I’m hard-pressed to know how to start this post without sounding melodramatic. Ah, screw it – I’m just going to tell it how I see it. In the last week, after a long stealth-campaign against it, the Tories declared all-out war – in a carefully managed way, of course – on the NHS.
But if you blinked, you might be excused for missing it. Nobody in the mainstream media is drawing much attention to it. Even the better papers, such as The Guardian and The Independent, who are trying to highlight the government’s actions and plans toward the NHS, haven’t yet (that I’ve seen) drawn together the various threads into one article to let people see the the scale of this ‘declaration of war’. So I’ll try to do it here.
I wrote a few days ago that I could see, from the way ‘Health Secretary’ Andrew Lansley (I put ‘Health Secretary’ in speechmarks because in his Health & Social Care Act, he severed his duty to provide health, so as far as I’m concerned Britain no longer has a Health Secretary, just a stuffed suit responsible for demolition) and the right-wing media were behaving, that the Tories were planning a new ‘push’ in their plans to downgrade, dismantle and sell off the NHS. In his statements in Parliament and press, Lansley (whose office is part-funded by a private healthcare company!) was carefully staging a ‘non-protective defence’ of the NHS, while a media campaign was building to knock down its standing in the eyes of the public. This is how the Tories always prepare for an attack on one of our public services, to divide public opinion and soften public resistance to measures that it would never tolerate if it knew the truth.
Well, I was more right than I knew, and how I wish I’d been wrong. The campaign has stepped up from being a war of attrition or stealth to an assault on all fronts. If you get your news mainly from the television media, you could be forgiven for missing it – the silence of BBC television on recent announcements and revelations concerning the NHS has really been quite shameful. The latest banking scandal is exactly that – a scandal – but yesterday BBC News devoted a whole day almost exclusively to the resignation of one man, while measures that will cause tens of thousands to lose their jobs and millions to suffer degraded health-care have passed unmarked – and it’s far from the first time.
Meanwhile, the campaign in the right-wing print media (and via Lansley’s comments in Parliament and interviews) to swing public opinion away from the NHS has picked up pace. Last week’s King’s Fund report on a record fall in public satisfaction with the NHS since the coalition took office, instead of being seen correctly as a damning indictment of the government’s treatment and handling of the NHS, was somehow spun into demonstrating that the NHS needs fixing. This week, among many other items, a Marie Curie Foundation report into the care of dying patients is reported in the Telegraph as a demonstration of nurses’ hard-heartedness.
Let’s look at this article a little more closely, as it’s really so outrageous that I can’t let it pass without a more detailed comment. The article was headlined ‘Patients in hospital are needlessly dying in pain and being stripped of their dignity and privacy‘, and the first line ran ‘half of families said hospital nurses did not always treat their dying family member with respect‘.
Way, way down the article is a quote that acknowledges that, in fact, 75% of people said that the care their dying loved one received was outstanding, excellent or good, but the article is clearly slanted to leave readers with a bad taste in their mouth about the attitude of nurses – to strip away our natural sympathy for the people who do things we wouldn’t dream of in order to improve life for the ill and dying.
As you’ll know if you’re a regular reader of this blog, I’m married to a nurse – a very diligent, passionate and compassionate one. She’d be the first to admit that hospitals aren’t perfect, and neither are nurses. But it’s the height (depth?) of irresponsible (or malicious) journalism to treat a report like the MCF’s superficially and use it for cheap headlines.
Being married to a nurse for 27 years, you hear some stuff. I’ve lost count of the number of times I’ve seen my wife in tears over the death of a patient and the sadness of his/her family. But I also know that – excusably under the grief and stress of bereavement – relatives tend to have a skewed perception of what’s going on around their loved one. Family might visit a patient to find he’s soiled his bed and become understandably outraged – understandably, that is, if you don’t realise that he’s already been cleaned and changed 4 times that day and would have been again if the patient in the next bay hadn’t just ‘coded’ and needed ‘all hands’ to save his life; or they might become angry that he’s in pain and not understand that the nurses have given him as much medication as they’re allowed to and are waiting for a very busy and overstretched doctor to come and write a new ‘scrip’ so they can increase the morphine dose. And then there are the people who don’t see or don’t care that their loved one is not the only patient on the ward in need of care, and who become resentful if there’s a delay even of a couple of minutes in the provision of something.
