NHS and politics; how to turn a triumph into a tool
I apologise for diverging from my normal form of article, but I have dwelt long and hard and in my spirit of fair and ethical care must address the current confusion regarding NHS reform and the scope of political involvement. As a doctor, patient and British citizen I implore you to read this article with an open mind. I preface the following with stating that my political allegiances are only relevant as far as protecting the NHS and fair public service provision as a whole. My opinion of particular politicians may not be favourable, but this is based on their action and not their person. My views are my own and may not reflect those of my peers or employer. I implore you to read my extensive previous report on the junior doctor contract for more information.
It is often stated by the medical idealists that the current dispute regarding the changes in the NHS should be handled in apolitical fashion. In the sense of the BMA (British Medical Association) and GMC (General Medical Council) and with regard to their own internal policies and external image, I completely agree, as these organisations exist for the continued success of the NHS itself remaining a viable source of free, accessible evidence-based clinical care for patients. The problem is, and has been for time immemorial, that the NHS is both a health and a political tool.
It is difficult to discuss the NHS as a whole, and the changes within it, without examining the financial and political motivation behind such changes. The most current issues surrounding the NHS reform is the junior doctor contract and the dubious argument of the evidence base for the need of seven-day services. At the time of writing, there has been no direct evidence to support the assertions of the Department of Health (DH) that a seven-day NHS is needed or indeed possible in the woolly terminology in which it has been expressed. Or indeed that a lack of doctors on weekends increases risk of death.
To understand the seven-day proposals, we must first examine what is meant by 'seven days'. This seems to be an issue of debate, as far as the Health Secretary himself being unclear on what constitutes a weekend. As far as I am aware, and I realise my own limitations due to lack of available information from the DH and Government, there has been no official line on what constitutes seven-day care. There is also to date no evidence to suggest that the DH itself has any idea what services currently operate at weekends, or indeed has not, undermining its entire assertion that reduced staff numbers are a problem.
Second we must consider which services are being extended into the weekend, and here we can divide service in half, as emergency and elective. Emergency services are those including the emergency department and hospital cover and by nature are time-sensitive. These services require 24/7 doctor care as well as the associated staff for imaging, pharmacy, nursing, administration and links with social care. Elective care, and that extends to clinics except two-week wait referrals, is by nature not as time- sensitive and thus can be organised to exist with a five-day structure without any significant compromise to care. A simple example is a heart attack against control of arthritis: one requires emergency care, the other requires long-term control.
The current confusion in the public arena is caused by an ambiguity in what the Government and DH are clarifying as seven-day care. Let me be clear in stating that 24/7 emergency care has always existed. Elective care is for the most part Monday to Friday, and this exists in this form as this is what has always sufficed and has been shown to be preferred by patients and staff alike in numerous studies.
So why the confusion? The ambiguity is beneficial to a government seeking to extend elective service into weekends, as the public may confuse it with emergency. Simply put, they wish to take what can wait and make it available all the time. The problem with this approach, although theoretically admirable, is it requires extension of all service lines including imaging, nursing and others as mentioned above. Simply extending doctor hours without the rest of the healthcare team creates an unsustainable system. So why extend the non-essential care into weekends? To fulfil political promise, and to generate cash through diversion of these services to private sectors.
The DH and Government's current approach is to extend the working hours of doctors into the weekend without increasing pay or staff numbers, essentially stretching the current workforce. This is akin to stretching a bridge over a river without more materials and, without bringing more bricks (nursing staff), girders and support (imaging, pharmacy) and plans (money), this structure will collapse. The current estimate is around £20 billion and thousands more staff are needed. The government will not provide these funds
Why is all of this important? Because although it is clear that the current extension plans are indeed unnecessary, unwanted and impractical, the Government still wishes to proceed.
Numbers of expert colleges, academic and clinical staff, politicians and leaders have been critical of the Conservative-led reforms not due to political allegiance, but due to the unstable nature of change. We can see the NHS is being set up to fall and with it patient health. These changes are being forced through in direct contradiction to medical advice, by politicians who refuse to engage with frontline services, filibuster any bill challenging their ideas and repeat disputed information in the face of strong evidence.
The current movement to reform the NHS is not being made with patient safety in mind, or else extra funding would be allocated and further study into the effects of the changes made. The current reforms are political, and are unfortunately based on a Conservative manifesto that is unrealistic. The party wishes to, through the DH and its Health Secretary, enforce change in line with its promises in blatant disregard of destroying the machine it promises to save. Upon questioning, the party neglects rational discourse and has at times resorted to name calling and use of the media and social networks to turn the public against those attempting to protect them.
So why is the Government, in the presence of overwhelming evidence to the contrary, continuing with this new contract and its reforms? The answer is not simple, but revolves around finance. They wish to extend a service without funding to a point of abusing and exhausting its current staff, whilst removing all avenues to challenge their decisions. They do this not to just save money, but to turn the NHS into a machine of austerity. The only way to do this is by extending service unsafely, then selling it off to the highest bidder.
So why has the public not heard this? The public is unaware of this because the media have been sent partial or misleading information regarding motives. The DH has used 'death' without evidence to scaremonger the public, conflated essential and non-essential service provision to confuse the public into feeling they needed 24/7 elective care, and scapegoated doctors to make us seem the enemy. It takes a quick perusal of the headlines, which seem unfairly and curiously anti doctor, to see this.
This is an example of where politicians have used the NHS as a tool to fuel their own party's apparent success without any consideration of the NHS's future as whole as a nationally funded entity. It has in fact become less of a public entity under the Government, with more care becoming privatised, principally the social services, children's care and soon to be many other service lines. The Government wishes to dig in its heels and create an austere state at the cost of its public sector. It may plan to sell off the NHS by these means
In conclusion, to consider the current reforms without seeing the political and financial arguments is impossible, as like it or not the decision makers are politicians and their arguments political. The DH and the Health Secretary have been misleading, vague and unwilling to engage with the people. They will not listen, and silence any rational argument. The people's power comes from question and peaceful disagreement. I urge readers to do their own research and come to their own conclusions, and to spread this information, as the Government, in the spirit of any democracy, must be questioned and accountable. The current Government has begun a dangerous and Orwellian path to running the country, one which must be addressed.
And one warning: it starts with the NHS, but will extend beyond this scope. Talk to your doctor and nursing friends and get a different view. We can make a change here and now, protect patients and the NHS, and establish a new mandate for the power of evidence and the question for the public.
The opinions above are the author's own and do not reflect those of the employer.