper Than It Seems

Sometimes, when you live in a western country with a privatise-at-all-costs philosophy, it's easy to forget that things used to be very different. Utility companies and transport facilities, such as airports and railways, were owned by the state, rather than by unfeeling multinational conglomerates who see it as their capitalist duty to rob you blind while still offering a lousy service (the jury is out on whether nationalised services were any better, but at least back then there was a person on the other end of a telephone complaints line who had no choice but to listen to you moan.)

Modern political thinking suggests that private hands are the most efficient way to run services, when my own experience of private firms running local government services is that they are no more efficient and are often more costly and more prone to failure.

So should nationalisation of assets become part of the national debate once again? Goodness, even to use the n-word is to hark back to the 1970s and the times when it seemed the sun never shined (though of course, black and white TV is at least partly to blame for that perception.)

Seriously though. Should it? Only if the International Chamber of Commerce (ICC) have anything to say about it, it could be cheaper than it seems to do so.

In Venezuela, the ruling party has instigated a sweeping pattern of political reforms and nationalised massive swathes of the country's vast oil industry. Of course, such nationalisations do not come without a price, but the compensation awarded to international oil firm Exxon is a mere $908 million - to give that figure a context, it is less than 10% of the figure that Exxon asked for, and less than 0.1% of the amount that the British government paid to bail out banks four years ago. So in light of this ICC decision, what is to stop us from looking at our own infrastructure and nationalising some of it on the cheap?

Now, before I am viciously assaulted by swathes of Tory trolls for daring to question their ideology, I am aware that such moves in Britain would not be as clear cut as this example. I am also aware that not every dispute would necessarily be due for referral to the ICC. But where there is a will, there is a way. If you play the stock markets wisely, you buy when assets are cheap and sell when the price goes up. Why not nationalise when the effective value of the compensation you would have to pay is low, and then sell again when it is high? Or have I just out-capitalised the capitalists?

Would such nationalisations reduce the amount of private investment in Britain at the time that I have been calling for it most? Well, theoretically that could be a possible outcome. But there is plenty of observational evidence suggesting that modern companies are greedy, dumb, and will descend on any untapped market as soon as an opportunity presents itself. We can therefore reasonably assume that as soon as the economy starts to pick up (which according to George Osborne could now be as late as 2016/17) someone will be there, ready to pay good money for access to British markets.

The prevailing political agenda is to reduce the size of government but the nationalising of infrastructure assets will clearly do the opposite of this. The wisdom of this move clearly depends on how much you believe in the Tory philosophy that states that private companies will move in to offer jobs and create growth when the public sector is deliberately shrunk - but in this respect, David Cameron has talked himself somewhat into a corner. He needs the British electorate to feel fear or otherwise they will not understand the need for austerity. But until there is enough confidence to overcome that fear, neither businesses or individuals will start spending again.

Addendum: A little background on Hugo Chavez

Left-wing Venezuelan leader Hugo Chavez is a staunch opponent of capitalism and neoliberalism (which essentially means a relaxed economic state in which financial institutions are self-regulating - and look at how well that's worked recently.) He has been leader of the country since 1999 and has instigated political reforms that mean that in theory, he could remain leader, subject to periodic democratic vote, for the remainder of his life.

Chavez is a controversial figure even by the standards of the socialist haven that contemporary South America has become. He is intensely popular with his own people and admired in parts of the world for consistently opposing US foreign policy, but in March 2011 the international organisation Human Rights Watch criticised his administration, saying that it had 'effectively neutralised the independence of Venezuela's judiciary' and 'systematically undermined freedom of expression and the ability of human rights groups to promote basic rights.'

Chavez endeared himself to English audiences by demanding in 2010 that England hand the Falkland Islands back to Argentina. John Otis in 'The World' also accused Chavez of supporting Muammar Gadaffi and Bashar al-Assad following the Arab Spring - though we should perhaps be careful to temper our criticism of him for supporting these regimes, given our history of selling them weapons.

Who Cares?

While the shock of seeing the assaults and abuse inflicted on those with learning disabilities at Winterbourne View in Bristol will still be fresh in the minds of those who have seen this week's episode of Panorama on the BBC, news is also emerging that one of the UK's largest healthcare providers, Southern Cross Healthcare, has imposed a unilateral reduction of one-third upon the rent that it is willing to pay landlords.


It has been something of an open secret within the industry for some time that Southern Cross has been suffering financial difficulties. Purchased for a sum in excess of £150m in 2004, Southern Cross quadrupled in value in two years under the stewardship of the Blackstone private equity group.

However, accusations have since been levelled at the private equity group that they asset-stripped the firm prior to selling it in 2006. Central to this accusation was the conversion of equity-to-debt in 2005 at a time when it was extremely cheap to borrow. Most of the company's premises were subsequently sold and leased back at what have since proven to be uneconomical rates. Worse still for the company, rates of occupancy have fallen and local authorities have frozen the amounts that they are willing to pay to providers.

At Southern Cross, income is falling as costs rise, and this may be the perfect storm that sinks the company and makes 31,000 people homeless while the former owners sail into the sunset with billions of pounds in profit - proof, if it were needed, that this government's aim to privatise as many of its functions as possible does not necessarily guarantee the best outcomes for users of those services.

Providing social care for the next generation in Britain will be the single largest challenge that local authorities face in the future and is likely to be a major issue in deciding the outcome of the next general election. Here in Norfolk, the single largest outlay that Norfolk County Council makes is on social care provision. There is also a major shift towards personalisation in care, meaning that more individuals will be taking on the responsibility of becoming employers, with all the legal complications (sick pay, pension and holiday provision, etc.) that come with that role. Thankfully in cases where service users are vulnerable, at this time the council still takes responsibility for directly commissioning services.

With Southern Cross frantically trying to keep the wolves from the door, instances such as the Connaught collapse in Norwich and an intensifying drive for transparency in government spending, the pressure upon authorities to make the right choices when commissioning services has never been greater. Regardless of central government's obsessive desire for councils to become commissioners rather than providers of care, it is that very same duty of care that means that councils may have no choice about doing the jobs themselves if responsible private providers cannot be identified.

Increasingly, I feel that there should be a legal obligation for local authorities (or indeed any government bodies) to assess the financial strength of care home operators and other providers of essential services before placing valuable contracts with them. There should also be a independent body working alongside councils with a set responsibility for vetting care homes and performing random checks on standards to ensure that scenes such as those seen at Winterbourne View are never repeated.