And so on. My wife doesn’t blame her patients’ relatives for these misunderstandings – when you’re losing someone you love, you get pretty much a free pass in terms of attitude. But when you understand the dynamics of a bereavement situation, it’s very clear that to achieve over a 75% ‘good or better’ rating in such a survey is a gargantuan achievement – especially in the context of the cuts in staff and resources that have already taken place and how these overstretch both staff and facilities.
And this overstretching is not accidental. The Guardian – one of the very few mainstream publications to take a proper stance to draw public attention to the governments motives and methods – published yesterday a report on comments by Dr Gabriel Scally, who has resigned from the Dept of Health to be free to reveal how Lansley’s team are conducting a campaign of ‘planned enfeebling‘ to allow the government to achieve its aim of dismantling the state, including and perhaps especially the NHS, in ‘a systematic downgrading, if not destruction, of civil society in England’. No wonder nurses can’t always make time to be as attentive and sensitive as they should be and would wish to be. But you won’t see that highlighted in rags like the Telegraph.
Anyway. Hopefully that little aside will give you at least a flavour of how headlines can mislead, but back on track: all-out war. We’ve already looked at the media front. Here are the other fronts that the government on which the government is attacking the NHS (I may not be aware of some, so if I’ve missed something let me know!):
Massive cuts in numbers
Unbelievably, in spite of admitting that the NHS made a surplus of £1.6 billion in 2011, and in spite of the NHS being rated as the 2nd most efficient health service in the developed world, a few days ago Lansley ‘trailed‘ cuts in numbers of beds and closures of wards and even whole hospitals as a result of his ‘reforms’, and even has the audacity to claim that such cuts would ‘lead to better services‘ (!!!!). These cuts are part of the government’s long-stated aim of ‘efficiency-savings’ of £20 billion per year by 2015. However, what is not so well known is that the government has set the NHS the target of a further £30 billion in cuts by 2020. Since the current annual NHS budget is around £120 billion, this means cuts between now and 2020 of around 42% in NHS spending. So much for ‘safe in our hands’.
Plans to cut over 50,000 NHS jobs were revealed by TUC ‘Freedom of Information Act’ requests last year, as Trusts planned ways to achieve the £20 billion target. Plainly, more than doubling the cut – or ‘efficiency improvement’ – target can only be achieved by further big reductions in staff and treatments. This can only mean falling service levels, clearly part of the government’s strategy of setting the NHS up to fail so that it can justify each privatisation measure as it’s announced.
Lansley based his outrageous claim that the cuts will lead to improved services on the idea that services would be provided in the home instead of in hospitals. But if a patient is in his or her own home, either a nurse has to stay with each patient 24/7, which would mean a massive increase in staff numbers and costs; or nurses will have to travel from home to home, leaving each patient and their family to fend for themselves as the nurse moves on to the next home – and in neither case are the resources for acute intervention going to be available like they are in a hospital. Can anyone really defend either as an ‘improvement’? Not even the Telegraph, actually – again well down the article, the very last graph shows that management of pain at home for terminal patients is far worse than for those in hospital. Which is absolutely to be expected.
Cuts in spending to develop new drugs
The government is planning to save £3.5 billion a year by squeezing its spending on the latest drugs and concentrating on cheaper, older – and less effective – medicines. Patient outcomes will inevitably suffer, and in the end it will be a false economy. Patients will recover less quickly or less fully, and require more and longer treatment and care, which will put more strain on resources in other areas (a subtle extension of the ‘setting up to fail’ policy?). In addition, drug companies will be demotivated to spend on drug development at a time when resistance to antibiotics is at an all-time high and increasing.
