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Shibley Rahman

Passionate about promoting wellbeing for people diagnosed with dementia. Trained in medicine, law and business. Disabled.

It doesn’t surprise me that potential voters in the UK general election on May 7th 2015 want think the NHS is the most important topic. So let me do some weaponising.

All topics are, of course, extremely important. These include getting a replacement passport on time… or getting your disability living allowance processed on time. People expect adequate quantity and quality of housing, and good transport services. Sadly, it wasn’t that along when we could be reasonably confident in the future of the NHS. But the last few years has seen a diatribe of abuse about how ‘unsustainable’ the NHS in, in the most part by journalists illiterate in economics who use unsustainability as a synonym for “we can’t afford it”.

 I have a big disclaimer to make at the outset. I owe my life to the NHS. I am not talking about being born, but perish the thought there were the NHS thinks about charging for “add ons” for mothers giving birth. People who run cinema chains often brag about how the film is not the lucrative part, but the peanuts and popcorn are. There seems to be a resentment amongst some of the NHS being paid for, in that it is not intrinsically “wealth creating”. The reason I owe my life to the NHS is that I had a cardiac arrest and epileptic fit one summer’s day in 2007 before I had a six week coma on the ITU department of the Royal Free department (where currently there is a patient being treated for the Ebola virus). I dare say my temporary visit on the ITU cost £000s. But I am worth it.

  I am not some cranky ‘idealist’ where I think we have to get rid of money altogether like an Amazonian jungle. But I don’t happen to think you can run the NHS on the basis of people ‘competing’ against each other. When a patient has a cardiac arrest, there are very strict protocols to be followed, whoever the doctor is. Everyone warned that introducing the market into the NHS would add billions to the bill, and cause extra work in monitoring transactions or regulating on misdemeanours. The current massive top down reorganisation of the NHS has no effect on ‘patient choice’ – one lie. It did not put doctors into the driving seat – another lie. Clinical commissioning groups are simply state insurance bodies, and GPs would many rather see patients than negotiate commissioning

  Unless you’ve actually worked in the NHS, as I have done as a junior doctor, it’s incredibly easy to underestimate the public sector ethos of people working in the organisation. We have enormous solidarity, and sense of justice and equity, as other public sector employees, including all health professionals and teachers, for example. The ‘brand’ of the NHS is so strong that private providers need the NHS logo to make their brand acceptable to the public: put quite simply, this is a legal deception or fraud.  People who resent this brand royalty resort to emotional abusive comments like, “They treat the NHS like a national religion.”

  What isn’t a legal fraud is a criminal fraud, as alleged for a number of large corporate private providers. You can google these outsourcing companies, and you can find this sad litany. To fulfill their legal duty to shareholders to maximise profit, some fraudulent practices have been alleged. It is far from efficient if these companies are spending huge amounts of money defending criminal fraud.

  The NHS is possibly the one organisation where being big is considered to be evil. To this end, people who resent the NHS call it “monolithic”. Anyone who has done any postgraduate business training will know that running a big organisation can be advantageous, e.g. in ‘economies of scale’. But we do know that the NHS has massive procurement problems – but this is an operational issue not to do whether the NHS should exist or not. The concept of the NHS should not be attacked if the management of the NHS is not up to scratch.

  Likewise, the concept of the NHS, a free-at-the-point of need, comprehensive, and universal service, coping with the common headache to a rare cancer, depends on us pooling resources, and having a real sense of ‘we’re in it together’. I believe that anything can happen to anyone at any time. To give you an illustration of this, I became physically disabled in my young adulthood. The way the NHS is funded, out of general taxation, is our insurance policy for the future. If I happen to have a particular genetic mutation that I will almost certainly develop a dementia aged above 60, no private insurance system will wish to touch me with a bargepole.

  But all the talk of the ‘smaller state’ is highly duplicitous. A ‘smaller state’ means a state on its knees, with corporate welfare benefits from the taxpayer to outsourcing companies. Such legitimisation of corporate scrounging cannot go unchallenged. Making it a virtue not to contribute a decent amount to fund through general taxation essential public services is a nasty policy. It is not really to defend ‘cutting back the state’; it is more to do with ‘having more money’ in your pocket so you can spend your money on private insurance if you want to. Every single mechanism to crow-bar new markets for NHS patients has been tried; personal budgets giving the option of ‘top ups’ looms large in care policy from political parties who firmly believe in the free movement of capital. Also private equity entities in the City have lucrative stakes in private finance initiatives for hospitals; these are highly profitable as these entities can get regular loan repayments from these contracts, and sell at a massive profit their stakes at some later stage.

  It is therefore little wonder that politicians listen more to hedge funds than the people actually working in the NHS. It seems acceptable for many hardworking nurses not to receive a pay rise, when the economy is supposedly recovering. But if you looked after staff in the NHS, you would prioritise the health and welfare of its workers. A sick health professional in work has been proven to be as unproductive as one out of work altogether. And patient safety does matter, as well as how you’re treated as a patient. Being a regular inpatient and outpatient of the NHS has been a real eye opener for me in the last few years.

  The Health and Social Care Act (2012), which turbo-boosted privatisation, does not contain a single clause on patient safety apart from the abolition the National Patient Safety Agency. How did it boost privatization? It made it unlawful for any contract to be offered to be more than one bidder if no competitive tender takes place. The private sector is at a huge advantage in winning lucrative contracts because of its superior legal and business expertise. And is it privatisation? You have to be either fraudulent or negligent to be unaware of the definition of privatisation: that is, simply, the transfer of resources from the public to the private sector.

  The NHS needs to be properly funded. Its staff needs looking after. Hardworking staff do not deserve the non-stop abuse from the media. Hospital managers need to stop chasing targets, and realise that high marks in the 4 hour target is not a win if there are general concerns about patient safety from regulators, concerns about continuity of care, protracted lengths of stay due to misdiagnosis at admission, or delayed discharges if social care in the community has gone to pot. Yes, you’re right, the NHS is a cherished institution.

 And yes, it has been treated disgracefully by the current Government, who do not even wish to make it an election issue.

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