Some readers of this blog will be familiar with the work of Dr Julia Grace Patterson and the Every Doctor UK organisation she leads. It has had a strong campaigning presence on Twitter for some time. I have supported her campaigning work that seeks to restore the NHS as we once knew it not so long ago. Now, Julia has written a book about that campaign entitled ‘Critical: Why the NHS is being betrayed and how we can fight for it.
The book is well-written, flows well, and is a good read. I have to stress the importance of that: I am struggling to read far too many turgid books at the moment, however worthy their authors and the issues that they espouse. This book does not suffer in that way.
That said, if you are familiar with the failings of the NHS (and I am) you will not learn much that is new from this book. Although it is clearly researched and referenced, I am not sure it breaks new ground with any of the information that it has to tell.
However, I am not sure that is the purpose of the book. That purpose is to deliver a narrative in five parts. The first deals with the promise of the NHS, which few doubted was being honoured by politicians until 2010, although Labour's disastrous flirtation with the Private Finance Initiative and its consequences are rightly addressed, as was its failure to create a single IT system for the NHS.
Patterson then tells of the political betrayal of the NHS by the Tories since 2010. She has the data. She has researched the changing narratives of successive health secretaries, and what she says are three things. The first is that the Tories do not believe in the NHS. They evidence that by, secondly, denying it funds. And third, they have organised effectively to support this active undermining of the NHS.
The method that they have used to achieve their aim has been the ever-greater fragmentation of the NHS. This has undermined its effectiveness whilst opening it up to progressive privatisation by ever more outsourcing, even though there is strong evidence that this does not result in better clinical outcomes, even when the outsourcers can (and do) cherry-pick the easiest cases.
The impact is obvious, and has got progressively worse. The NHS was not ring-fenced sufficiently during austerity to provide it with the funds it needs. Excess funds have flowed from it to the private sector, including via PFI. Real pay has been cut. Required investment has not taken place. Morale and service quality have crumbled. Staff have left and are not being replaced. The refusal to pay wages appropriate to the tasks demanded has resulted in ten per cent understaffing. A vicious downward cycle has resulted. The private healthcare sector is far too small to pick up the slack in any meaningful way. And so we have 7.4 million people waiting for care right now, although the delays they are suffering, like everything else in this approach to healthcare management, is just a statistic and not a tale of human stress, pain and suffering in the eyes of Tory politicians.
So, Julia Patterson argues that we need a better NHS. Or rather, she argues that we need the NHS we were promised. That would be state run, properly staffed by personnel on fair pay and with manageable stress levels, working systematically to provide universal healthcare at lowest possible cost. It's hard to disagree.
But then the problem is encountered. There is no description as to how this will be delivered. The absence of an economic argument is the weakness in the book. What needs to change in the structures of power, the thinking of politicians in all leading parties, and the economy at large so that we can actually attribute value to something as fundamental as healthcare for all are issues that are not addressed. I am left feeling this is a campaign without a solution to offer as a result, and I have only ever worked on solution focussed campaigns in my career.
I also note that it leaves the arguments in the book open to attack. Former Labour health secretary Alan Johnson reviewed the book recently for the Guardian alongside one by pro-Tor Isobel Hardman. He praised pro-privatisation (or perhaps more correctly, privatisation denier) Hardman and damned the pro-state line Patterson promotes. His suggestion was Patterson ‘better go to Specsavers' to understand the value of private care.
Johnson accurately reflects the modern Labour Party and the mountain that those who believe in the NHS have to climb when that party is now part of the problem that the NHS faces and appears to offer no solution to its issues. An economic argument would make the difference. Maybe that should come next, but despite that I still recommend this book to those interested in saving the NHS: it is an invaluable sourcebook and call to arms.
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I’m sure most members of the public don’t realise how far privatisation has gone already. Here’s my anecdotal halfpenny’s worth: I work in the MRI department of a District General Hospital. My manager estimates that 30-40% of all the MRI referrals in our hospital are already being outsourced to private companies.
