Hospitals are complicated. I'm no expert, but I've been to hospitals. They were full of machines, chemicals and highly trained people. All doing medicine and operations and caring and being clean. All at the same time.
So who would wake up one morning and think "we can make this better by putting Tarmac in charge?"
If I want a road covered in tarmac, I might call, er, Tarmac. Or a bridge built. Or a big hole dug. But for running a hospital? Bottom of the list.
Yet that is what has happened. Thanks to privatisation, Tarmac runs our hospitals. And it makes exactly the hash of it you might imagine.
This isn't widely known, because Tarmac has used a very subtle trick - changing its name. It is now called Carillion, a word with no meaning.
Not only did Tarmac change its name to Carillion. It also stopped being a "construction" firm, moving into "support services" - that is, instead of just building things, it leeches money out of the NHS and other state services. It runs them badly, but expensively.
Thanks to the Private Finance Initiative (PFI), Tarmac got the £132 million contract to rebuild and run hospitals in Swindon. Labour's John Prescott gave it the massive deal in 1999.
It managed to provide fewer beds than existed in the crumbling Princess Margaret and other hospitals being replaced. They could have been refurbished for less money, but Tarmac needed a big juicy deal.
Right now we are hearing a lot about the unreasonable "demands" sick people make on the NHS - according to all kinds of "experts" all those old folk and obese people put too much "pressure" on the NHS, so there must be cuts or an end to free services.
But the demands of big corporations on the NHS are ignored. Since PFI came in the NHS has been made to look after the financial health of big corporations as well as patients.
Tarmac seems much keener on the new financial engineering than old fashioned building engineering. When its Swindon hospital opened in 2002, the GMB union produced a report in which the staff described a catalogue of disasters.
From stuck lifts to crumbling plaster work, mould on the walls, a repairs backlog, badly designed wards and a shortage of beds - it was all there.
Tarmac responded, as noted, by changing its name and changing its contracts.
In October 2006 Carillion "refinanced" the Great Western Hospital PFI - because the hospital was government-guaranteed, it was able to get new, cheaper loans, giving the firm and its partners a £32m windfall profit. This was free money scammed from the taxpayer.
Carillion was doing well, but in May 2006 Swindon Hospital had to cut 200 staff to pay for its ongoing debts, including to the PFI companies.
This was part of a process called "financialisation" happening across the economy, where business became better and better at making money from complicated financial management while being just a bit crapper at managing the actual work.
Tarmac has been involved in some aggressive management in construction. But Carillion's management of cleaners and housekeepers in Swindon matches the worst conditions on building sites.
The Morning Star has reported the shocking treatment of these staff very well. I am pleased to say that both Private Eye and the Guardian have also picked up the story.
But the very best report was written by Louise Raw in this newspaper (Carillion's Victorian values, M Star July 24 2012). As a historian of the matchgirls' strike, she could best comprehend the Victorian conditions.
The 145 workers, mostly women from Goan backgrounds, told her about racial abuse and bullying by their supervisors. Most shockingly, they told her about extortion - as managers demanded "considerations" in the form of money, goods and even gold in exchange for annual leave, overtime or shift changes. These were shockingly explicit demands. One worker was told: "I can sack you - and if you give me gold I will let you keep your job."
The workers have been on strike over a dozen times, demanding that their union GMB be recognised and the corruption investigated. The GMB members have also launched an employment tribunal case against Carillion, arguing that the firm is responsible for their managers demands for cash, gold watches, bangles, cigarettes, alcohol and even a duvet from the low-paid cleaners.
The many problems in Swindon have not put Carillion off NHS contracts - it has decided to go further in medicine.
The company formerly known as Tarmac now does eye operations - as successfully as you might imagine.
Carillion has a subsidiary called Clinicenta that runs a "surgicenta" doing NHS eye ops. The tacky names are matched by tacky performance.
The Care Quality Commission said the standards of care, quality and management at its Stevenage "surgicenta" "require improvement."
Stevenage's Tory MP Stephen McPartland has said Clinicenta should "not be involved" in eye ops. "They have failed and I will not accept or allow them to fail my constituents," he added.
Last year McPartland and his fellow Tory MP Grant Shapps lobbied the health minister on Carillion's performance - if a Tory minister is rebelling against NHS privatisation, things are bad.
Carillion's failures could be very serious. As the Observer has reported, two patients' deaths and the loss of six patients' sight following treatment at the centre are currently under investigation.
Which is all a long way of saying that handing the NHS over to Tarmac sounds mad because it was.
But we need a strategy to get the dodgy builders' hands off our hospitals.
In the short term we can support the Swindon GMB members. In the medium term, we need to get the Tories out.
James Kirkup, deputy political editor at the Telegraph, described Health Secretary Jeremy Hunt's current strategy as "lobbing a few grenades at bits of the NHS" - Hunt knows that the market reforms mean the NHS will run out of control, so thinks that he could win votes attacking it.
I must emphasise that when Kirkup talks about a mad plan for Grenadier Hunt to assault the health service, it isn't a criticism - Hunt's pals think this is clever.
But we also have a more powerful need to get Labour to change course. The Tarmacking over of the NHS was done by the Blair government, not the Tories.
Undoing the damage also means changing Labour.
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