GPs are in a very good position to see, feel and understand the pressure austerity and underfunding of public services have placed on the poor, the vulnerable and, increasingly, the better off. In my surgeries, I have seen support slashed for people with severe mental illness; patients summarily evicted from their privately rented homes because they expressed the slightest complaint; 90% of child protection concerns rejected as resources become stretched beyond safety limits.
Complaints about access to the practice are multiplying as our resources become stretched beyond safety limits, food banks are becoming essential for our patients. I have seen the increasing difficulty of obtaining social care, and, of course, the threats to our registrars, doctors in training, nurses and allied health professionals.
These multiple and diverse threats to our state and civic life are profound. Austerity and marketisation have been chosen as hammers for the NHS and social care. Housing, health and education are being turned into a competitive, fragmented free-for-all to which the more vulnerable are increasingly exposed. Risk is being transferred from the state to individuals – it is an increasingly harsh world.
NHS under pressure
The impact of austerity on the staff and the running of the NHS is also profound. Targets missed, social care falling apart, and the junior doctor strike.
Behind these assaults is a programme, a plan begun even before Margaret Thatcher’s government. Her main task was to smash the power of the unions. She had ambitions to change the nature of the state and the NHS but had neither the support nor the time to do that part of the programme.
We can catch a glimpse into the plans in key documents such as Privatising the world: a study of international privatisation in theory and in practice written in 1988 by John Redwood and Oliver Letwin, both still prominent Conservative figures.
The 2005 Tory policy book Direct Democracy: An Agenda for a New Model Party called for the NHS to be replaced by an insurance system. This was co-authored by Jeremy Hunt, although he denies that the chapter on the NHS was written by him – and says that it does not represent his views.
There are steps in these publications that include:
- The NHS to be established as an independent trust (or trusts).
- Increased use of joint ventures between the NHS and the private sector.
- ‘Extending the principle of charging’, starting with a system of ‘health credits’ to be combined with a contributory national health insurance scheme based on personal health budgets.
If this vision for the NHS were to bear fruit, our health service could have CCGs acting as insurance pools, buying care from private companies. The NHS would become a state insurer along the lines of Medicare in the US.
Personal health budgets, which allow patients rather than doctors to decide how money is spent on treating their conditions, will be extended to 5m people by 2018. Critics of the scheme fear this could lead to co-payments funded through private insurance.
These changes may be more likely to come about if the NHS is allowed to be run down to a point at which everyone agrees SOMETHING MUST BE DONE. In some ways, the more chaos and strife in the health and care sector, the better for those who would like to see a move to an insurance model – it could seem increasingly obvious that the current way of managing the service is inadequate and inappropriate, and that an alternative must be found.
Voices suggesting we have reached this crisis point are beginning to howl, like wolves in the night. Professor Bruce Keogh, medical director of the NHS in England, suggested last year that the NHS may be forced to abandon the provision of universal free healthcare. The taxpayer-funded NHS, with services free at the point of use, may not be 'sustainable in the longer term', he warned.
What part should we GPs play to protect the NHS and our patients in this forbidding scenario? We have a feeble new contract which goes nowhere towards fixing our problems. We increasingly patch up a failing system by using workarounds and going the extra mile. The special LMC conference in January showed our anger – but moved back from the brink of industrial action.
We face organised, long-term neo-liberal planning to destabilise and dismantle our NHS. Even if we run the risk that industrial action could be used as further evidence for abandoning the social contract that underpins the NHS – we have to fight back. The BMA and RCGP have begun the process of demanding a fair and safe service for ourselves and the people of England. We have to back them up with a loud and clear stand on industrial action. I understand Unite is exploring legal options. One possibility might be a work to rule. If we stuck to the hours in our contract, I imagine the NHS would grind to a halt. We should also support the nurses and AHPs as well as our consultant colleagues whose contract seems to be as threatening as that of their juniors.
We no longer want to see, every day in our surgeries, the impact of this callous long-term plan on our patients and ourselves. Together we can make a difference.
- Dr Brian Fisher is a GP in Lewisham, east London, and honorary vice president of the Socialist Health Association.
Photo: Dan Wootton