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Save the NHS?


I haven’t done anything particularly touristy yet, nor have I thought of anything else interesting I could post about. But that’s OK. Now’s a good time to talk about the marvel (and some would say, I suppose, disaster) of the UK welfare state: the National Health Service!

Even as public healthcare systems go, the NHS is perhaps more socialized than most: the government directly employs doctors, for instance, and it is free at the point-of-use.

Despite ongoing government efforts to erode and ultimately dismantle the NHS, the public remains very satisfied with its service. To the extent there are major complaints, they revolve around wait times and low funding, both of which would be addressed through (obviously) increased funding. Money isn’t magic, of course: more money means more staff, more equipment, more facilities, better pay for staff (which suggests better retention of staff to provide NHS services), and so forth.

In the news lately has been the topic of a junior doctors’ strike. This is related to a contract negotiation in England (Scotland and Wales are not involved). As is typical when workers strike during a negotiation, the perception is that the contract being imposed would make junior doctors worse off. But there is more at stake, much more, as Joan Smith writes in The Independent:

At the beginning of their careers, doctors used to be attached to a consultant, accompanying him or her on ward rounds and seeing the same patients. There was continuity of care, support from other members of the team and a chance to see how patients progressed. Now junior doctors are basically shift workers, moved around to fill gaps on rotas, which isn’t good for them or their patients. It’s especially difficult for couples where both partners are doctors or have children who need childcare on weekends. The lack of continuity is frustrating for everyone, doctors and patients alike. The Government’s grasp of the public finances looks increasingly shaky, and I don’t doubt that ministers are terrified by the rising cost of healthcare. It doesn’t want to shoulder the blame as people’s experience of the NHS gets worse, as it inevitably will if it continues to try to provide a universal service without funding it properly. Hunt is still trying to divert our attention, quoting alarming statistics about elevated death rates in hospitals on weekends, even though the reason more patients die on Saturdays and Sundays is that they are sicker than those who are admitted on weekdays. Hospitals already provide a seven-day service, but extending clinics and routine appointments to weekends won’t just mean changes to how junior doctors work. It will require all kinds of support staff and diagnostic facilities, at a cost the Government hasn’t quantified.

Indeed, it’s not an unusual strategy for a conservative government to attempt to destroy a popular public service by underfunding and mismanaging it in order to turn public opinion against it. Republicans in the US have done this repeatedly with the Affordable Care Act. It can be strikingly effective.

The new contract being imposed has an even worse feature: it legalizes “indirect discrimination,” meaning any discrimination that occurs as a consequence of meeting a “legitimate aim.” Laura Bates of the International Business Times has a few words about this:

In other words, the document repeatedly finds areas where women in particular are likely to be disadvantaged under the new contract, and repeatedly declares this indirect discrimination acceptable if it is the price to pay for the outcome the government claims the new contract will deliver. One of the biggest areas in which the new contract is likely to adversely affect women is maternity leave. Under the new contract, pay will be tied more closely to career level, rather than time served, which means that those who take longer to progress through the system, such as women who take time off for maternity leave, and those who work part-time in order to juggle childcare or other caring responsibilities will be disadvantaged. The change will also disproportionately impact disabled people, who are more likely to work part-time. Perhaps most extraordinarily of all, the 'mitigation' section of the analysis relating to this particular change sets out "flexible pay premia" that will be introduced for doctors who might be affected for a variety of reasons, including those spending time in academic placements or taking time out for research. The document explains: "Consequently this will ensure that staff who need to take time out from training posts for these vital reasons will not lose financially". Maternity leave, however, is not included as one of these "vital reasons" for time off.

Once again, it’s a policy approach so cynical I’m surprised American conservatives didn’t come up with it. (Of course, there’s no legally-mandated paid maternity leave in the US at all, but if there was, I’m sure something like this would quickly hit the pipeline.)

I wouldn’t suggest that the NHS is a perfect system–it certainly isn’t, and it appears to be lacking in some areas compared to other public health systems. Nevertheless, as an American, I would happily embrace such a system (or a similar one) if it meant better healthcare access for all Americans, which is still a problem facing many people in the US.

It would be a shame to see the UK dismantle, rather than preserve and revitalize, one of its most effective public services.

Photo by arripay