NHS2

11^th February 2016

The NHS began with a bitter doctor’s dispute. Nye Bevan, the towering socialist Welsh force of nature, and Minister of Health whose single – some would say bloody – mindedness in pushing through the root law that set up the world’s first fully funded public healthcare system, in 1948, was a hate figure for most doctors. Hello Jeremy Hunt.

Doctors – and then that meant mostly GPs – were afraid they would lose their independence in the NHS, as most were ‘sole traders’, acting on their own, but with the Hippocratic Oath to guide them in their interactions with patients. Medicine back then was less heroic, with more simple interventions. With almost no antibiotics, and needing a huge dose of tlc and bedside manners, doctors were revered, even worshipped, when they could be afforded.

The doctors finally gave way to Bevan and signed the contract. The consultants of the time were bought off: ‘I stuffed their mouths with gold,’ he said. The dentists never joined, which is possibly why the British are among those countries at the bottom of the WHO list for healthy teeth.

Fast forward 70 years and we have another bitter dispute between a health secretary and doctors, in this case junior hospital doctors. This dispute, in the way of the modern world much more like a standard industrial spat, no longer middle class professionals fighting an ideological socialist government, has rumbled on for years. No one should forget that, for a minute.

Government propaganda has it that they are only trying to introduce a ‘seven day NHS’. The blatant lie this slogan espouses (only GP surgeries shut at the weekend) is built on extremely questionable statistical data about mortality rates among those admitted at the weekend. But junior doctors have felt it unwise to attack on the statistics, thus diverting attention from what they consider the more important issue: overall patient safety.

They view the new contract, which extends the definition of standard hours to reach up to 22.00 on weekdays, and includes Saturdays as a de facto ‘week day’, as increasing their weekly hours, and thus the chance they will still be on duty when tired and exhausted. Junior doctors point out that they rarely begin a shift on time, usually arriving for a hand-over early; and almost never finish on time, having to do their own hand-over to the next doctor. Their book hours do not reflect the truth in any accountable way.

Junior doctor is a misnomer. It can be applied to a medic who has chosen to stay at this level, possibly for family reasons, but who may well have a dozen years experience behind him – or her. Women junior doctors, with family commitments, will be badly affected by the current form of the new contract, if it is imposed, as Jeremy Hunt has threatened.

Behind the rhetoric on both sides, many in and out of the service cannot but help wonder if this dispute is the equivalent of the miner’s strike. Has this been engineered by the Health Department, designed to bring the health service – and its most significant set of staff (junior doctors are the absolute backbone of the tertiary NHS) – into line.

Into line for what, one might well ask? Creeping privatisation has been the unhealed sore at the heart of everything going on in the NHS for years. Allied with the shibboleth of an ‘internal market’ is the new GP contract, in which they have been bought off with money. In turn they lose weekend and evening working, but agreeing in turn to set up clinical commissioning groups (more of the market). These moves arguably are bringing the service to its knees. After 70 years, into its dotage, the NHS could currently be a candidate for a geriatric ward: creaking, atrophied and costing the earth (like older patients, on whom 80 per cent of all money spent on them as patients will come in the last 18 months of life).

For once, let’s not focus on the ever increasing demands by the public for NHS services, or the huge growth in medicine as an industry (offering the consumer more and more exotic – even luxury products), but look instead at its real nemesis: not patients but politicians.

Ever since Nye Bevan, health secretaries – even Prime Ministers – have dabbled in the day to day operations of the NHS, eager to leap on any success stories, or to attempt to deflect criticisms, right down to local levels. Interference from Whitehall, let alone the numerous interventions over its almost daily need for more cash, and the endless re-organisations, has kept the NHS in a permanent state of crisis –  in this case by no means an over used word.

The service was set up in a very different world, where public health issues, diseases of poverty and ignorance abounded. Old people died young, so to speak. Heroic surgery to replace hips, hearts, and the rest, was unimaginable. Top down organisation was deemed the best for all.

What the NHS needs today, above all, is for government to get out of the operating theatre, the clinic, the consulting room and the surgery. As with the Office for Budget Responsibility, we need a similar unit set up to provide independent analysis of the UK’s public health service. Alongside it, NHS England and the other equivalent national bodies, should have complete autonomy – in practice, not just in name – to run the service within an agreed budget. Every door in the NHS should have a sign saying ‘government: keep out’.

The NHS should be taken back into full public ownership, in law. At the same time, money has to go into schools, to educate pupils from the very start, about their own health, and how best to maintain it. Adults – the parents of those same children – have to face up to paying something more to their own healthcare. It could be done on a sliding scale, extra insurance contributions, ring-fenced just for health, a similar system to the French or the German.

As well, we should all be prepared to pay a flat fee to access primary services. This is where most of the log-jams of demand fetch up. Each time we paid that £10, or something similar, we would be minded, in timely fashion, what we were about to receive: and be all the more thankful and grateful for that. Amen.