Of all the reasons to end a long and bitter industrial dispute, imposing an unwelcome contract on a demoralised workforce to “end the uncertainty” has to be the most bizarre, given the inevitable outcome of the imposition will be not less, but more uncertainty. The demoralised workforce, our junior doctors, are already in bad shape, overstretched and in poor morale. Record numbers are considering – though we don’t yet know how many will pull the ejector seat lever – working abroad. Late last year we learnt that almost half of juniors completing their foundation training chose not to proceed directly with their training – a sure sign of ambivalence about the direction of their chosen career. Hospitals face unprecedented recruitment problems, winter pressures are now being mirrored by summer pressures, with the imminent prospect of all year round pressures. The health service is in a critical way, at risk of implosion. So what does the Health Secretary do when he doesn’t get his own way with the juniors? He hits them on the head. Hard.
Browsing the web about the latest round of Health and Social Care Bill backed pile-em-high, sell-em-higher NHS services currently out to private sector tender, Dr No chanced upon a success statement (SS) so hilarious his eyes would have popped (EWP) were it not for the fact that it came from the Orkneys, where Dr No had the privilege of spending a few weeks as a medical student with a real GP doing real medicine. The statement reads:
SHARED SERVICES IN THE ORKNEY ISLANDS
Yesterday’s news was bob-a-job docs, £55 for each and every dementia diagnosis, with old hands who should know better – they have been handbagging item of service fees in various shapes and forms since the beginning of time – decrying the idea as bribery, likely to cloud professional judgement, possibly even unethical. Dr No will believe their wails when they start handing back the contents of their handbags. For his part, Dr No thinks the idea, though crude, is not without merit, even if the sum is paltry for what is rather more long-term work than a snap diagnosis, because it sends a signal in terms the ex-apothecaries have always understood – payment for an item of service. Dementia is under-diagnosed, and patients and carers who want to know and plan miss out on help that is or at least should be available. Indeed, upping the recorded prevalence might even push up dementia funding. So all in all, though a bit grubby, the idea gets Dr No’s approval.
As acronyms go, it’s the tits-up PITTs, but for many concerned about the NHS, it is a pile of shit. Presented as a partnership, TTIP – the Transatlantic Trade and Investment Partnership – is, depending on your point of view, either a sensible deregulation of transatlantic trade and investment that will free up a few extra bob for the folks back home, or Ernst Stavro Blofeld writ large, hell-bent on a grim SPECTRE TM – much more of this, and Dr No will need treatment for acronymitis – of corporate world domination at the expense of the nation-state. At the crux for health care is a TTIP proposal to allow private capital to sue sovereign states in ‘ad hoc’ tribunals for loss of profit. Claims of this sort have already happened under other trade agreements: in Europe, the private Dutch health insurance company ACHMEA recently sued Slovakia after a new government introduced a more socialised health service that threatened ACHMEA’s profits. The outcome appears for now at least to be in Slovakia’s favour: the tribunal said it had no jurisdiction – ‘the design and implementation of its public healthcare policy is for the State alone to assess’ – meaning, in effect, ACHMEA had lost.
Writing in the Guardian last week, Simon Jenkins had a Big Idea, that small is best. Correctly concluding that central political meddling in the NHS has failed, he opted for the nuclear option. The core of his idea, which like the core of an apple had both rough bits and voids in it, but sadly unlike an apple no seeds, was that, since every other conceivable option has been tried and seen to fail, that left but one course of action: the NHS must be broken up. In prose that crashed about like a driverless juggernaut, the final jack-knifing when it came was curiously more hanging whimper than decisive bang: ‘Denationalisation is now the only version of a public health service not tried’. One fancies a Churchill bell may have been tolling in Jenko’s head. ‘It has been said that democracy is the worst form of government except all the others that have been tried’…‘denationalisation is the best arrangement except all the others not tried’ (sic).
