If we are to save the NHS we need collectively to regain the kind of confidence which was crucial to the establishment of the service in the dark days of the Second World War...
Andrew Lansley, recently deposed as Secretary of State for Health, said that he wanted to be remembered as the last Health Secretary. What on earth did he mean?
NHS staff must take responsibility for the service. Theatre staff at St George’s Hospital, London, show the spirit needed.
That he would remain in post until the last syllable of recorded time? That his successors would be so entirely forgettable that no-one would remember them? That they’d have faces only recognisable by dogs? Presumably, using the tortured logic of free marketeers, what he was trying to say was that no SoS should have any influence in how the Service is run. That it should be run by those who know, “clinicians”, and not by “command and control” mechanisms which frighten the life out of the bourgeois. In practice, this means that the service should be run by that hallowed modern deity, The Market.
Well, we’re about to find out just how forgettable Lansley is. He’s gone. And while it would be easy to say, “they’re all the same, it doesn’t matter a jot which creepy politician is SoS”, that would be a mistake.
Lansley didn’t want to go. Reason enough in itself to rejoice. A less articulate yet more arrogant buffoon has not been seen in that office for a generation. Cameron didn’t want him to go. A cause for even more rejoicing. Just about anything that puts that oleaginous ruling class twit’s nose out of joint is to be welcomed. Those wanting to destroy the NHS didn’t want him to go. The private companies infecting the Service like a bacillus didn’t want him to go.
Need we go on? That he’s been replaced by an equally objectionable jumped up worm with a name that James Naughtie on Radio 4 had so much trouble with is only to be expected from this shower of no-hopers masquerading as a government. We must set as an objective that we’ll see him off too.
So, given that Lansley didn’t jump, why was he pushed? The time had come to make a sacrifice. A ritual blood-letting. A scapegoat had to be found who would carry the historic can when the NHS, our so-called “national treasure” finally falls apart.
When that begins to happen we’ll see why he was pushed. “It was all Lansley’s doing” will be the cry from the yellow press. Murdoch will need someone to blame when the election comes round and the electorate worries for its health. Politicians who survive scandal for long enough all get sacrificed in the end if they become an electoral liability. Lansley was a vote-loser.
Lansley’s so-called reforms are the most reviled, complicated and disastrous in the history of British healthcare. They dwarf what can be seen with the benefit of hindsight as the uncharacteristically meagre tinkering of Thatcher, and even the traitorous Trojan horses dragged into the service by Blair. Let’s have a look at what’s going on, and at some of what he’s proposed.
The Health & Social Care Act is a monstrosity. It is longer than the Act which established the service in 1948, and is qualitatively more dangerous than all other Health Acts put together. Why? Because it proclaims the triumph of capitalism. It gives our wonderful service to those whose priority is to make money. It destroys planning. It introduces fragmentation.
Crucially, it weakens the authority of those who work in the service, under the pretence of doing the opposite. It will be seen to be a king-size rivet in the coffin of the NHS. If we allow it.
The creators of the wonderful Olympic opening ceremony knew just how dangerous these developments are. They took the brave step of highlighting the significance of the NHS to Britain, and thereby to the world. In order to give more clarity to their vision of the NHS they used Great Ormond Street, one of the world’s leading children’s hospitals, as a focus. That very same Great Ormond Street could now be used as a small, a very small example of just how insidious is the drive to destruction.
The H&SC Act requires all trusts to become foundation trusts. But the invention of this creature, the foundation trust, can’t be laid at the door of Lansley. It was the brainchild, if that’s not an oxymoron, of the despicable ex-trotskyite Labour minister Milburn after he was taken to see a couple of similar institutions while on holiday in Spain.
Two heads, same beast
In a great example of the Tory and Labour parties being but two heads of the same beast, Lansley has now made it virtually a criminal offence for a trust not to become a foundation trust. And, unsurprisingly, a hospital’s attitude towards money comes right at the top of the list of what it needs to become a foundation trust. “Financial prudence” is key to the foundation trust application process (actually the very notion of a trust “applying” to become a foundation trust is like a prisoner on death row agitating for the use of lethal injections in preference to the electric chair). Every single step to make money must be used, and must be shown to be used, if a trust is to become a foundation trust.
So at Great Ormond Street, world-class medical procedures in dealing with the most difficult-to-treat cases (although many of these patients are often sent to equally world class but less well-known institutions such as the Royal National Orthopaedic Hospital) are not enough. Pioneering research and staff development count for little. What’s necessary is to show that if something can be done more cheaply, then it will be.
So the hospital’s IT department, run as an integral part of the hospital since there was information technology, is to be flogged off to a company no one has heard of but which can do it more cheaply. Allegedly. Perhaps this will be the kind of “cheap” seen in the railways, where far more is spent from the public purse on subsidising the profits of private companies than ever was spent on subsidising railways when rail was state-run.
And, as a precursor of what is to come, a completely different attitude towards unions is also a requirement of Lansley’s reforms. Not that it says that anywhere in the Act. In fact the same fluffy “partnership” tripe is trundled out by this bunch as was by the last. But in order to bring about the changes necessary then the attitude must change. Unions must be sidelined, or taken on.
At Great Ormond Street there was no consultation with the relevant union, Unison, on the proposed privatisation of IT. Consultation is required under the recognition agreement between the unions and the employers – but that is cause solely for a call to re-write the agreement. The agreement has been ignored.
A dispute has been lodged, and ignored. That Unison has responded by ensuring 100 per cent membership in a department hitherto a minority shop is an achievement, and against the odds. But now these new union members must be challenged to do more, to fight.
New way of fighting
This is new-style NHS warfare. It is not pretty and will not be governed by gentlemanly agreements. It will be a trial of strength. And British workers don’t like that. They’d rather that the better argument – always ours – should prevail, that there will be a fair arbiter somewhere who will come to our aid and decide in our favour.
There is a craving for an ACAS, or recourse to a benevolent law which does not exist – or to a Labour party which will sort it out in Parliament. It is the inner desire that led our ancestors to dream up Robin Hood. Someone to ride to our rescue. Well, there comes a time when we’ve all got to grow up and shed our illusions. And the illusion that there’s someone out there who will help us is the greatest illusion there is. We will have to do it ourselves.
And if that is true of one small department in but one hospital, how much more true is it throughout the NHS, and indeed throughout Britain as a whole?
So a re-think is required. Our enemy has had just such a re-think, and came up with the Health & Social Care Act. It also came up with the so-called “recession”, shorthand for lifting the hand that holds the whip in the air and threatening us with a beating.
We need to match that re-think, and outstrip it. We need collectively to regain the kind of confidence which was crucial to the establishment of the service in the dark days of the Second World War.
We can run the Service ourselves; we always have. We do not need legions of financial rather than medical consultants costing more than a grand a day to invent a language only they can understand. We do not need foundation trusts, clinical commissioning groups, a Commissioning Board, a National Trust Development Agency, Public Health England, Clinical Senates, Commissioning Support Units, uncle Tom Cobley and all.
There is deep disquiet in the Service. There are some who are leaving because they cannot stomach the “direction of travel”.
That attitude must be rooted out. It is more dangerous than anything Lansley could ever come up with. If we desert the field we are lost. The service would be lost and our health would exist only as a source of profit.
In war those who betray, who turn their coats, are more dangerous than the enemy. The job of those active in Unions is to create confidence, not sow despair. It is to find new ways of attacking the enemy, not being content to defend. It is our job to remove every politician who threatens the NHS, and ultimately to remove the system that allows such forgettable politicians to exist. ■