Just as the Church of England is the Tory party at prayer, so is the Medical Profession the Tory party at work. Doctors, for all sorts of reasons, are natural conservatives.
But they tend – they are doctors after all – to be a particular type of conservative. They tend to be ‘One Nation’ conservatives. And that allows them to be both conservative, and, at the same time, as most doctors do, value the principles, if not the day to day practicalities, of the NHS, and all that it stands for.
It is no surprise, therefore, that some of Jobbing Doctor’s colleagues, and no doubt many thousands of doctors across the country, are eager for a Tory government after the next election, hoping that such a government will replace Labour’s ruinous policies with ‘honest and integrity’, and that we will see:
“…a new era where many working in the NHS are not undermined, subverted and ground down by top down comment, briefings and ‘initiatives’.”
Now, Dr No is of an age such that he remembers not only the last Tory government, but even back to when they came into power. He recalls the Lady from Grantham’s elocuted stridence, the destruction of the miners, the derision of ‘society’, and its replacement with a new mantra, the mantra of the market.
And he recalls that it was the Tories who, in the late nineteen eighties, started the NHS fragmentation and privatisation party. He recalls the early nineteen nineties, and the descent into wheeze and sleaze, and the overwhelming sense of relief when at last the Tories were voted out, and Labour came to power. Labour, we felt sure, would be true to its roots, and look after the NHS. History tells a different tale.
It is now so long since we had a Tory government that it seems not unlikely that few people remember (if they ever knew) the reality of those Tory years. But a leopard does not change its spots.
Mrs Hacksaw may no longer know her penny from her pencil, but her BAT-man is still very much in evidence, ready to jab a cigar in the eye of anyone in his way. Cam-the-Man talks openly of boosting the private sector. Even the sleaze has already begun. And we haven’t even had the election yet.
The fact is that no political party thinks that it can afford the NHS, but equally they know they cannot afford to ignore the NHS, for it is and remains one of the greatest achievements of the United Kingdom in the last century. For that reason, it is rightly loved and greatly valued by the people.
This is an intolerable position for any political party. They are, in effect, damned if they do, damned if they don’t. But they will. The next government, whatever its persuasion, will seek to wash it hands of the NHS financial black hole, while all the while assuring us that the NHS is, of course, safe in their hands.
The Tories, we should remember, have form on chopping up the NHS. Last time round it was Mrs Hacksaw who showed the way. Next time round it may be not a hacksaw, but a chainsaw, that the Tories take to the NHS.
It seems the real choice come the election will be between Labour’s death by a thousand cuts, and a Tory blood-bath.
Medical school intake mix is indeed tiger country, as JD notes.
Dr No was commenting on the change in the mix ten years ago. Dr No suspects that the shift towards more female and ethnic minority students and so doctors has been driven as much by alpha-1 white middle class males rejecting medicine as a career choice as much as better fairer selection procedures. In fact the selection procedures – particularly those that exclude face to face interview – may even be worse.
Dr No is public school middle class (surprise surprise), and so is no expert on what it is like to be from a deprived background, and doesn’t presume to be one. But he does note the apparent logic of more money = more opportunity; and that aspirational parents might give rise to aspirational kids. But he would prefer to listen to what JD and Fox in sox have to tell us, because they have been there and know what it is like.
Having said that, sometimes Dr No fears that JD’s solution – make state education as good as private education – is perhaps a little Utopian, and so wonders whether there should be a positive bias (for example, by accepting lower grades) towards selecting candidates from deprived backgrounds, on the grounds that – for example – a grade B achieved from a deprived background actually represents the same level of attainment as a grade A from a more privileged background (in other words if the students swapped places, they would also swap grades) – but he can also see how quickly such a system would lead to all sorts of rows about you’re only here because you come from the sink-estate…
Fox in sox – quite agree about nation of small businesses, and that it works, and the parallel with medicine. But society is moving away from this: out of town supermarkets spring up, village stores go, and what we buy is managed by a central logistics computer; and the real beneficiaries are the shareholders. Money talks. If we are going to get back to “Small is Beautiful” there needs to be some economic interference – left to their own devices, markets will trend towards bigger is better, economies of scale etc.
Dr G – the intelligent Martian might wonder if it was all to do with markets, and using markets to drive down costs. GPs might be independent contractors, but there is no market in the ordinary sense of the word to drive down costs – GPs’ pay is centrally fixed, and GPs – God forbid – do not compete to provide medical services on price. But that is exactly what a private supplier would be able to do. Two patients for the price of one, that sort of deal…