Re cherry-picking: the list of cases that can’t be referred to the mobile MRI scanners is long: too old, too young, too big, too claustrophobic, too immobile, examinations too long, scans too complicated, too difficult in any way? The challenging cases remain with us in the hospital, where we are rightly proud that we do a very good job, but clearly the work burden is heavier as a result of most of the relatively easy cases being diverted. Not at all uncommon for outsourced examinations having to be recalled to repeat in-house, as the private scanners messed up in some way. Our radiologists only reluctantly accept that work is sent elsewhere – for assured quality and accountability they prefer the hospital scanners.
It used to be that the outsourcing was justified as ‘helping relieve the burden on the NHS’. Nowadays the narrative has changed: at a recent meeting hospital managers told us ‘the NHS has no capital – only the private companies have the capital to invest in more scanners – the NHS can only meet the running costs. This was in relation to the latest advancement down the slippery slope: CDCs (”Community Diagnostic Centres”).
Someone somewhere has signed the contract. There will be no new investment in NHS-owned and run scanners – an American healthcare company is going to set up a MRI scanner in the middle of town, which will effectively take the place of a long-needed third MRI scanner at our hospital. Where will they get the radiographers to staff the CDC? No problem – it’s going to be a ‘joint venture’ with the NHS, so we – the NHS trained radiographers – will be expected to work at the CDC along with the privately employed staff.
When some of us voiced concerns at the aforementioned meeting our comments were greeted with silence. It hadn’t apparently occurred to the managers that we might not want to work for a private company. Were in-house alternatives to this further outsourcing considered? ”We could talk about the politics of this for three hours, so no, we’re not going to discuss this”. This is the whole direction of travel – There Is No Alternative!
It is not difficult to imagine where this is all going – further slips down that slippery slope could find us without NHS employment contracts. Or maybe someone will think it’s a great idea to ‘give the contract’ for running the whole of radiology over to the businessmen. Our hospital management proudly announced the sell off of our pharmaceutical division a few weeks ago (the NHS staff there are devastated), so I don’t doubt that could happen to other areas of the hospital as well.
It’s bad enough to know that we work for an organisation – the NHS – that the government’s actions shows it loathes. It is also very depressing to realise that many managers within our own hospital/Trust are actively working to undermine the NHS in this way. Such existential concerns just add to the stress of working in the NHS – the well publicised pay disputes are just a part of it.
Sadly, I do not believe that a change in government will make any difference to this at all – Wes Streeting et al appear to be just as keen on continuing the privatisation process as the Tories.
I believe every word you say and all your conclusions and think your concerns 100% justified.
I believe that it is essential to compare with the US private health care which costs almost twice as much as a percentage of GDP. Workers will require greater pay to afford health care, manufacturing and all employers beware.
The NHS is not underfunded because of a lack of money (though that is what is claimed). It is deliberately defunded to break it, in order to privatise as much of it as possible. The is HUGE money in healthcare, and those who own the shares will become very rich.
This is not a conspiracy theory or wild guess, it is already happening. Private Finance Initiative (PFI) schemes have already siphoned £250-billion from public services into private hands. In the US when Aids treatment was developed for a few dollars, it was resold to patients for about $10,000 per year.
Read: How to Dismantle the NHS in 10 Easy Steps by Dr Youssef El-Gingihy
https://www.amazon.co.uk/How-Dismantle-Easy-Steps-second/dp/1789041783/
Read: The Real Anthony Fauci: Bill Gates, Big Pharma, and the Global War on Democracy and Public Health, by Robert F. Kennedy Jr.
https://www.amazon.co.uk/Real-Anthony-Fauci-Democracy-Childrens-ebook/dp/B08XQYGC68/
Watch: The Great NHS Heist https://vimeo.com/ondemand/thegreatnhsheist
https://www.youtube.com/watch?v=ro-oU0us
Watch: Do No Pharm, https://www.nopharmfilm.com/
Thanks
at the end of January 2021 the BMJ opinion website gave a figure of 850 NHS staff who died of covid. Probably some did not contract it at work but it is still a large figure and how many are suffering long covid? By comparison 457 service personnel died in Afghanistan and 179 in Iraq.