Coercive cuts in pay and conditions
For some time now, the government has been floating the idea of regional pay – the idea that public staff in some areas should be paid less and that this will be good both for public finances and private businesses. This idea is absolute nonsense and can only harm both local economies and the national one. But once you start to turn over the rock under which the government hides its real motives for these ‘reforms’, you see that they have nothing to do with cost-saving and ‘efficiency’ (it can’t be, because in spite of Tory claims, the NHS is the 2nd-most efficient health service in the world and costs less than half as much per person as the US profit-based system the Tories want to emulate), and everything to do with making the NHS more attractive and profitable for the private companies who pay heavily into Tory coffers and will provide employment for ex-Ministers once they’re out of power. So, how are they planning to achieve this plainly damnable aim?
The Cambridge Dictionary defines a cartel as:
‘a group of similar independent companies who join together to control prices and limit competition‘
Businesses found guilty of forming cartels are subject to severe penalties. Companies face huge fines, while directors can face substantial prison sentences. Government ministers rail against cartels, grandstanding to win public approval for supposedly standing against attempts to collaboratively avoid competition and fix prices.
Truly the hypocrisy of this government knows no bounds. To force staff into accepting the destruction of their pay, terms and conditions, the government is sanctioning actions that would usually be completely illegal. While condemning commercial cartels when it suits them, they give a nod to the blackmail and extortion of doctors, nurses and other health workers. 16 NHS trusts in the South-West of England have banded together – paying a £10,000 fee to a ‘consultant’ to do so, in order to corral health-workers, giving them no choice but to accept cuts in pay and terms, and extended hours, if they want to continue working in the NHS in the south-west region, because all the local trusts will be working in concert. But it’s not a cartel, it’s a ‘consortium’. So that’s alright then.
If it walks like a duck… – without question this predatory measure fits exactly the definition of a cartel and would be considered completely illegal in any other setting. But as part of the government’s war on the NHS? Oh, that’s entirely different – knock yourselves out!
And the south-west is just a pilot project. Already a similar cartel has been formed in the north-west, and without question if these two are allowed to succeed the same model will be used all over the country. It’s nothing less than gangsterism – and it should be recognised, vilified and punished as such.
Which brings us back to the media front. If you’ll excuse the mixed metaphor, the above two ‘fronts’ are like two legs of a tripod – they won’t stand up without a third. To get away with robbery of the public treasure on this scale long enough to push these measures through and make them stick, the government needs to win the public-relations battle – either by keeping them out of the public consciousness or by turning public opinion against the NHS.
The revelations by the TUC – thanks to a co-ordinated Freedom of Information campaign – of the numbers of staff NHS trusts are planning to cut has forced the government’s hand to a degree. So far they’ve managed to keep any mention (so far as I’ve seen) of these cuts and of the pay cartels out of the television news, but there has been some mention in other media. So the government is going to concentrate on degrading public esteem for the NHS – primarily via ‘friendly’ media in order to distance itself from the process. There will be a marked increase over the coming weeks and months in the number of negatively-spun articles on the NHS in the right-wing broadsheets and gutter press, all designed to prevent the groundswell of outrage that the government’s criminal assault and sell-off would otherwise surely provoke.
It’s up to us – the right-thinking people who can be bothered to find things out for ourselves rather than accept being spoon-fed lies – not to be fooled. And to work hard make sure this doesn’t happen; to spread the word, tell our friends, colleagues, anyone who’ll listen and some who won’t. To be unafraid to be a nuisance, a bore or labelled as a ‘fringe’; to join in when we hear about a protest or a campaign; and to ensure that the groundswell builds.
It can be done. There are no grounds or excuses for apathy or inaction. I’ve had several conversations in the past week that started with people being sceptical or completely ignorant about what is happening, and which ended with them being as outraged as I am. The facts speak for themselves, if we can just make them known – that’s why this government is working so hard to hide, disguise or spin them, and to vilify the NHS and our other public-sector workers.
If we can build recognition and awareness, outrage will surely follow. And with enough outrage, on a wide enough basis, we can stop this crime – or at least retard it to minimise the damage done until we can remove these gangsters from power in 2015 (at the latest). Let’s get to it.