When the Sunday Telegraph emblazoned "Labour vows war on health unions", the shadow health secretary tweeted about it not being "the headline I expected." In that case, Wes Streeting is more stupid than I thought for supposing the Tory party's house journal would treat him fairly. Thing is, I don't believe his protestation. The headline was an accurate reflection of his comments about doctors and the NHS. And as the piece put distance between Labour's front bench and the militant mood of nurses, there will be Leader's office spinners satisfied with a job well done. Making capital unafraid of a Keir Starmer government remains Labour's main strategic objective, and the weekend's intervention on health matters ticks that box.
Streeting's interview had all the subtlety of a sad trombone at a wake. He attacked the British Medical Association and GPs specifically for voting to reduce their working day from 8-6.30 to 9-5. What he failed to mention was practices would flex their hours and schedule GPs to meet local demand. Nor did he address that the move intends to help the retention of doctors. If Streeting had bothered with his briefing notes, he'd know 45% of junior doctors were considering leaving the medical profession, which means a recruitment crisis for GPs. Someone might be "living on a different planet", but it's certainly not the BMA who are looking at stemming the bleed of doctors.
Pouring more petrol onto the fire, he said the BMA were "hostile" to his plans (what plans?) to increase GP access and enforce better standards. Streeting said he wanted to end the "something-for-nothing" culture, and this would be contingent on making extra cash available. There is indeed a something-for-nothing culture in the NHS. It happens daily in every clinic, walk-in centre, and hospital in the land - that is nurses and doctors come on shift and end up finishing long after their contracted hours. They donate something - their unpaid labour - in return for nothing to cover staffing shortfalls and budgets cut to the bone. This is very obviously not what Streeting is talking about. Instead he's playing to his audience, who imagine money is lavished on the NHS so nurses can dance around doing TikToks on the ward, and doctors nip off to enjoy long liquid lunches. And if Streeting-style change isn't accepted by the health unions, what then? Is he going to deny hospitals cash to speed up waiting times and securing more beds because health workers won't show the necessary subservience?
Ah yes, beds. Streeting did the Sunday round of politics programmes defending his plan to use private health capacity to ease the crisis in the NHS. This was him being "bravely" pragmatic, arguing that if people are in pain then using empty beds is the right thing. Patients won't care as long as they're treated and they don't pay a penny. Okay, in a pinch I could imagine any Labour government doing this as a stop gap. Including the one we never got led by Jeremy Corbyn. But to make a song and dance about it? After all, it wouldn't make much of a difference. Between 2001 and 2021, the NHS lost just over 80,000 beds with the steepest falls registered when Labour was in government. Meanwhile, with 6.8m who awaited hospital treatment in September, and the number of beds available in private health are just 8,000. It's but a drop in an ocean, suggesting Streeting's posturing on this issue is less about clearing backlogs and more to do with virtue signalling at wealthy donors and for-profit health interests.
Save perhaps Starmer and Rachel Reeves, the shadow health secretary is the most right wing member of Labour's front bench (putting aside this summer's dalliance with rail nationalisation and backing strikes). The only thing he can be reliably trusted with is ensuring capital finds more profitable outlets in the NHS, while continuing to underwrite it with state money and sustaining the ruinous role played by markets - so dysfunctional that NHS institutions had to find work arounds, until the government kyboshed their efforts. The NHS is in need of serious reform, but one that unleashes the creative power of its staff, throws off the strait jacket of commoditised relationships between its components, introduces proper democratic functioning and accountability, and enjoys budgets that meet clinical demand and staffing needs. This is diametrically opposite to Streeting's arrogant, briefcase-and-sharp-suit managerialism. And that is why when Labour win the next general election health workers and all who support them have to be ready to take on a Labour government as surely as they're fighting the Tories.
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Over several decades I collaborated from time to time on diagnostic R&D with NHS medics. For two years more recently I spent time meeting nursing staff to discuss problems and developments and recommend changes (even as trivial as cleaning lights in corridors) as well as visiting wards and patients as a friendly outsider to pick up patient feelings for feedback. In all that time I never met anyone in the NHS who was not dedicated to making things better for patients and improve the effectiveness and efficiency of the service. There was plenty of innovative thinking going on. There may be the bad apples but I never met one. My most painful experience was on a ward round chatting to a woman whose left arm was in a sling so that the right hand could move it. This was after cancer surgery that removed tumour in left arm lymph nodes causing nerve damage. I asked her about her work - she said she had been a professional cellist. I wept for her; this is what nurses have to cope with every day in plenty. To make any derogatory comment or deny them an income they need to live comfortably is malice, as well as economic madness.
ReplyDeleteIf you don't think Starmer will fight NHS privatisation and advance the class struggle, you're possibly not understanding social democracy correctly from a Marxist viewpoint.
