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The Tory Party at Work

Posted by Dr No on 16 January 2010

camclarke.jpgJust 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.


Some of us remember only too well how ghastly the Tories were, and how we hated them (JD still does).

Nice picture with the odious buffoon Kenneth Clarke in the background (who accused GPs of feeling for their wallets!)

God, I don't want the tories back. But labour have been more Tory that the Tories are, and we face a relatively disastrous dismantlement of what was once a wonderful service.

It makes you want to weel.

Actually it makes you want to weep!

One of my colleagues thinks it has been easier for New Labour to work towards privatisation of the NHS than it would have been for the Conservatives. New Labour has never been open with the public on privatisation and the public have been naive enough to think that the NHS is safe in Labour's hands. The Tories might have been more honest in their intentions and the public might have been more suspicious. Paradoxically it is just possible that for these reasons the NHS might just be safer in Tory hands.

Memories are short and some are too young to be able to remember Kenneth Clarke. All my children are now voters. One is a doctor and another a medical student. They have been told that their first phrase was "Kenneth Clarke is a bum" - words learnt from their father as he watched the evening news. But at least you knew where you were with Ken. He did tell you of his intentions and he was not afraid of hiding his views on GPs with his unforgettable slights about their wallet feeling. This went down like a lead balloon in the Grumble household where Dr Grumble was working a one in two on ITU and Mrs Grumble was a GP struggling to bring up young children while doing a one in three on call for a notoriously deprived part of London.

Leopards don't usually change their spots but who would have thought New Labour would turn out the way it did?

It is not privatisation that is the problem, after all GPs have always worked on that basis, and hospitals alwaysbuilt by private contractors. The problem is the model of privatisation that is being followed. This combines the worst of both sectors, with top down control and contracts, with little responsiveness to consumers. The model being followed parallels the railways in it's combination of poor consumer service and high corporate subsidy.

If you want a dynamic private sector providing services you need a multiplicity of small providers, as in GP services. The government, labour or Tory, will not do this partly because they would lose control (and neither really trust the Market) and partly because their ear belongs to large international health care organisations.

Not much hope for us docs, much misery to come, and another missed opportunity to improve things for patients.

Dr G: Another of the Nottingham MP's statements - while Sec of State for Health - was "The NHS is not a business but it should be more business-like".

If the Tories gain power after May - I wonder what honest Ken will say then. "The NHS is not a business - its lots of independent businesses that need to be encouraged to provide patient choice" perhaps?

Whichever Tory party wins in May, ersatz "markets" and patient "choice" will I'm afraid continue to squeeze out those good local services offering continuity of care previously provided under the low cost monolith which we now seem to remember with affection but took for granted at the time.

I'm glad to see most of us here have robust memories and no illusions about Clarke. I didn't mention it earlier, but I still vividly remember the day I heard Clarke on the radio - must have been 1988 or 1989 - when he referred to the NHS not as the health service, but as the health industry. It spelt out to me in one simple word shift that how fundamentally different were our views of the NHS. Industries are there to make money, while a service costs money.

Fox in sox - a good reminder - the independent contractor status and all that, and in that sense it could be said that the vast majority of primary care has always been provided privately. But while we all know GPs who always have (and always will) seek to run their practice to maximise their income regardless of other considerations, most of the GPs Dr No knows and has known accept they have a good and reliable income, and place as great if not greater emphasis on good service provision as on coining it in. This is a very different setup to a fully and genuinely private concern, which will have a primary duty to ensure maximum profit for shareholders.

Doctors, for all sorts of reasons, are natural conservatives.

Is dat cos doctas is all edjacated at skools for privates?

Maybe if dose med skools wydened up der axces 2 us lo-rise types, da doctas hood wudn't keep luvin up 2 cameron's booty.

This fox went to a comprehensive school, you betray your prejudice indahood.

As my mother used to say, only the rich can afford to be socialists.

Dr No: GPs do indeed operate their practices variably as money machines, or with varying degrees of altruism. An economist might depict this as long term self interest, but I think that most small businesses feel a part of their communities and want to be a sound part of those communities. Britain was described as a nation of shopkeepers, but more accurately a nation of small businesses. It is large business alienated from it's roots that acts as a psychopath. Small business will need to revive to sort out the economy, and I see it as the way forward in medicine also.

Most European countries work their health systems via small providers, mega corporations are a feature of the more dysfunctional systems in the UK and USA. I believe that it is this that is the most important reason why their systems produce better results.

Since GPs are independent an observer from Mars would wonder why the government is so apparently intent on privatisation of primary care - especially since most patients seem very happy with the service they receive from their GP.

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...