Hunt v doctors

tag : junior doctors BMA NHS Hunt contracts seven day working

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In my line of business, I often have to help people understand why they do things in preparation for working out what they could do better.

Invaluable in this process is the purpose and outcomes model. This essentially says

there is a difference between your purpose in doing something and the outcomes that arise when you have achieved your purpose
it is helpful to decide which is which.

For example, a business owner might say that the purpose of his/her business is to make money. But isn’t that really an outcome of doing something else? In the case of a business, it may well be that the purpose is to provide good customer service, the outcome of which is lots of customers, and therefore lots of money.

What is the purpose of senior politicians?

As I have argued elsewhere, it seem to me that the overriding purpose of senior politicians—in any country—is their self aggrandisement largely achieved through preferment.

[New Scientist has kindly made my letter to them on this subject “Editor’s pick” (17 february 2016).]

In that light, it is interesting to speculate what the current health secretary, Mr Jeremy Hunt’s purpose has been during his ‘negotiations’ with the British Medical Association, which represents junior doctors, over their pay and conditions of work.

It seems rather unlikely that his purpose was the improvement of the National Health Service. Doctors have, almost to a man and woman, expressed the view that the changes—which Mr Hunt has chosen, today, to impose unilaterally on the BMA—and his attitude to the doctors have been

highly prejudicial to doctors’ morale
detrimental to the safety of patients [*1].

Had his purpose been the improvement of the NHS, clearly he would have gone about talking to the BMA entirely differently. He is, after all, a senior politician with considerable power, considerable resources and not a few friends in higher places than his. It would have been perfectly within his power to do so. Or, if he felt it wasn’t, he could have got someone to help him.

(That said, Mr Chris Grayling managed to struggle on as ‘justice secretary’ for some time with only, apparently, the vaguest notion of what justice is.)

In fact, had his purpose been the betterment of the NHS, to have ended up where he is today would indicate such a remarkable degree of ineptness and incompetence that even Mr David Cameron would (probably) have felt he had to relieve him of his duties. (As indeed happened to Mr Grayling in the end.)

It is therefore terribly tempting to assume that Hunt is entirely sanguine about the outcomes he has achieved. Of course, had he been a better negotiator, he might have got a better outcome and antagonised fewer people in the process, but something tells me that his negotiating style was suited to the outcomes he got, which were precisely the outcomes he intended.

How so?

Well, in this case, it isn’t enough just to assert that Hunt’s purpose was self-aggrandisement. We need to ask what would else need to take place for that aggrandisement, that preferment, to happen. Why, of course, to be seen by his masters to have done a good job.

To argue that the damage that has been inflicted on the NHS, and will continue to be, is just an unintended consequence of an unfortunate failure to negotiate competently is naive, to say the least. As I say, Hunt and the conservative government have all the talent, ability and resources they would have needed to reach an amicable conclusion; possibly even a consensus. It is impossible not to conclude that the outcome achieved suits them just fine.

The difference between the national health service and the National Health Service

This is a crucial distinction which is deliberately muddied by conservative politicians and stupidly and carelessly so by opposition ones.

The National Health Service consists of four publicly funded legal entities set up following the Beveridge report, published in 1942 [*2], and usually collectively referred to as the National Health Service (capital N, capital H, capital S).

The “national health service” (small n, small h, small s) is a generic term covering all the health services, whoever supplies them, whatever they might be, which are available in the UK. One might equally talk about a national education service (and I notice that, last August, Mr Jeremy Corbyn did actually float the idea of a National Education Service [*3]).

The conservatives are frequently accused of wanting to “privatise the NHS”, in the sense that the conservatives under Mr John Major privatised the British rail network. I don’t think they do. A step too far, electorally, even for the most cynical of conservatives.

What the conservatives want to do is ‘marketise’ the national health service.

That means opening up the provision of health services to commercial organisations most of whom will be corporates, which only have a duty to maximise profits for their shareholders (see The psychopathic corporation and related articles).

The NHS would be one such provider. But, currently, it has such a substantial advantage in most areas of health service provision that, for the private sector players to get a foothold, the government needs the NHS to be softened up with a damn good kicking.

In this way, it will be weakened, thus easing the path for new entrants into what the government wants to be a marketplace (hence the ghastly verb, “marketise”).

So, when Mr Cameron, then and still the leader (I use the word advisedly) of the UK conservative party, said at the 2006 conservative party conference, “for me, it is not just a question of saying the NHS is safe in my hands—of course it will be” [*4], one has to provide rather specific definitions of the terms “NHS” and “safe”, not least because of what happened after the 2010 general election.

Six months before that election Cameron said, “With the Conservatives there will be no more of the tiresome, meddlesome, top-down re-structures that have dominated the last decade of the NHS” [speech to Royal College of Pathologists, 2 november 2009].

Within days of winning the election, Cameron’s party presented detailed plans for the very top-down reorganisation of the National Health Service he had undertaken not to carry out, one of the largest reorganisations in the history of the NHS. The reorganisation cost an estimated £3 billion, money the country did not have at the time and still doesn’t.

