The foundations of populist politics are easy to explain.
First you say that the people are oppressed by an elite.
Then you say that the experts in that elite are not telling the truth.
In place of their expert view you offer an alternative explanation that undermines that expert view.
You wait for anger to rise as people turn against the elite.
You then capture that anger for political gain.
Having done so you offer a solution that concentrates the power - which usually means the economic power - of a few amongst the elite that you have previously been attacking, with suitable kickbacks built in to provide political economic return.
You then declare that the people now have the solution they desire although in practice not only has nothing really changed, but matters might actually be very much worse, and there has most certainly been no gain for ‘the people'.
Sajid Javid's NHS reforms now announced for this model exactly.
Out of the billions of new funding to be raised from a wholly unnecessary increase in national insurance on the low paid a small part will be going to GPS, who provide more than 90% of all NHS appointments.
People are then being told that they have a right, in exchange for their additional national insurance, to see a GP face-to-face.
As a matter of fact GP practices have been unable to meet all demand for GP appointments - which is rising steadily per head of population - on a face-to-face basis for years. So triage systems, usually involving telephone appointments, have been put in place to ensure that the worried well get the reassurance which is all that they really need, albeit over the phone, and the really sick hopefully get to see the doctor whose attention they really need.
Experts have worked out how to match demand and supply, and overall it pretty much works, although it is is incredibly stressful for GPs because it increases the risk that they take because they cannot always eyeball a patient, which is a pretty powerful diagnostic tool in a great many cases.
Javid is now saying GPs have this wrong. He says they are lazy experts rationing care.
He says their claim that they do not need to see all patients face-to-face is false.
His claim is that they do not have the ability to decide who needs to be seen.
His suggestion is that it is not the doctor who should determine who needs a face-to-face appointment, but the patient. His suggestion is that it is the patient who is the expert, so they must reject the arrogant elite who say otherwise.
He is deliberately fuelling anger amongst the patients who cannot get to see a doctor face-to-face by telling them that they have a right that is not actually theirs to enjoy: the GP contract does not say that a patient must be seen at their demand. It provides the GP with discretion, and rightly so. Their ability to direct healthcare to those who really need it is critical to effective healthcare supply when there are limited resources.
Javid's aim is simple. It is to turn people against GPs, and so the NHS. A false service expectation - that anyone must be seen on demand by a GP - is being created to fuel resentment and then anger.
It will then be said that the NHS is failing.
It will then be argued that a private sector alternative would be better.
The NHS GP service will be privatised.
GPs will be stripped of their existing contracts and be offered employment contracts on worse terms.
Some will retire. Others will work to contract. There will be a poorer service. But the elite - excepting those running the new service who will provide the political kickback to the politicians - will have been tamed.
People will be told they have a better service. It will actually be worse. But they will be told otherwise. And because people will be relieved that the cause of their anger - NHS GPs - have been defeated, they will accept the lower service.
Meanwhile the kickbacks will continue. And new resentment will be fuelled against hospital doctors, who will become the new enemy.
This is what Sajid Javid is doing in plain sight. And the media are interviewing this Ayn Rand enthusiast as if he us really seeking to find a solution to NHS issues instead of seeking to destroy it - which is so obviously the case.
And so the destruction of all that is valuable goes on.
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I work in radiology the NHS, and I have to say that I’ve long suspected that this is the Tory game plan. It won’t just be the GPs that are privatised. Radiology services are already heading in that direction. They would rather pay private healthcare companies thousands of pounds a day to help with ever increasing waiting lists, than invest in more equipment and staff to get a usually much better job done in-house.
Thank you
Agreed – the Tories are going sweat the assets and manufacture consent.
They’ll break it first, then pretend to have fixed it, filling the pockets of private providers brought in to ‘help’.
It makes you wonder that when it comes to MMT and being ‘courageous’. it’s not ignorance that we are actually dealing with.
Rather it is just that they intend to change the NHS intentionally because everything is a profit centre to them and their funders. It’s not that they can’t see- it’s that they won’t. It’s wilful.
It will be the perfect English fudge won’t it – the NHS will be just about free, but have loads of profiteering going on in the background? And the profiteers will come back for more and more.
It will be the rich who have inserted themselves into the NHS, feeding of people’s illnesses like a parasite.
It’s disgusting and certainly the end of what was envisaged after WWII.
Agreed
[…] Cross-posted from Tax Research UK […]
Many years ago I saw my GP about a bad foot, thinking something might be broken. The first thing he did when I sat down was ask to see my hands. When I asked why he explained that there was a yellowish tinge to my skin and wanted to check my fingernails for possible jaundice.
Try that over the telephone!
You can’t
But that’s not normal either
A doctor on Kay Burley referred to Savid Javid’s name and shame idea as the administration of the NHS by the Daily Mail.
Savid Javid announced £250 millIon “extra” funding for GPs to help in deprived areas (or so he inferred) apart from the fact that this sum is comparatively small how many \GPs in the most deprived areas will get this benefit? – there are no surplus doctors available to help out. even locums are fully stretched. It is a fudge and a PR stunt only.
It isn’t “extra” either, it’s from somewhere else inside the NHS
Aren’t GP Practises already private? My aunt used to be a practise nurse and she explained that GPs are indivuals or partners who sell their services to the NHS. They aren’t owned by the NHS or part of the NHS, no more than a factory that makes bandages or makes ambulances.
They are notionally private but basically are contractually tied to deliver for the NHS and very few GPs have any other income of any significance
So the probem is the NHS is a monopoly purchaser? If you can only contract to one purchaser, isbn’;t that like IR35 tax code, it makes you a the same as an employee.
I suggest you stop eating my time with silly lines of enquiry
Just go and look at the whole story
Another move is to coalesce multiple GP practices in an area into units of 30-50,000 patients, thus creating entities that of the size that make them attractive targets for corporate takeover. According to my English GP friend.