As part of a welcome recent trend, the Today programme this morning was presented by Monty and Mish, the twin set who occasionally manage to drop pearls. Devoid of the deadweight of burnt-out testosterone that burdens the older male presenters, Monty and Mish manage at times almost to sing, but since ’tis the season for mistletoe in the house and so guest editors on Today, the links were peppered with references to “the musician P J Harvey” and “P J Harvey the musician”, who, it was said somewhat defensively, was responsible as guest editor for doing ‘something unusual’ to the programme. As doing anything let alone something unusual to the Today programme is known to provoke a mailbag the size of a mammoth, Monty and Mish were right to sound anxious, but the bigger question was could anyone really do anything unusual to the Today programme? The answer, as it turned out, was an unexpected yes.
One of the more tiresome ways of our legislators is their habit of changing law through the use of amendment clauses. You know the sort of thing: instead of rewriting the clause from scratch, and presenting it in its entirety, we have ‘In section 650 of the National Health Service Act 2006 (Chapter 5A of Part 2: interpretation) (the existing text of which becomes subsection (1)) at the end, insert—’, the end result of which is a serpentine spaghetti of words so convoluted that the eyes glaze over and the temples throb. Never mind that the apparent zero after 65 is in fact the letter ‘O’, or that the said Act 2006 appears in fact to be said Act 2009; the fog generated while trying to cobble together the parts to make an intelligible whole is a masterpiece of Sir Humphreian obfuscation.
While Dr No has been away frying other fish, it seems the Tories have been sneaking a few of their own right old brown trouts through the S bends and P traps of US/EU trade negotiations. Like those in the wild, these fish are well camouflaged. Against a backdrop of general do-goodery – free trade, liberalisation of markets, and boosting of GDPs – there is some serious mumbo-jumbo about the steps needed to break down barriers to trade not just in goods, but services. The scope is grand: all sectors are covered unless specifically excluded. No longer will Detroit be able to give das auto da boot; nor will M. ’Ollandaise be able to stop Hollywood setting up Frollywood on the French Riviera – unless exclusions are granted. But here’s the thing: while other governments are geeing up to protect their important sectors, our Tory led government is eerily silent on excluding what is arguably today our biggest and most defining sector: the NHS.
The night before last, the Section 75 Regulations slipped through The Lords like a U-boat, silent and deep. A limpet mine attached to the hull by one Lord Hunt failed to go off, and the boat got through unscathed. The crew even found time to loose off a few tin fish at 38 Degrees, but, on the whole, anyone watching the surface of events would have seen nothing remarkable. Certainly the BBC saw nothing remarkable, and reported nothing. The recent Reynolds analogy, that if the Health and Social Care Act was an aeroplane, then the regulations were the engines that would enable it to fly, failed to take off, leaving no scope for engines on fire, or jumbo-jets falling out of the sky. The health service revolution said to be so large it can be seen from space is all but invisible on earth. There has been no bang, not even a whimper, just the night time passage, silent and deep, of some regulations through the Lords. Nothing has changed – except that the U-boat is now on the inside, torpedoes armed and periscope at the ready. The lumbering ships of the health service convoy still steam across the healthcare seas, unaware of the peril that now lurks in the deeps.
One of the consequences, most probably intended by David ‘I want…the NHS to be a fantastic business for Britain’ Cameron, of the NHS reforms is a rise in the promotion of healthcare insurance. Against a background of a financially squeezed NHS, junk insurance mailshots have started rising like miasmic bubbles through the financial swamp, and now regularly surface in Dr No’s inbox and on his doormat, where they emit a foul and distasteful odour. The gist of the pitch is usually see a doctor of your choice today for only a few pence a day. Why indeed wait weeks to see one of those nasty mean health service docs when you can get an appointment right away with Dr Nice at Clinics-R-Us? Dr No’s answer is simple: he has already paid for his healthcare, through general taxation, so why on earth would he want to pay twice?