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Safe in our hands

Submitted by on September 2, 2012 – 7:16 pmNo Comment

By Jonathan Allsopp

The wonderful People’s History Museum in Manchester includes a section on famous political speeches. In addition to the Grantham grocer’s daughter talking about U-turns there is a clip of Nye Bevan speaking about the National Health Service a decade after it was founded in which he describes the NHS as “an example of real socialism”. It’s a lovely few minutes of powerful oratory, well worth searching out if you visit the museum. Bevan speaks with a tremendous sense of pride in the organisation that he helped to create in 1948. Sadly, 64 years on, the health service as we know it, a comprehensive service with access for all, based on need and free at the point of use, is in serious peril.

In March the Health and Social Care bill passed its final hurdle in Parliament fourteen months after it was first launched. It was the subject of more debate and scrutiny than any bill in living memory resulting in over a thousand amendments to the original document. Ultimately the debate was lost despite the tremendous efforts of many hundreds of NHS staff (doctors, nurses, therapists and other clinical staff united with healthcare managers and support staff for perhaps the first time) and campaigning groups such as Keep Our NHS Public. This was a complex piece of legislation and whilst the campaign against it was a fine effort, ultimately it received scant coverage in the national media and failed to galvanise the general public. How do you get people to rise up against the abolition of Primary Care Trusts when they don’t even understand what a PCT is in the first place?

There a number of strands to the coalition government’s health reforms, not least of which is the gradual opening up of the NHS to greater private sector involvement. This is both in terms of providing front-line services, whether that’s in a hospital or community setting, or supplying back office support. A comprehensive critique of the reforms, that details the creeping privatisation of the health service, is set out in the superb book “The Plot Against the NHS” by Colin Leys and Stewart Player.

In addition to the reforms the NHS is trying to save £20 billion by 2015. It’s the health service’s share of the tab for the bail out of the banks. To put that into perspective the annual bill for the NHS is currently about £110 billion. One of the ways for the health service to save money has been to offer fewer treatments and operations to patients; the rationing of services. To date, this process has been largely piecemeal and localised. Indeed many people who do not work in the NHS may not even be aware that the rationing of healthcare is already happening. It’s not immediately apparent in the typically impenetrable jargon of the NHS that refers to “low priority procedures”, “procedures of limited clinical effectiveness (POLCE)” and “planned procedures with thresholds (PPwT)”.

All this means that, depending on where you live, treatments for certain routine conditions such as cataracts and hernias are no longer available to everyone. For instance, an elderly patient with cataracts may no longer be entitled to an operation at their local NHS hospital unless they fulfil certain criteria. They may be required to demonstrate that their current “visual acuity” is less than a certain value, or they have another condition affecting their eyesight such as glaucoma, or the cataracts are having a “substantial effect” on their daily life. Failure to meet any of these “thresholds” will mean that they are not eligible for an NHS operation.

In other areas, complex procedures such as bariatric surgery for the treatment of obesity may only be available if the patient has a Body Mass Index (BMI) above a certain level and other conditions such as diabetes or coronary heart disease. The service is no longer a comprehensive one. And as the financial squeeze on the NHS tightens in the next few years it’s likely that the issue of rationing will become a national one.

A news story in a local paper in Surrey a few weeks ago provided an interesting insight into the right wing perspective on healthcare rationing. According to John Butcher, a Conservative councillor in Cobham, people who drink, smoke, take drugs or are obese should be forced to wait longer for NHS treatment as their ill-health is “self-inflicted”. This would force the “self-inflicted” ill to move out of Surrey and improve the service for those who remain. Of course, Thatcherites have always taken an individualistic view of society. They view unemployment as a result of laziness and ill-health as the result of poor lifestyle choices, completely ignoring the influence of a whole host of social and environmental factors on someone’s health such as employment, pay, housing and education to name but a few.

In an email leaked to the Elmbridge Guardian, the councillor describes the NHS as a “Marxist organisation” that is “bound to fail” in times of financial crisis. He goes on to predict that the NHS will break up into two types of service depending on where you live. One type of service where all patients are treated equally regardless of whether their condition is deemed to be “self-inflicted” or not. And another type where the “self-inflicted” ill are forced to wait longer for treatment or perhaps not treated at all. There then follows a description of the influence of the flight of the “self-inflicted” ill on local house prices (apparently they will rise thus making it difficult for anyone who is likely to make themselves ill to be able to afford to live in Surrey). And political parties that “pander to the needs of the self-inflicted unhealthy” will struggle to win power as their voters will either be dying off or concentrated in particular areas that make it more difficult to dominate Parliament. It’s a startling analysis even by the standards of the rabid Tory right.

One of the arguments for health service reform is that the top-down administration of the NHS is “undemocratic”. The argument goes that important, strategic decisions about the use of NHS cash should no longer rest with the Secretary of State for Health and the Department of Health. Instead, responsibility should pass into the hands of local Clinical Commissioning Groups (CCGs) which will replace PCTs from April 2013. The sense of a national, comprehensive system for all is fast disappearing. And tucked away in the small print of the Health and Social Care Act there is a proposed greater role for local councils in NHS decision making through “health and well-being boards”. These boards will bring together local NHS commissioners and elected councillors to agree an “integrated way to improve local health”. Yes, that means a greater say in the running of local health services for the likes of Mr Butcher.

The creation of the NHS in 1948 was the result of one of the most progressive pieces of legislation of the last century and marked a significant redistribution of wealth from the rich to the poor. It meant that everyone was able to access the same health services regardless of how much they earned or could afford. The Health and Social Care Act represents an attempt to turn back the clock to a fragmented health service where the poorest in our society may struggle to get access to the very best healthcare. To close with another quote from Nye Bevan; “the NHS will last as long as there are folk left with the faith to fight for it”. Let’s not stand by as the NHS as we know it is dismantled. It’s not too late. This is something worth fighting for.

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