So, today, of course the NHS will continue to exist: it will be the rump left over. It will consist of all the unprofitable, dirty jobs that corporates don’t want to be involved with.

According to Wikipedia, Hunt had previously [ie, prior to his appointment to the job of health secretary in 2012—actually in 2005, see next quotation] co-authored a book calling for the NHS “to be replaced by a new system of health provision in which people would pay money into personal health accounts, which they could then use to shop around for care from public and private providers. Those who could not afford to save enough would be funded by the state.” [*5]

And, in 2009, the Observer revealed that leading Tory MPs – who include Cameron’s close ally Michael Gove – are listed alongside controversial MEP Daniel Hannan as co-authors of a book, Direct Democracy, which says the NHS “fails to meet public expectations” and is “no longer relevant in the 21st century”.

Others listed as co-authors in the book, published shortly after the 2005 general election, include shadow cabinet members Greg Clark and Jeremy Hunt and frontbencher Robert Goodwill. [*6]

A damning description of the actions currently underway, all designed to achieve this destruction of the NHS, can be found in a lengthy article by Dr Bob Gill. He writes:

In 1968 Arthur Seldon, later Margaret Thatcher’s privatisation policy adviser, produced a pamphlet for the Institute of Economic Affairs called After the NHS, explaining the aspiration to “improve the NHS” by abolishing it so as to build profit opportunities insurance industry.

Further incarnations of this same plan to enable the insurance industry to increase its profits in the UK by destroying the NHS surfaced in the 1980s. This included Health of Nations by the Adam Smith Institute …

The stealth privatisation of the NHS had quietly begun under the Thatcher administration and has continued unabated ever since. …

PFI started on John Major’s watch and continued under Tony Blair and Gordon Brown.

Blair’s New Labour government continued with the privatisation project, while maintaining the deceptions contained within successive pointless top-down reorganisations which actually took the NHS further down the privatisation road, precisely following the steps laid out in the Health of Nations NHS privatisation plan. …

The NHS has been fundamentally transformed in the last 20 years. Our nationally integrated hospital network has been split up into distinct business units (“foundation trusts”), which were deliberately burdened with PFI millstones which would throw them into insolvency as soon as a funding squeeze was applied to trigger this at the right time for privatisation.

Since 2013, health services have been funded through clinical commissioning groups (CCGs). These were designed by John Redwood MP to be self-collapsing, state-funded insurance pools. Though many CCG boards are fronted by GPs, the commissioning decisions they take are ultimately shaped by a set of rules which incentivise outsourcing to private healthcare companies with administrative support provided by yet more private companies.

CCG boards have great discretion over which services they will pay for and NHS-funded care will be increasingly restricted, damaging universal and comprehensive care. This will inevitably lead to patients paying charges for care, out of pocket, or through private top-up health insurance. Or, to quote Letwin and Redwood on page 16 of Britain’s Biggest Enterprise: Ideas for Radical Reform of the NHS:

“Another avenue which has been tentatively explored by the Government is charging. In principle, this could be extended to the point of universality — a charge for every service.” [*7]

And so on, and so on.

My advice

I regret that for staff to leave the NHS as a result of Hunt’s actions today plays into the tories’ hands. They need the NHS to be weak, and a good way of achieving that is to reduce the numbers of essential staff, such as junior doctors, below the minimum necessary for trusts to function. Trusts may have no choice but to increase further their employment of agency staff as they already are obliged to do with nurses, and incur unnecessary costs for which they do not have the funds.

The NHS is a patient with a life-threatening infection. It needs to be strengthened, not further weakened.

Postscript

In a recent (January 2016) Ipsos-Mori poll, politicians were found to be the least trusted group of professionals to tell the truth (at 21%); doctors were the most trusted to tell the truth (89%) [*8]. In the same poll, 95% of respondents believed that bears… (OK, let’s leave it there—Ed.)

[*1] Junior doctors say they may leave the NHS after contracts imposed (Damien Gayle, news item, the Guardian, 11 february 2016)
‘We can’t be stretched thinner’: junior doctors respond to Jeremy Hunt ( Eleni Stefanou and junior doctors, opinion, the Guardian, 11 february 2016)
[*2] National Health Service Act 1946 (for England and Wales) . National Health Service (Scotland) Act 1947 . Health Services Act (Northern Ireland) 1948
The Beveridge report
[*3] Jeremy Corbyn: I want to build on Tony Blair’s legacy and create a National Education Service (Michael Wilkinson, news item, The telegraph, 27 july 2015)
[*4] NHS safe in my hands (news item, BBC, 4 october 2006)
[*5] Wikipedia article on Jeremy Hunt
[*6] Key Tory MPs backed call to dismantle NHS (Toby Helm and Rajeev Syal, news item, The observer, 16 august 2009)
[*7] The connection between the junior doctors’ contract and the American corporate takeover of the NHS (Dr Bob Gill, The official website for the Keep Our St Helier Hospital (KOSHH) campaign, 18 november 2015)
[*8] Survey reveals most and least trusted professions (news item, ITV, 26 january 2016)