How to save the NHS

NHS SOS Edited by Raymond Tallis and Jacky Davis. Oneworld publications

Available from Keep Our NHS Public 

There are few things that staff can agree on in an organization as vast and multi-cultural as the NHS, but there are two fundamental points that almost everyone from porters and pathologists to receptionists and senior management can agree on, a dislike of constant government interference and a belief that healthcare should be provided according to need. The coalition’s NHS reforms managed to combine a massive government imposed re(dis)organization with the end of the legal duty of government to ensure healthcare is provided where and when it is needed. Given this, one wonders how they got away with it. NHS SOS explains how it happened, why it matters and what we can do about it. It documents the failures of democracy, the penetration of government by lobbyists, the uncritical regurgitation of government rhetoric by the media and the inability of the medical professions to mount a united front.

The principles underlying the reforms are that the traditional model of medicine as a vocation, health care as a public good and the sick patient as a vulnerable citizen who has a right to care and for whom the state has a duty of care are no longer fit for purpose in an era of market values where medicine is a business, health care a transaction and the sick patient a customer. Professor Allyson Pollock has been sounding the warning bells of NHS privatization since some members of the coalition were still at school and has co-authored a chapter with researcher David Price. They explain that the first clause of the Health and Social Care Act 2012 has repealed the duty of the Secretary of State to provide or secure a comprehensive health service. They assert the pivotal significance of this,

This repeal was the fulcrum of the free-market agenda, since this long-standing duty compelled the minister to allocate resources according to need instead of leaving allocation to market forces and unaccountable organisations.

Theirs, the seventh chapter of the book is the clearest statement of why it is so important to defend a publicly funded and provided, planned and accountable National Health Service, and is a good place to start for anyone still wondering what all the fuss is about.

Stephen Dorrell, past Conservative Health Secretary and present chair of the Health Select Committee was right when he said that the NHS reforms were revolutionary because of the £20bn cuts to funding by 2015 – unprecedented in any national healthcare system anywhere in the world and evolutionary because they continued the process of privatization that started roughly thirty years before. The long view is shared by the contributors to NHS SOS most of whom have been working in and campaigning for the NHS for long enough to harbor no illusions that this is a problem merely of the coalition’s making. One of the contributing editors, Raymond Tallis notes in his introduction that conservative Ken Clarke said in 2008,

Labour secretaries of state have got away with introducing private sector providers into the NHS on a scale which would have led the Labour Party onto the streets in demonstration if a Conservative government had ever tried it. In the later 1980s I would have said it is politically impossible to do what we are now doing. I strongly approve.

The righteous anger that comes across in NHS SOS comes from the knowledge that the reforms will punish the poor, the elderly and the chronically sick and will harm the rest of us when we are most vulnerable. I’ve recently been studying medical professionals’ accounts of their own illnesses. What is particularly striking is just how vulnerable they feel. Serious illness is unpredictable, frightening and exhausting, decisions that seem clear when we’re feeling healthy and confident are anxiety provoking and sometimes overwhelming when our own precarious health is at stake. No amount of re-branding patients as consumers, nor the rhetoric of patient choice used to justify the reforms can change this.

This book is not so much a lament for the NHS as it is for democracy.  Democracy, the contributors of NHS SOS argue in painstaking detail, is in crisis, from political parties to unions and academic royal colleges and the media; all are charged and found guilty – there is too much lobbying, too many vested interests, and amongst those uncontaminated by these sins, too little understanding of what is at stake.

It is all too easy to feel dismayed by what has happened and is happing to our NHS, but the strength of the book, and something that comes across strongly if you are lucky enough to hear any of the contributors talk – and they are all still campaigning, is their indefatigable and contagious passion for genuine public engagement upon which a national health service that puts patients before profits depends. The final section of the book is a guide to ‘What you can do to save the NHS’. In essence it’s a guide to how to become a politically engaged citizen. It would appear that we are only going to be able to save the NHS if we can save democracy while we’re at it.

Other reviews:

Guardian

Socialist Health Association

Open Democracy

NHS Managers