This week: Stella Creasy MP
Why she matters: The Labour centrist who even (some) influential Corbynistas admire thanks to her innovative thinking. The Walthamstow MP entered the Commons in 2010 and in 2015 came second to Tom Watson in elections for Labour’s deputy leader. She recently played a central role in winning greater abortion rights for women from Northern Ireland.
“It’s not a progressive outcome just to say to my community, ‘when you are very sick with diabetes, there will be somebody there to help you with the amputation.’ I want them to keep their feet.”
Ms Creasy is fiercely determined to use her role as MP to increase the influence of the community on decisions about health and wellbeing and, then use that as a lever for shifting the emphasis towards prevention rather than cure.
She describes the Health Act 2012 as “the villain of the piece” when it comes to preventing effective community engagement. She believes “it stripped out any coherence about accountability” (a subject the Bedpan will explore in more detail soon).
To begin to right that wrong, she has been championing community health projects and harrying the local health organisations to be more inclusive in their decision making.
Her local clinical commissioning group, she says, had got “two thirds of the way down” its plan to reconfigure GP surgeries without consulting the public. Ms Creasy “made them do a big public workshop”, which revealed to the commissioners a range of important factors they had not taken account of.
Public involvement, she says, is “not necessarily a trade-off between empowerment and equality. You get better decisions for the whole community and you hear voices you don’t hear in our current structures”.
In those “current structures”, she claims, those who “shout the loudest” get heard.
To tackle these problems Ms Creasy would like to see a radical increase in citizen or patient “choice”. Not the kind, she stresses, which was championed during the New Labour years – saying offering a decision between which health provider to access is “no [real] choice at all”.
The power and the budget
She is also hesitant about personal health and care budgets – not for the reason often heard on the left that it is another “backdoor to privatisation” but because it does not easily allow community action.
“A [disabled] mum who had a social care budget came to me and said she wanted to buy childcare for her [18-month-old twins]. She had a mate who had also got a personal care budget and they [wanted to pool their budgets]. They could have started to do work again. Nobody would allow them to make that choice, and yet anybody looking at that case… could see that was the right welfare choice. When I took it up to the minister, there was no clarity about who was actually making decisions.”
She states there is no way a shift towards prevention can be imposed on a community and that it must be done “with them”
The answer to inequalities and inefficiencies in the system she believes is to give communities the “power” and the “budget” to drive change.
Claiming the NHS has “never explored” the effectiveness of collective action to “actively design services”, she also states there is no way a shift towards prevention can be imposed on a community and that it must be done “with them”.
Challenged that radically increased local involvement would simply be met with apathy or demands for a GP surgery in every street, she responds that people want public services to work “in a different way” and if the NHS actively asked them to make balanced decisions designed to “to help each other” rather than simply to meet their own needs it might be pleasantly surprised.
Her own contribution to this push is to refuse to hold any meetings with the NHS without some of those directly affected being present. She freely admits this has cut her out of some potentially useful background briefings and that the organisations involved have found it “challenging”.
“I have a particular perspective, she says, which is that it’s not for senior managers in the NHS to tell me what is going on [so I can] tell everybody else. My job is to create a platform on which a constructive conversation can happen about the kind of healthcare we need.”
”I’ve only ever built processes to hear what people say and to try and show what different could look like – because it’s very difficult now for people to imagine different could be good”
She continues: “People are sick of politicians telling them they’ve got to… well, they’re just sick of politicians generally. I get that and I think there is something quite important about not [pretending to] have all the answers.
“I’ve always said I’ve never had a good idea in my life. I’ve only ever built processes to hear what people say and to try and show what different could look like – because it’s very difficult now for people to imagine different could be good.”
At the same time, she has described herself tongue-in-cheek as her constituents’ “worst nightmare” in being “equally challenging to some of the groups within the community who think all they’ve got to do is complain”.
While acknowledging that if you “create a structure that only allows people in through complaints, then complaints is all you get”, she insists those with a beef about public services become part of the solution. She adds that in her experience “when you ask people to be involved, they do it”.
The ’crazy’ world of PFI
On the national stage, the Walthamstow MP has been an active campaigner against PFI.
Explaining her motivation, she says: “Whipps Cross needs the money back.” However, her transformation into a self-acknowledged PFI “nerd” has left her puzzling at the “crazy” decisions made by previous governments and determined to help develop a nationwide fix.
She says her objections are not about the use of private money per se, but instead, “about the rate of interest [charged]. Barts was a £1bn project. They’ll pay back £7bn. That is not good value for money”.
One of her first revelations was how PFI had been set up in a way that meant only “eight or nine companies” constitute the lending market. This decision not to “shop around”, she concludes produced a “lack of competition” which effectively means the public sector does not “know what a reasonable rate is to borrow [at]” or whether “the price we’re being asked to pay for these services truly reflects the cost or even a reasonable rate of return for these companies”.
The official Labour position on PFIs is to “buy back” the contracts. The Walthamstow MP welcomes the party leadership’s interest in the area but says: “I feel very strongly these companies have had quite enough public money.” Her proposal is to levy a windfall tax on the PFI companies – both as a way of generating funds and/or as a powerful lever in getting greater value for money from existing deals.
Second in the queue
In the meantime, Ms Creasy has been active in trying to persuade the Treasury to get better value for money from the many “poorly written” PFI contracts. She points to the way that after the collapse of Carillion, the NHS found itself second in the debtor queue after the banks as an example of where the promise of transfer of risk within PFI was illusory.
The government has made intermittent noises about taking a tighter grip on existing PFI contracts. Ms Creasy wonders if a Brexit-distracted Treasury has the right “mindset” to take a more robust line but is in no doubt that it should.
“I would not want Barts to negotiate with Innisfree [its PFI contractor] on its own”, she says. “They have a lot of very expensive lawyers,” and as a result any savings secured would be cancelled out by fees for advisers. The Treasury can negotiate across all of a company’s projects, reducing that problem, she claims.
The current chancellor has of course already declared the death of PFI, and Ms Creasy says contractors and lenders “know that change is coming, especially if we get a Labour government”.
She adds, however, that those who believe PFI is already over, “haven’t understood what the government means by public private partnerships. Nothing [I’ve seen shows] the government has learnt any of the most basic lessons about how to get a good credit deal.”
Next week: Medicinal cannabis campaigner and CCG sceptic Sir Mike Penning MP
Coming up: Commissioner turned MP, Paul Williams
If there is any political figure you would like me to interview, please email email@example.com or if you are reading this on the website leave them in the comments box.