Some of the dead were cleaners without whom more would have died. Staff had to comfort people dying alone with an impact on their emotional health.
We remember Faisal Islam crossing off Truss’s tax breaks but one which wasn’t was the reduction -given I think by Sunak-of a reduction in the bankers surcharge from 8% to 3%. Money for the bankers but not the NHS.
We owe the people in the NHS. Then to say their salary must be reduced in real terms as , yet again, they fall behind inflation is morally bankrupt.
It makes me very angry.
Me too
They always say that they can’t afford the junior doctors claim of 35%. Nobody ever conters by saying that some junior doctors are paid £14 an hour, so 35% on that takes them up to £18.90. I bet most people expect that doctors, junior or not, are paid a lot more than £20 an hour. Junior is a misnomer as well.
Starmer and his Labour MP cronies are part of the the Neoliberal Death Cult. Not very bright individuals pretending that they are. Don’t touch them with a barge pole as they used to say!
In 2013, Easter weekend, I had an aortic dissection. I had an MRI scan more or less straight away, but as it was Easter weekend, there was nobody there to read the scan properly. If my sats had been 1% higher they would have sent me home. One doctor said you’re the one with backache, aren’t you?
On the Tuesday when the staff came back and could read the scans properly, I was quickly sent by bluelight ambulance to a hospital that could cope with aortic dissections. The doctor who said I’d had backache had the grace to apologise.
I can imagine exactly what would have happened if it hadn’t been an inhouse radiography department.
Everybody surely knows by now that private hospitals can’t cope without NHS staff.
Last month I attended 5 zoom meetings about the NHS. 1st week of July there is one every night, as it is the 75th anniversary of the NHS. There are also meetings in Downing Street and outside about the NHS.
https://actionnetwork.org/events/nhs75-conference
The biggest rally so far next Saturday in London, for anyone who can attend.
Thanks for what you do
EXCLLENT
With regard to Labour they seem to have given up already.
Why do they bother? Well – it’s just for themselves isn’t it – ‘opportunities’ and all that.
https://socialjusticeparty.uk/
A party to take over from labour and do their job for them?
Hope it works.
My daughter worked as a senior nurse for Premature Baby ICU in a major Midlands hospital for 13 years. For those not aware, a lot of prem babies are non-viable (incapable of unsupported life). Many parents blame the staff, some even accuse them of not praying for the kids. Stressful! Privatisation of the morgue (24/7 under state provision) meant that dead babies had to be concealed (to avoid distress to other parents etc) between 8pm and 8am, as they couldn’t be transferred until it opened. She often had to work double shifts, as agency staff didn’t turn up, weren’t qualified to enter such a sterile environment; she had on occasion a cleaner, a junior doctor and a clinical assistant work an unpaid shift with her, as there were no other staff with clearance.
Privatisation crept onto the agenda for the ICU nearly a decade ago. Fortunately, Virgin and United Health walked away as there was no profit there.
She quit to go into the community as a health visitor. As a single mum, while training, she qualified for Universal Credit. That’s how much value is placed on vital basic healthcare for children.
That’s where the Tories AND New Labour have taken the NHS.
My wife worked in neonates before becoming a GP
I recognise your tale, but you make it clear it is so much worse now
My mother used to work in a maternity hospital as a nurse in the 60s. She would be appalled to read about what has happened to her NHS.
Just had a link to the Every Doctor book from Jeremy Corbyn’s Facebook page.
You can buy it for £14.19 from Hive, post free.
https://www.hive.co.uk/Product/Dr-Julia-Grace-Patterson/Critical–Why-the-NHS-is-Being-Betrayed-and-How-We-Can-Fight-for-it/28572724
There is also going to be an online SCG rally on 17th July at 7.00 with Labour Against Austerity called How we Save Our NHS.
Not all labour MPs line up to agree with Starmer and Streeting. I have a feeling they have to ignore certain groups of MPs, otherwise they would never be able to call themselves the opposition.