The doctors' strike in context

By Bernadette Meaden
April 26, 2016

We will hear a lot this week about who is to blame for the junior doctors' strike. Is it Jeremy Hunt, or the doctors who are being unreasonable? But instead of dwelling on the minutiae of the new contract, or who said what and when, it is sometimes useful to step back and look at the big picture, to get a little perspective.

Many commentators, as a preliminary to talking about the strike, mention the fact that the NHS is under increasing pressure, with the demands of an ageing population and a squeezed budget. But they refer to this as if it is a natural phenomenon, simply the way things are, and something we have to accept. But it is not. It is a political choice.

Throughout his Chancellorship, George Osborne has chosen to give the NHS the minimum amount of money it was possible to give whilst technically not making cuts (although this is arguable). As the King's Fund has reported, "Over the past parliament the annual average real increase in UK NHS spending was 0.84 per cent. This is the smallest increase in spending for any political party’s period in office since the second world war."

This means that UK health spending is slipping down the international league tables.

"Internationally... health care spending in the United Kingdom as a share of GDP is slipping backwards...Compared to others, the United Kingdom has slipped further into the bottom half of the Organisation for Economic Co-operation and Development (OECD) health spending league – overtaken by Finland and Slovenia."

"It is clear from both the historical record and international comparisons that health spending in the United Kingdom could hardly be considered profligate – yet it is now set to reduce further as a share of our expanding national wealth."

Perhaps this was only to be expected. There are many senior figures in the party of government who have long been anxious to see the NHS replaced by private health insurance.

In 1999, Liam Fox was recorded telling a meeting of private insurers that the Conservatives' 'Patient Guarantee' was in fact a cleverly devised 'trojan horse' within the NHS. He added, "no one has picked up yet what it actually means" and the public "haven't thought through the implications of what we're doing". He then helpfully explained that if you are seeing the sickest people first, "it inevitably means that those with the in-growing toe nail or the cyst will have to wait.They will have to find other ways of getting the treatment required, perhaps by having private medical insurance."

Oliver Letwin, a low profile but highly influential figure in the Conservative Party, was famously reported to have said that "The NHS will not exist within five years of a Conservative election victory", and wrote a five point plan for the privatisation of the NHS, two of which have already been implemented. Perhaps this is the context in which we should view the doctors' strike.

The strike has arisen because the government is trying to cover seven days with the same number of doctors as now cover five days, paradoxically claiming it is doing so in the interests of patient safety.  Elementary mathematics tells us this is not feasible, something will have to give. But perhaps like Liam Fox's Patient Guarantee, Jeremy Hunt's '7 day NHS' is a policy designed to sound good to the public, whilst simultaneously concealing and facilitating a different agenda which the public would not support – namely driving down pay and conditions for staff and removing staffing safeguards.

It's not just the doctors who are being squeezed. The government is also abolishing NHS student bursaries , which will affect student nurses, midwives, occupational therapists, speech and language therapists, podiatrists, radiographers, dieticians, operating department practitioners and possibly paramedics. They will have to pay for their training, graduating with a debt of at least £51,600, even though nurses spend 50 per cent of their training time working on clinical placements.

If the government is deliberately starving the NHS of funds and creating conflict, in an attempt to erode public confidence and drive people towards private insurance, everything it is doing makes sense. If it is attempting to run a quality health service in which patients and staff are safe, it is failing spectacularly. And, can we always be sure that stated intentions are true intentions?


© Bernadette Meaden has written about political, religious and social issues for some years, and is strongly influenced by Christian Socialism, liberation theology and the Catholic Worker movement. She is an Ekklesia associate and regular contributor. You can follow her on Twitter: @BernaMeaden

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