Sunday 15 January 2023

Labour's NHS Crisis "Solutions"

The NHS is in crisis. You know it, I know, and even though he won't say it so does Rishi Sunak. The Labour Party have had a lot to say as well, but there has been studious avoidances of certain issues. Consider Keir Starmer's article for The Sunday Telegraph, which pretty much repeats everything the criminally overrated Wes Streeting talked about before Christmas.

According to Starmer, there are "hard choices" to be made about NHS reform. Committing to doubling the number of graduating doctors and nurses, and massively expanding training places, splashing out the cash isn't the only string to the Labour leader's bow. There needs to be proper reforms, "a ruthless focus on ensuring patients are treated better and sooner." The nod to prevention is there, consistent with his critique of sticking plaster politics. And he knows about the crisis in primary care, with the loss of 4,000 GPs over the last decade just as demand is growing - a demand that leads to swamped A&E departments. What's the big idea for addressing this?

Rolling back what Nye Bevan conceded when the NHS was founded to get the British Medical Association on board, Starmer wants to turn GPs into salaried employees. At present most own or are employed by practices that, for all intents and purposes, are businesses contracted to provide NHS services (indeed, amalgams of practices bid for and won for profit contracts for other services under the marketised provisions of the 2012 Health and Social Care Act). And here lies the first problem that Starmer nor Streeting have thought about. Yes, phasing out practices is something that should be cautiously welcomed. But because of how both men like to use NHS talking points to bad mouth medical professions, this has little to do with saving money or freeing up GPs from practice admin duties (what do they think practice managers are employed for?) and more about bureaucratic fiat: of being able to impose whatever working practices they wish directly versus the relative autonomy they currently enjoy. And this undoubtedly means more unsociable working and longer hours. What a way to curry favour with a profession Labour could do with having on side.

The second problem comes out of listening to too many focus groups and not enough medical opinion. Starmer would like to see an end to "bureaucratic nonsense". Who wouldn't? But to tackle it, why can't patients self-refer to specialists? This would leave GPs for more primary care functions, at least that appears to be the reasoning. Except all it's doing is displacing queues from one section of the health service to another. Instead of GPs having to sift through patients and deciding if they need targeted treatment, that now becomes the function of the specialist - leaving them less time to practice medicine. What a genius idea.

There are two omissions. As new Starmer number one fan, Anna Soubry, highlighted on last Thursday's Question Time, the NHS can't attract and is losing staff because the government are holding pay down at below market rates. Where in Starmer's screed or anywhere does he acknowledge this problem, let alone suggest a solution? Instead, when challenged on it he talks about not wanting to say anything ahead of pay negotiations yadder yadder. Starmer might have a particular approach to NHS staffing in mind in line with his emerging position on trade unions, but he's terrified of making too many costed promises mindful of a monstering by the right wing press and the Tories. The second problem is the bureaucracy he doesn't talk about. How the NHS is organised is bewildering and far from sexy, but its marketisation, ad hoc cooperation between providers, and subsequent direct subordination to the health secretary has left an organisational mess. As far as I'm aware, nowhere has Starmer or Streeting addressed the blockages and burdens this places on the NHS. Nor have they said anything about legacy PFI debt - of which between £60bn-£70bn is outstanding.

When politicians are making promises but drawing significant silences over other outstanding issues then something is afoot. And where they say it is significant too. There aren't too many of the 200,000 or so readers of the Sunday Telegraph champing at the bit over GP contract renegotiation or specialist referrals. All they see is Starmer has a plan to increase primary care's capacity to see more people. An obvious boon for the mainly elderly readership. But electorally speaking, they are but a sliver. More important are the Telegraph-reading Tory donors looking at Labour and wondering whether any pecuniary interests they have tied up in health will continue to provide returns in a benign environment. By not directly talking about pay, by talking up roles for the private sector (which Streeting has claimed he wants to "out-compete"), and not mentioning anything about the market, what conclusion can you draw other than "your investments are safe with us, and there will be future commercial opportunities too"?

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Robert Dyson said...

