The Public Must Fight to save the NHS

Note: This post was published in the Brighton & Hove Argus on 14th January 2017. Regrettably, references to donations to Andrew Lansley M.P. were edited out.

The Red Cross says the NHS is in the middle of a “humanitarian crisis”. The Opposition and unions agree, blaming Conservative cuts. Health Secretary Jeremy Hunt denies it.

Meanwhile, Dr Rob Galloway of the Royal Sussex County Hospital addressed a blog to “Politicians and the Press” that went viral: “You do realise don’t you that this winter 1000s and 1000s of our patients cannot get beds when they need them after they have been seen in A&E. They are lying in corridors of A&Es, despite the fact that 1000s and 1000s of elective operations are being cancelled to free up beds.”

They do know. In 2015, the Kings Fund reported that over the previous 26 years, hospital beds in England had more than halved. Meanwhile, demographic changes increased demand.

Dr Galloway said the Government has “woefully let the NHS fall apart. Funding has been cut per patient to both GPs, hospitals and crucially social services.” Yet “there is silence from our politicians and the majority of the press.” Faced with “a wall of silence” he asks “Why?” He deserves an answer.

Firstly, members of our political and media elite know that, though they may need NHS emergency care, they are wealthy enough to pay privately for any longer term care. Hence their overriding interest in A&E standards rather than bed-supply and inpatient care.

Secondly, it’s easier for politicians to attack each other than admit that all major political parties have been complicit in the decline of the NHS. Its destruction has gathered pace since George Osborne launched his austerity agenda, but wasn’t caused by it. The grubby truth is that the NHS began to be destroyed by competition, privatisation and greed, decades before the Coalition’s Health and Social Care Act delivered the coup de grace.

The Conservative’s 1990 NHS and Community Care Act triggered the sale of NHS hospitals for disabled and elderly people and those with mental ill-health. Hospitals were turned into luxury housing, while politicians, journalists and even left-leaning professionals celebrated a more ‘humane’ way of dealing with these issues. However, they abjectly failed to fight for adequate NHS-run alternatives. Responsibility for ‘social care’ (basic nursing care) for disabled and sick elderly people was passed to local councils, there to be chronically underfunded. Future generations were left to the mercy of profiteering private services, ever decreasing NHS beds and council cuts. The current crisis in mental health and elderly care services is a direct result.

By 1991, new hospital ‘trusts’ brought competition to the NHS, created an internal ‘market’ and gave tax cuts to private providers of health insurance. Hospital maintenance budget cuts set the scene for Private Finance Initiatives (PFI) – a means by which private firms built and maintained hospitals (often with fewer beds than before) then leased them back to Government. Huge risk-free profits were available to private consortia, with costs and risk born by tax payers.

When New Labour came to power in 1997, it had the mandate and massive majority it needed to end competition and reverse privatisation. It didn’t do so. Labour enthusiastically continued PFI, locking us into 30 year contracts paying huge rates of interest to private consortia. It is estimated that by the time debts are paid off, it will have cost taxpayers an eye-watering 301 billion pounds to pay for benefits worth only 54.7 billion. Hospitals are trapped in costly maintenance and service contracts with often extortionate fees. As a result, many trusts face the prospect of bankruptcy. Well paid administrators manage worsening care, while private companies profit.

Alan Milburn and Patricia Hewitt, two of Tony Blair’s key Health Secretaries, were enthusiastic supporters of private health provision. After leaving Parliament, Milburn became a consultant for Lloyd’s Pharmacy and Bridgepoint Capital, a private equity group which acquired Care UK, a health-care company that has benefited from the privatisation agenda. After Patricia Hewitt stood down in 2007, Alliance Boots, a private NHS contractor, employed her as a Special Adviser. Later, private health provider Bupa hired her as a Director. Cherie Blair, Tony Blair’s wife, is founder and ‘Key Executive’ for the Allele Fund, a private equity firm with an interest in “investments in healthcare, hospitals and healthcare centers”.

All this was within the rules – as it was for Andrew Lansley, then Conservative Shadow Health Secretary to accept, while in Opposition, a 21,000 pound donation from John Nash, then Chair of Care UK.

Ordinary people love the NHS, but have been duped into thinking it still exists – when as Professor Allyson Pollock, campaigner and public health researcher, says, it has really “become just a logo, a funding stream”.

Dr Galloway is right to ask the public to campaign for the NHS. Unlike so many of our leaders, we have a real interest in defending it.

Sexism & Ageism have no Place in the NHS

A Harvard University study has recently revealed that hospital patients are less likely to die if they have a female doctor than if they have a male one. UK doctors have broadly welcomed the findings and suggest they provide a powerful argument to end the UK pay gap between male and female doctors.

The most common explanation why patients of female doctors survive (echoed in the Harvard study) is that they listen more. This is probably true – not because females are born good listeners but because our society still educates men to act and speak and women to observe and listen. These are excellent skills in a doctor, but I suspect undervalued in medical schools.

A more sinister explanation for the difference is sexism and ageism, pernicious attitudes rarely challenged in medical schools or identified by recruitment boards. There are frequent reports of women with cancer or heart disease being diagnosed late because doctors ignored their reported symptoms. Many who receive the poorest treatment are old and female, often widowed. Too often they are treated with casual indifference. I recall that when I took my father to A&E he was frequently referred to as “Sir”. My mother was never called “Ma’am”. I could rely on doctors to fight for my father’s life. I had to argue with them to keep my mother alive.

The brutal truth is that if a doctor values the lives of men over those of older women – he will not fight as hard to keep his female patients alive. Such attitudes need to be challenged at every level of the NHS.