Cutting the care?

The Tories are back in power.  So naturally the public sector gets it in the neck.  I don't believe this is entirely because we have a national deficit to repay, caused as much by criminal recklessness among top financiers as by political mismanagement; even if we had a healthy balance of payments, the Tories would still be after us.  They just don't like public services.  They schmooze up to Murdoch, the artful tax-dogdger, and rail against the BBC, which has not to my knowledge ever hacked any celebrity's phone nor sought to boost its audiences by showing pictures of topless girls, and which is legally bound to provide accurate and impartial news coverage, a concept quite foreign to many of Murdoch's outlets, Fox News being only the most notorious.  They smack the bankers' little handies for helping themselves to obscene salaries and bonuses, and the bankers tell them to get stuffed.  So instead they cut funding to charities, bang on about the "work-shy" (like there are all these jobs around, with unemployment at 7.9% and climbing - you wait until the year end) and tell us we're all in this together.  You wouldn't mind so much if their "market knows best" ideology delivered better services, but does it?  Under Major they privatised the railways and gave us Railtrack, plus a ticket pricing system that makes quantum mechanics look like Enid Blyton.  I rest my case. 

Politicians, of whatever colour, cannot resist the urge to tinker with the NHS.  As the piper's paymaster they must be seen to be calling the tune, so the NHS has been undergoing reform for as long as I can remember.  There is of course no consensus about what's wrong with it and whose advice should be sought as to how it might be improved, but it may be taken as read that the last people politicians consult with when they want to reform any given organisation are the people actually running it.  (I found in my days as chair of governors for a primary school that, in the eyes of the Department of Education, they knew how to run schools, parents knew how to run schools, inspectors and governors knew how to run schools, even pupils were supposed to have some idea  how to run schools; but teachers, what did they know?)

So, naturally, the latest lot of reforms are meeting enormous resistance, and catastrophe is predicted.  No-one has asked rank and file NHS employees how they would improve the service, and there's a reason for that: we dissent from Government ideology at the most basic level.  We work for the national health service.   Tories think it should be a business.  Like it is in America, whose health service is the envy of us all .... er, not.  It is of course the most expensive in the world; and something like the 37th most effective in terms of service provision, according to official figures. 

In a real market place it's good to have competition and choice; in healthcare you just want quality.  I don't need to choose between various hospitals for my treatment; I just want to know that my local hospital will do its job properly.  If it doesn't, I want to be able to hold it to account and ask for improvements: I am not looking to "take my business elsewhere".  By opening up what is still a recognisably national health service to the private sector, Tory policies will have two effects, one intended, the other inevitable: it will become fragmented and regionalised; and care quality will suffer as commissioners award contracts to, not the best, but the cheapest, provider.  But it will suffer much more in some regions than others, so the idea is that we shop around for the best care, which will then make the under-achieving providers buck their ideas up.  If this produces a better NHS than we have now, if indeed there stll is an NHS in ten years' time, I am Schroedinger's cat.  What it will produce is a lot of demoralised staff - those that still have jobs - a postcode lottery of care quality, and some very well-heeled CEO's of private healthcare corporations.

It had better not impact on my dad's care, that's my main concern.  When he went for his long appointment at the elderly care clinic I was simply staggered at the effiiciency and thoroughness of the clinical team.  Royalty could not have been treated better and I wrote a letter of thanks to tell them so.  This was later printed in the house newsletter, but minus my entirely reasonable and reflective comment that in a sane world the NHS would be looking to reform Government, not the other way round.  Pressure of space no doubt led to the omission.  Lansley had better not try fixing that bit of the service because anything less broke I never saw in my life.

Looking ahead though to the kind of care Dad will need in the future ... well, here's an extract from an article by journalist Hugh O'Shaughnessy, about the care his wife received from the NHS.  Having praised them to the skies for their work earlier, he then reflects on his experiences as his wife drew closer to death:

"The NHS offered to provide someone to be awake in her room from 10pm to 6am and thus relieve the burden on the household. The first carers came from the Marie Curie organisation, a British charity created in 1948, when the NHS itself was established. The Marie Curie personnel were conscientious, well trained and punctilious.

Sadly, subsequent ones did not match up. They seemed inexpert, ill-trained and with a tendency to settle down to sleep shortly after they arrived at the bedside of the person they were expected to look after throughout the night. Distrusting their conduct, I took to sleeping in the same room as Georgie, sending the carer into another room and thus defeating the objective of the exercise.

Then the carers began coming late. The person expected at 10pm on Christmas Eve arrived at 12.15 on Christmas morning. Apparently her managers, truculent people unwilling to listen to suggestions, had not organised the minicab from her south London home. On a subsequent evening two carers arrived, each claiming to have been sent by their managers. The NHS had, I later gathered, been obliged to take the second-class service offered by a disorganised offshoot of some US corporation: unsurprisingly its low standards allowed it to undercut Marie Curie's bid for the work. It seemed bizarre that the NHS was manoeuvred by an aggressive privatisation lobby into accepting a clearly inferior service from a company run from a country incapable of organising a health service for its own citizens.

At this rate I know that I – perhaps most of us – will die without the care Georgie enjoyed."

This is one man's view, and I have still to study the many responses posted to it online; some will offer similar stories, others say hang on, the NHS often lets its patients down while private care can be first rate, and the debate will then polarise along predictable fault lines.  And yes, I am a Guardian reader whose hostility to all things Tory runs deep - I would say with reason, as naturally I would.  But Hugh O'Shaughnessy reports his experience and that's what you can't argue with.  My dad has had, so far, 5 star care from the NHS and you can't argue with that either.  If as time goes on he is less fortunate AND that is attributable to Lansley's reforms, the minister will be getting a piece of my mind.

O'Shaughnessy's piece, and the discussion prompted by it , is here.