I will be brief. Yes.

Zoltan Jorovic said...

It feels like we are being forced down a narrowing tunnel of increasing darkness, with no light at the end. The walls are built from solid blocks of dogma, cemented with populist slogans and misinformation. Day after day the repetition of slogans and stock phrases substitutes for genuine analysis, and reinforces the constricting structure. Instead of offering a shining a light into the darkness to help us find our way out, we have more mindless chanting, recycling the failed ideas that have led us into this pit of despair.

Our choices are between more of the same, the same with added oppression, or the same but with a concerned expression. Imagination is directed and controlled to such an extent that it evaporates and we swallow the lie that there is no alternative to trudging forward into the bleak and lightless emptiness ahead. Surely the way is open for someone with the courage to offer a vision and the guts to say that we can do better? If it is not to be from the ranks of the main so called progressive party, it will be from those who can use people's anger, frustration and despair for their own ambitions.

It is no surprise that leaders like Trump, Bolsonaro, Erdogan, Orban, Johnson and even Putin, have arisen over the past decades. The failures of our own political system are creating the perfect conditions for a similar creature to erupt from the fetid swamp of the lies, manipulation, greed and exploitation that has been left to fester for so long. All Starmer does is splash about in the shallows, trying to keep from slipping under, while holding his nose and tutting.

Anonymous said...

NHS care worker here (mental health). GP appointments are impossible to get for patients and staff. You get put on hold for ages, only to get told to do e-consultant, or triage. It increases peoples distress which can impact on other NHS services (999/111, a&e, mental health).
Wider issues from NHS mental health;
A lot of the patients in the mh service require care packages, which are all outsourced to care agencies. Quality of cares lesser, no continuity of care, lack of accountability, time wasted chasing up agencies.
Many staff are NHSP, which is costly, and no continuity of care.
Over emphasis on university degrees. A newly qualified but far less experienced worker can earn more than a time served and experienced, but non-degree educated one.
Over reliance on the 3rd sector like MIND and various homeless and addiction charities. Again, lower quality care, no continuity of care, time wasting, undermines NHS staff labour etc.
It says NHS above the door, but thats about it.

Anonymous said...

Re gp appointment process - thats down to being under resourced, not individual fault.
Other issues are;

Overly target driven - this puts lots of pressure on staff and patients, often unrealistic.
Pen-pushing - staff expected to do increasing amounts of paperwork, rather than time with patients.
Depoliticized - unionizing isn't encouraged by way of omission, and the unions at times are useless. Staff made to feel, overtly and implicitly, at fault for service failures, because managers don't want to talk about the real issues - low pay, bad conditions, lack of resources and wider situation.

If you head over to the 'probation matters' blog you'll find the same issues.

Blissex said...

«NHS care worker here (mental health). GP appointments are impossible to get for patients and staff. You get put on hold for ages, only to get told to do e-consultant, or triage.»

Also after George Osborne out-thatchered Thatcher by managing to privatise the Royal Mail, every tory politician wants to be the one to pass to history as the one who out-thatchered Osborne by privatising the NHS.

As long as property prices keep booming (and they may be dipping for a bit), their voters write them a blank check on pretty much everything else.

Also the average middle-class "aspirational" tory (Conservative, New New Labour, LibDem) voter with a £100k-£200k/year family income are fed up that they are paying through taxes £8,000-£16,000/year for the same NHS service for which someone on £15k-£30k pays only £1,200-£1,600/year, when the real cost is around £4,000/year.

They would rather that the NHS disappeared, so they would go private and get a much better service, not burdened by subsidising low-income "scroungers".

Anonymous said...

Theres also, believe it or not, a lack of solidarity; us lesser/unskilled workers are looked down on, not advocated for or given voice etc. So everyones pitted against each other.

Anonymous said...

Attended an RCN pre-strike meeting today and was told that because Im in a union thats not yet balloted, I cant strike. After a reminder that Im also an NHS worker have been allowed to attend, but apparently cant hold any RCN banners or be in any photos, which isnt an issue.