GP and health campaigner Dr Louise Irvine stands alongside TV comic and actor Rufus Hound in front of around 50 college students.
She’s headlining this political-comedy double bill, but her warm-up act, back at his former sixth-form college in Godalming, Surrey, has the teenage audience entertained with a passionate argument against mainstream politics.
‘The NHS is being taken apart piece by piece,’ he warns. Introducing Dr Irvine, the comic says she would ‘rather be helping sick people’ than standing against health secretary Jeremy Hunt. Dr Irvine, however, seems to be enjoying herself.
The South West Surrey constituency – where Mr Hunt has been the MP since 2005 – is a world away from Dr Irvine’s practice and home in Lewisham, south-east London – a multicultural inner-city borough with areas of high deprivation. The contrast is stark as the predominantly white students ask questions enthusiastically in polished Home Counties accents.
The face of Mr Hunt – South West Surrey MP since 2005 – peers from signs standing in manicured bushes around expensive homes throughout Godalming. In 2010 the MP won almost 59% of the vote.
Dr Irvine is buoyed though, after bookies placed her as second favourite. She is standing as a candidate for the National Health Action (NHA) party, founded by doctors opposed to Andrew Lansley’s Health and Social Care Act. ‘Things are beginning to change in society,’ she tells the college students. ‘People are beginning to want something other than the main parties.’
Democracy, Dr Irvine tells the sixth-formers, ‘is about more than voting - it's about trying to change the world’.
You've given me an option other than spoiling the ballot."
Sixth-former's response to Dr Irvine's campaign
She became involved in the women's movement as a college student, she says.
They won important battles, just as the campaign she led against Mr Hunt’s plans to downgrade Lewisham hospital also won.
Her manifesto calls for an immediate cash injection of £4.5bn for the NHS followed by sufficient funding to plug NHS England’s projected £30bn black hole.
A student asked Dr Irvine how, in these apparently straitened times, the country could afford the proposals. ‘You can make choices,’ she responds. Citing Nobel economist Paul Krugman, Dr Irvine argues that paying off the deficit doesn’t have to take priority over funding services.
NHS funding plans
Over lunch in the local pub, Dr Irvine says the ‘elephant in the room’ of the election is the 2-3% productivity growth NHS England says is necessary, on top of an £8bn-a-year above-inflation funding rise, to maintain services at current levels – equal to £22bn a year efficiency savings by 2020/21.
Recent Health Foundation research suggested the NHS had achieved productivity growth of just 0.4% over the last parliament, well below the 1.2% previously assumed.
‘And that was on the back of massive cuts,’ Dr Irvine says. ‘They've exhausted opportunities for efficiencies in the last five years.
‘You saw a winter crisis that's a year-round crisis, you've seen cancer and primary care going backwards, massive cuts in community nursing, mental health is in crisis.’
The savings target was missed, Dr Irvine says, because staffing cuts made to improve productivity had to be reversed. ‘If you want to improve your efficiency you cut your inputs, cut your staff. You do that, you get Mid Staffs.’
If the system was unable to manage 2% over the last five years, how will it achieve 3% over the next five?
Integrated NHS care
She is sceptical of the official consensus that savings will come by transforming services, better integration and care closer to home.
It needs parallel funding, she says. ‘You can't close hospitals before you find out what alternatives really work.
‘We don't know if it would cost less. We can't carry on cutting there until and unless we know we have an alternative that's really working. It's possible you need both.’
An immediate cash injection will be necessary, whatever the next government plans, otherwise the service is ‘heading to a cliff edge’.
NHA proposes reforms that Dr Irvine says would save money, such as writing off PFI debt and abolishing the internal market and competition.
The party calls for a 1p income tax rise to increase funding, which Dr Irvine says the public have backed in opinion polls. ‘As a society we have to decide: do we want an NHS, or do we want low tax?’ she says.
Traditional general practice
The NHA says it supports the ‘traditional model of general practice’. This means, Dr Irvine explains, the core values of continuity of care, personal relationships and knowledge of the community. While not opposed in principle to new models of providing general practice, existing alternatives do not seem to meet those principles. APMS private providers tend not to value continuity, she says.
She is sceptical also about demands the service scale-up to meet growing and changing demand.
General practice is a cost-effective service, she says. It just needs proper funding. ‘People say you can't fix things by throwing money at it. Well I say, it's a good start.’
That goes for her party’s call for 10,000 new GPs as well. What differentiates her call for more GPs from similar pledges from the big parties, is that they refuse to accept that they have run down the service.
Dr Irvine, a GP training programme director, agrees with Labour and the Tories that recruitment depends on making the job more attractive.
‘We could recruit. If we are able to say to young doctors, come into general practice and it’ll be a great job again: you'll have time to see patients, you're going to have resources to do the job properly.’
After her talk at the college students hang around to talk to Dr Irvine and take selfies with her comedy sidekick. Several volunteer to help campaign. One young woman who spoke of her fear of anti-immigrant sentiments told Dr Irvine: ‘You've given me an option other than spoiling the ballot.’