Saturday 14 January 2017

Untangling Theresa May's Attack on GPs

It's not like the perennially slow and ultra-cautious Theresa May to take a risk. After all, her plodding leadership makes Gordon Brown look like Flashman. But that is what she's doing with her attack on GPs in response to the NHS crisis. It seems rash as government confrontations with medical professionals never end well for said government, so it's worth pausing for a moment to consider what's going on. Is this panic stations by a PM desperate to wriggle off the NHS hook, or something more calculating?

1. Theresa May is lucky at the moment. Her image as a grown up, calm professional politician remains the case for large numbers of people. She's not in control, her government is beset by crisis and paralysis, and those backbenchers retain their potential for trouble, but appearances assume a reality of their own if cultivated by enough outlets. May, understandably, would like to extend her honeymoon period indefinitely. Apart from the weekly drubbing at Prime Minister's Questions, the polls consistently show she hasn't got too much to worry about at the moment but she's been in the game long enough to know things can change, and however implausible it might seem presently Labour will close in on the government eventually. The NHS crisis has that potential to erode the Tory lead. Time and again, hospital winter beds crises follows Conservative governments as night follows day, and as they don't see it as a problem to be solved but rather managed. After all, taking the health service to the edge of crisis makes to argument that we can no longer afford to fully fund appear that bit more plausible.

2. May's announcement that the GPs will be expected to stay open for longer is entirely in this mould. Rather than release more money or undo the market mechanisms strangling the NHS, the Tories are looking for a way out, something or someone apart from themselves that are to blame. We know from repeat research, press reports and the like that the proximate cause of the problems is demand. Demand driven by the cutting of adult care services, the closure of GP surgeries thanks to an ongoing recruitment deficit, and the shutting down of NHS Walk-in centres. The Tories know this very well: their refusal to act on it isn't a matter of ignorance. Indeed, for them the fact that somehow the entire system hasn't collapsed and is treating record numbers is something to be celebrated. Nevertheless, singling out the GPs is about deflecting blame. The BMA are entirely correct that the government is casting around for a scapegoat.

3. Political ideas and arguments are powerful if they chime with enough people's experiences. The singling out of GP's services is no accident. Everyone knows, thanks to targets introduced under the blessed Blair that getting a doctor's appointment is bloody difficult. How many people have waited until the moment a surgery opens to try and blag an emergency consultation? It's not so much GP services are overstretched, but the rules by which they operate reduce the efficiency of the service and make for worse, more stressful experiences for patients. Because of this, lengthening opening hours appears to make sense. Dialing in to beat the engaged tone would become a thing of the past if only services were available for longer, and you wouldn't have to nip along to A&E. It therefore follows that GPs are the ones to blame for the NHS crisis because they're not doing their jobs properly. The political logic from the Tories' point of view is sound, because their argument might rub against a kernel of some patients' experiences. But we know this isn't a serious solution to a serious problem because the directive comes without the release of any extra money to fund the new opening hours, and that means reduced services, albeit available throughout the day.

It's almost as if the Tories are willing to run down the NHS further to avoid embarrassing headlines.


Walsie said...

The government seems to assume that having the doors open longer equate to more appointments. Untrue, given the recruitment crisis for GP's, the propensity for what new recruits there are to opt for "softer" areas than - say - Stoke or Sunderland - and the increased demands driven by demography.

Blissex said...

«the closure of GP surgeries thanks to an ongoing recruitment deficit,»

There is no recruitment deficit: rather the acceptance rate for medical degrees is around 6%, because medical degree courses are very expensive and the government has incentivised universities to restrict places to save money, and then to rely on ready-trained immigrant doctors to fill the gap. For Conservative and New Labour governments most universities are pre-employment holding areas to keep reported unemployment down, and the goal is to minimize their cost.

Blissex said...

«opt for "softer" areas than - say - Stoke or Sunderland»

As to that a lot of NHS problems are due to the dumping of older people onto it because local council care services have been savagely cut; and we all know that local council budgets have been cut especially severely in the north and other Labour voting areas. So there is a strong regional aspect to the NHS crisis.

To a large extent the «conservatory building classes» of the south are quite happy with that as they don't see why ever their taxes should be used to fund even bronze-plated public services for "useless scroungers".
Many of them can easily fund going private from their massive property capital gains.

And even today Labour, especially of course the PLP, will not draw attention to the consequences of the cuts in the north and in their "core vote" areas, because it might irritate the «conservatory building classes» as being "divisive" and "class war".

Blissex said...

The GPs are *partially* responsible for the NHS crisis: thanks to Tony Blair and his love of the «aspirational voters who shop at John Lewis and Waitrose», among them of course doctors, they got very, very generous pay packages if consultants and very, very generous profits if they run general practices. Plus they have severely restricted access to the profession via limited university places.

In addition every government have piled huge extra bureaucratic and continuous-training requirements on doctors and dentists, in response to various incidents or worries, mostly to cover-their-asses by making-believe that they had mandated all that could be mandated.

Anonymous said...

«It's almost as if the Tories are willing to run down the NHS further»

It seems a long run plan, a "salami slicing" or "boiling the frog technique", as per two of my usual quotes that taken together seems quite explicative, the first from K Clarke's memories, where he report being able to slow down the plan:
«His first challenge at health was heading off Thatcher, who "wanted to go to the American system", he reveals. "I had ferocious rows with her about it. She wanted compulsory insurance, with the state paying the premiums for the less well-off. I thought that was a disaster. The American system is hopeless … dreadful." He prevailed on her to take a different route by introducing more competition into the NHS. It became known – in a phrase he didn't like – as "the internal market". Ever since then, successive governments have pushed in broadly the same direction.»

The second from the Thatcher archive, her letter to Hayek where she says that the goal is to establish a Pinochet-style economy, but little by little:
««I was aware of the remarkable success of the Chilean economy in reducing the share of Government expenditure substantially over the decade of the 70s. The progression from Allende's Socialism to the free enterprise capitalist economy of the 1980s is a striking example of economic reform from which we can learn many lessons.
However, I am sure you will agree that, in Britain with our democratic institutions and the need for a high degree of consent, some of the measures adopted in Chile are quite unacceptable. Our reform must be in line with our traditions and our Constitution.
At times the process may seem painfully slow. But I am certain we shall achieve our reforms in our own way and in our own time. Then they will endure.

Igor Belanov said...

I think with this kind of underhand tactic enough mud sticks for the government to take the risk.

They have been very successful in evading responsibility for a huge variety of problems, and the range of scapegoats is impressive. It is truly ironic that hard-pressed local authorities with next-to-no freedom of action come in for more stick than Westminster.