ReplyDelete“Bravely pragmatic”.. I wondered why that sounded familiar? It echoes Starmer on the Andrew Marr show. He was asked what had happened to the Ten Pledges. The answer, “Look, I’m a pragmatist, not an ideologue.”
ReplyDeleteBTW, never trust any answer from a politician which stars off with “Look..”
«voting to reduce their working day from 8-6.30 to 9-5. [...] What he failed to mention was practices would flex their hours and schedule GPs to meet local demand.»
ReplyDeleteWhich GPs would they schedule? There is already a gigantic shortage of GPs, despite cramming every more "appointments" into each hour.
«45% of junior doctors were considering leaving the medical profession, which means a recruitment crisis for GPs.»
That means that 55% aren't, quite surprisingly... Also:
https://www.theguardian.com/society/2022/feb/09/britain-needs-to-double-the-number-of-doctors-it-trains
“Britain needs to double the number of doctors it trains
Last year 59% of new registrations in England had been trained by other countries, writes Prof Rachel Jenkins [...] This should not be as expensive to Treasury as feared, as the current putative costs are artificially set and do not reflect actual expenditure incurred by student training, either in the universities or in the health service.”
The treasury has been limiting the number of medical school places in England to save on training costs, because there is a steady stream of medical staff, mostly from south Asia and from Africa, trained at foreign taxpayer's cost more than willing to work hard in England. This also means that those people have a path to middle and upper-middle class earnings and status in a first-world country, rather than those being reserved to privileged english people.
«Between 2001 and 2021, the NHS lost just over 80,000 beds with the steepest falls registered when Labour was in government [...] and the number of beds available in private health are just 8,000.»
The issue is not beds, is that to expand the NHS it would take first of all expanding the staff numbers, and that would be expensive for higher-earning taxpayers; also despite immigration from south Asia and Africa having boomed since 2016, more than replacing EU immigration, it is still not sufficient.
«Save perhaps Starmer and Rachel Reeves, the shadow health secretary is the most right wing member of Labour's front bench»
In some columnist's view he is still a "trot":
https://blogs.spectator.co.uk/2019/12/corbyn-couldnt-have-done-it-without-moderates-like-jess-phillips/
“If Wes Streeting is your idea of an ally, your enemies have caught one hell of a break. On Thursday, he and all the other ‘friends of the community’ tried to put their anti-Semitic party into government and were only stopped by ex-steelworkers in Redcar and Workington. There is always a place for atonement but the Streeting tendency aren’t here to atone. They consider themselves victims of Corbynism when they were its enablers.”
«he's playing to his audience, who imagine money is lavished on the NHS so nurses can dance around doing TikToks on the ward, and doctors nip off to enjoy long liquid lunches. [...] budgets that meet clinical demand and staffing needs»
ReplyDeleteThere is a real problem there, and it is not the paranoid fantasies of affluent "Middle England" voters that their tax money is being frittered away by "lazy, uppity, overpaid NHS" workers, and it is this:
* Overall taxation (income plus other taxes) is mostly proportional (with some gentle progressivity), that is a percentage of earnings.
* If the NHS costs around 8% of GDP, that means that the average taxpayer household on £50,000/y has to pay 8% of their income to finance it, but 8% is also what must be paid by the lower earning people making £12,500/y and the higher earning people earning £200,000/y.
* That means that for *exactly the same service* lower earning people pay £1,000/y, average earning people £4,000/y and higher earning people £16,000/y.
* Those earning £200,000/y and paying £16,000/y are outraged by what appears to them discriminatory and parasitic price gouging against them, and know that if they paid £16,000/y per year for private medicine they would get a much better service than the NHS, and too bad for those earning £12,500/y, who could not afford much more than a dispensary with some pills.
The same for *all* state spending (especially state pensions and social insurance), and that's why tories and whigs in general want to move to flat taxes (not just flat tax rates...) like (in some measure) council taxes (and in the past the the poll tax).
Nobody on the "left" has explained to them that all state spending comes with a very expensive and enormously valuable form of insurance, that is insurance against the risk of being unable to pay the average cost of a state service.
In effect the average english resident who lives for around 80 years is paying for a lifetime medical insurance bill of around £320,000 in a way not too different from student fees.
Those who bitterly resent paying £16,000/y for exactly the same service for which someone else pays £1,000/y don't quite consider that if their earnings went from £200,000/y to £12,500/y they would become unable to pay for gold-plated medicine at £16,000/y, or even for an average level of medical support for £4,000/y, and that having *lifetime* medical insurance is extraordinarily expensive and can only be realistically paid in instalments proportional to earnings.
