Wednesday, 22 February 2012

In defence of the NHS proposals

I certainly don't agree with everything that this government plans for the NHS - particularly raising the cap on private income up to 49%, something which I strongly oppose. But there is some very bias and simplistic reporting going on - particularly from the Guardian, which gave up being a newspaper and now dedicates its time to finding a way of attacking the government on a daily basis. Everyone and their dog has leapt to their feet to defend the status quo, and Labour seems to have forgotten its own record of NHS reform and has instead opted to defend vested interests.

This point about vested interests is important. The British Medical Association (BMA) is often thrown around as if its disapproval of the reforms is the be all and end all of everything. The union of GPs isn't some kind of angelic, all-good body; it's there to defend the interests of doctors - it even makes clear one of its roles is being a trade union for doctors. The BMA has a long history of standing up for the interests of doctors, which don't always mesh with those of patients. Pressure from the BMA resulted in the wartime coalition government scrapping the initial plans for a health service, and when the 1945 Labour government started pushing ahead with their own more radical proposal, the BMA were there to pursue their own interests and ensure doctors got the best deal possible. Health Secretary Bevan, in his own words, "stuffed their mouths with gold" in order to appease them. And there's nothing wrong with a union which represents the interests of doctors, but there is something wrong with Labour and commentators pretending that if the BMA opposes something, then it must be bad for patients. The union has a vested interest in opposing legislation which would bring in more competition and place more responsibility in the hands of doctors - it's not in the interests of doctors to compete with one another or have the additional responsibility of managing finances and being held more accountable. If someone asked you whether you wanted to take on more responsibility and compete with others doing the same job, but keep the same pay, would your response be yes? The BMA and the GPs it represents raise legitimate concerns about the reforms, but it's very important to bear in mind that their criticisms may be self-interested. The interests of doctors and patients are not always the same.

I think the leading article in the Independent from the 8th of Feburary summarised this well:
"As a profession, doctors are highly resistant to change. Almost every attempt to reform the health sector produces squeals of anguish and warnings of imminent catastrophe. Indeed, opposition to the creation of the NHS in the late 1940s was so strong that the BMA voted nine-to-one against and some even drew dark comparisons with the National Socialism so recently overthrown in Germany. While the rhetoric may have changed in substance, the predisposition to protect their privileges remains. ... The vested interests of powerful blocs are too often glossed over by an assumption of professional distance that may not always be deserved."
The Independent

It's also a myth that everyone who works in the NHS opposes the reforms. There was an interesting call from a paramedic a week or so ago on LBC. He said that the reforms had to go through if we wanted to improve the service. In his experience, the ambulances he works in are too often used on wastrels and those who do not require hospitalisation. He suggested that the only way you can encourage GPs to not refer people to hospital for unnecessary treatment - and thereby speed up ambulance response and treatment times would - is to introduce the reform which ensures GPs are in charge of their own budget. Of course this raises questions about whether, if it's coming out of their budget, GPs would be more reticent to refer legitimate patients to hospital. The point I am making by highlighting this caller is that whilst the loudest voices opposing reforms come from the trade unions representing medical workers, their publicity isn't necessarily representative of everyone who works in the organisation. In fact, the chap who phoned the radio show said that he'd almost certainly lose his job due to the reforms because there would be a large decline in the over-use of ambulances. It was refreshing to hear a selfless, honest voice speaking about the reforms.

It's also been pointed out that the Conservatives have received donations from those with a vested interest in private healthcare. You can see the stats for yourself on this hideously-formatted blue and yellow spreadsheet. This is legitimate cause for concern, but I would also highlight Labour donations from trade unions. In the final quarter of 2011 (the latest statistics available) 75% of donations to Labour came from trade unions. If the argument is that the Tories pursue policies which appease their business and wealthy donors, then the argument must also follow that Labour are tied to pursuing policies which appease the trade unions, some of whom have a vested interest in the NHS as it stands.

Does this mean we should should all embrace the NHS reforms? Not necessarily. But neither should we be taken in by the Guardian viewspaper's attempts at undermining reform at every turn. Making the NHS better is a complex issue, and knee-jerk total opposition to everything in the legislation doesn't benefit anyone.

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