«the NHS lost just over 80,000 beds with the steepest falls registered when Labour was in government»
ReplyDelete«I wept for her; this is what nurses have to cope with every day in plenty. To make any derogatory comment or deny them an income they need to live comfortably is malice, as well as economic madness.»
During New Labour's government there was a turning point, that most people perhaps did not notice: New Labour made 500 NHS permanent career nurses redundant to replace them with cheaper (usually recently arrived) and younger agency nurses. This was a time when "the economy" was doing well, and there was no need to do that cut.
My impressions at the time was that this was a trial event, a "ballon d'essai", to see if "the public" (that is "Middle England"), who allegedly worshipped nurses, would be outraged by that cut. Well, "the public" drunk with joy on booming property profits could hardly care less, and if a haloed category as nurses could be deprived of their jobs just like that, that meant that that the “in the urgent need to remove rigidities and incorporate flexibility in [...] labour markets, we are all Thatcherites now” was a realistic policy, as the past 20 years of unremitting thatcherism have shown.
http://WWW.Economist.com/displaystory.cfm?story_id=486825
ReplyDelete2001: “MIGRANTS, according to research published by the Home Office this week, can help boost growth, reduce inflationary pressure and fill labour-market shortages. [...] The speed with which the government has executed a U-turn in its approach to immigration owes much to its need to bring in foreign workers to meet its recruitment targets for the NHS and education.”
http://www.guardian.co.uk/immigration/story/0,,1589275,00.html
2005: “Try this thought experiment: 43.5% of nurses recruited by the NHS since 1999 come from outside the UK.”
http://www.telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2006/07/02/do0202.xml&sSheet=/opinion/2006/07/02/ixopinion.html
2006: “It is bizarre that the Labour Party, which still continues to insist that it is the party of the poor and vulnerable, should endorse a policy the purpose of which is the creation of what Marx called "a reserve army of labour": a pool of workers whose presence ensures that rates of pay for cleaners and ancillary staff in the NHS can be kept as low as possible.”
@Shai Masot that Paul Mason quote never fails to entertain 😄
ReplyDeleteVery much like Blissex's point about insurance against loss of income. The other insurance is that against unexpected medical expenses; all commercial insurance schemes have limits. The NHS covers heart surgery, psychiatric care, cancers and all sorts of expensive treatments.
ReplyDelete'that their tax money is being frittered away by "lazy, uppity, overpaid NHS" workers,'
ReplyDeleteTake a recent paramedic shift from a FOAF. The first hour was spent picking up someone from a car accident. The next eleven hours were spent sitting outside A&E because there were no beds. This is not unusual.
The NHS consistently refuses to take responsibility for its performance. It takes an increasing slice of our GDP and delivers increasingly less for it.
Private companies don't do this. We don't hear a relentless stream of excuses from pharmaceutical companies, or scanning equipment manufacturers, about how hard their job is and can they have more of our money please. They have to find solutions or go bust.
I would have more sympathy for nurses and public sector workers in general if they hadn't spent the last two years demanding the economy be shut down, something which many at the time said was a decision taken without regard to the consequences including economic ones, and now want to be exempt from the consequences of the policies for which they fervently campaigned.
The solution for the NHS remains to adopt a continental style insurance style scheme. Would maintain the free at the point of use principle, would prioritise delivery over excuses, and would enable workers to get higher pay.
@Blissex
ReplyDeleteBy my calculations, the UK GDP is about £2.2trillion, and government spend about half of that - £1.1Trillion. Health spend is around £212Billion. So per head that works out about £3,260 (9.6% of GDP). If you multiply that by years lived, then it comes to around £260,000 if you live to about 80. That's in todays money.
Your argument about people paying different amounts of tax applies to all public expenditure, including defence, police, roads. You don't get more military support if you pay more tax, generally speaking. Nor do you get wider lanes on motorways. The problem is that there is an alternative (or a perceived one) to publicly funded health services, just as for education. So people can buy a "better" service - or at least, a more responsive / bespoke one. They then begin to question why they have to pay for a service they "don't use". The difficulty is in how to respond to this perception of "unfairness".
One way is to ban private medicine (and schools). Another is to tax it. But the first seems authoritarian, and the second compounds the perceived unfairness. The ideal response is to make the public service so good that the private one withers away through lack of demand. But this requires better funding, more government spending, and higher taxes. Which takes us back to the beginning. So long as it can be criticised, it will be, and any flaws used to justify a private alternative.
We need to accept that like all such services it will be imperfect, but that a shared service we all contribute too is best for the country as a whole, and by providing for a healthier population, we all benefit. This message needs to be reinforced and supported instead of continually attacked. Once again, as with so many issues, a significant factor is that the there are vested interests consistently and deliberately undermining this message.