“CASH-LED cuts dressed up as a rational planning process” was
the way that health campaigner and trade union activist Geoff Martin
described the major review of health services and 10-year plan
published by Health Minister Lord Darzi last Tuesday.
The review focuses on health provision in London but is likely to be
applied throughout England eventually.
The plan is full of all New Labour’s favourite buzzwords about
“patient-choice” and “improving outcomes”, with subtle hints of the
cuts to come, like “shift the emphasis from increasing the quantity of
care to improving its clinical quality”.
The culture of targets, once heralded as a panacea, is now old hat –
hinting that waiting lists can be expected to rise again.
But the culture of competition between NHS hospitals – the very issue
that cost the Tories millions of votes in 1997 – is to be increased,
with the publication of “death rates” for various surgical procedures,
comparing surgeons and hospitals – and the publication of patient
satisfaction statistics.
The “death rates” will be very misleading as currently – and under any
sensible scheme – the most skilled surgeons are called upon to perform
in the most difficult and desperate cases. They rescue the patients
that other doctors could not; inevitably their death rates are high
because they treat many whom no one could save.
But under the new scheme they will be reluctant to try to save patients
who have little chance of survival because that will spoil their
statistics. It’s school exam pass rates all over again, where hopeless
cases are abandoned early so as not to spoil the stats.
Patient satisfaction is a subjective quality, not easy to measure. But
this no doubt will be done with tick-box questionnaires with questions
carefully framed to protect the management and the Department of Health
policies at the expense of front-line staff – and most patients are
sympathetic with front-line staff and will feel guilty about being
critical.
Big general hospitals are no longer needed, we are told, and will make
way for specialised hospitals. Darzi, like so many senior health
professionals, is under the delusion that desperately ill people do not
mind travelling long distances to be treated if that is more convenient
for the doctors – while all the evidence is that most patients prefer
to be treated as near to home as possible. And pity the poor patient
who dares to have more than one condition or complication needing
treatment at different specialist hospitals.
Recently general practitioners have been warning about the Government
plans for super polyclinics offering a range of GP and other
out-patient services. The GPs are worried this will end their near
supreme power over their registered patients as the only gateway to all
other NHS services. But their warnings about potential privatisation of
all these primary services are well founded.
Now we discover that the polyclinics are to replace not only GP
services but local hospitals as well, performing many small and routine
procedures. And many services now delivered in hospitals – such as
chemotherapy – are to be delivered in the patients’ homes – saving the
NHS millions.
Patients with chronic conditions like diabetes or asthma are to be put
in charge of their own health budgets to spend as they choose. But what
happens if they get the sums wrong and the money runs out? Or if the
budget does not keep pace with inflation? Already many of these people
are not getting the treatment prescribed because they cannot afford the
prescription costs. These costs are now £7.10 for each item and
many low paid people who need several items every month cannot keep up
with the costs.
Experienced and highly qualified nurses will get to take on yet more of
the roles and responsibilities of doctors – again saving the NHS
millions. If these nurses are doing doctors’ jobs they should get
doctors’ pay.
The review pointed out rising public concern about hospital infections
but does not propose the one measure that would cure this – bring
hospital cleaning services back from the private sector and put them
under the direct control of senior nursing staff – and introduce proper
training for cleaners.
That would save the NHS money indeed but at the expense of the great
god private enterprise.
There is no doubt that the overall message of the Darzi review is that
the NHS is going to get smaller, with patients left to be treated by
nurses, pharmacists, relatives, local wise-women and themselves. Those
who can pay, of course, will still be treated by doctors or the
complementary practitioners of their choice.
Doctors have given the review a very cool reception. Speaking for the
British Medical Association, Jonathan Fielden said: “It is pushing an
old agenda, not a new one. Our concern is that this strips resources
from hospitals and GP services.
“Clinicians have not been as involved as they should have been with
this review and the concern [with the national review] is that that
will continue.
“The last administration worked by having a pre-conceived plan and then
having a consultation as a sop to the public. The fear is this could
happen again. Changes to hospitals must involve clinicians and the
public.”
*************
Editorial
What Labour could do...
GORDON BROWN has just
completed his first year as Prime Minister and it has been a disastrous
year for his ratings in the opinion polls and in the local elections in
May. Then just last week in the Henley by-election the Labour candidate
came fifth – behind the British National Party.
Brown is also facing further rebellions over the withdrawal of the 10
pence tax band, leaving thousands of very low paid workers facing
higher tax bills. Brown promised to sort out a compensation package but
clearly what he has produced is not adequate, still leaving thousands
worse off.
Seeing the Tories rising in the polls, all New Labour’s wealthy
business friends are abandoning the sinking ship leaving the party
significantly short of millionaire donors.
This leaves the Labour Party once again dependent on its founders: the
trade unions, for funding and the leaders of the big unions have been
meeting to discuss the policy changes they want to improve Labour’s
election prospects.
Though the press is attacking Brown’s leadership, the unions, along
with left Labour MPs like those in the Labour Representation Committee,
recognise that a change in policy direction is more important right now
than a change of leader.
Each major union will present its own demands ahead of next month’s
national forum to draw up the party’s programme. Unison is to propose
that all primary school children should get free school dinners to help
families and increase healthy living.
The GMB wants environmental workplace representatives to
encourage “green” workplaces. Unite wants more access to flexible
working for parents so they can prioritise the needs of their children.
The shopworkers’ union Usdaw wants “lifelong learning in the
workplace”, better protection for young workers and help for parents
and carers to balance home and working lives, tackling crime and
anti-social behaviour.
The free school dinners would have a major impact on people’s lives.
Improved hours for parents needs to be backed up by full implementation
of the European Union directive on working hours, and help for those
parents who are compelled to work longer and longer hours because they
are up to their ears in debt.
We could add other demands that will have a real impact on working
people’s lives and raise the popularity of the Labour Party: free
prescriptions; bring hospital cleaning back from the private sector and
under the control of the hospitals – with more properly trained
cleaners. It could enable local authorities to build new council homes
– and allow mortgage payers in serious arrears to apply to their local
council to buy out the home and allow the family to remain in the home
as council tenants.
Labour could also stop impending local authority cuts that are closing
down the very youth projects that are doing some really valuable work
in diverting youngsters from gangs and criminal activity. Far from
cutting these there should be far more investment.
Labour could also stop the cuts to legal and benefits advice centres.
It could improve public transport significantly while reducing fuel tax
for those who cannot avoid car use. And it could cap domestic gas and
electricity prices. All these things would improve the lives of
millions of people and they could all be funded by restoring tax rates
on the rich to where they were in the 1970s.
But at a time when they really at last have some real power over the
Labour leadership, the unions could be asking for so much more. For
decades they have called for the full restoration of trade union rights
– rights that are recognised as basic human rights by the United
Nations. Now those rights could be in their grasp, like rabbits they
have dropped the demands.
They could and should still be demanding the full restoration to the
public sector of all the privatised utilities – and a complete end to
the disastrous imperialist adventures in Iraq and Afghanistan.
Hard times are coming globally, with rising unemployment on the way as
prices rise and people cannot afford to buy anymore. This is beyond
Brown’s control; it is part of the capitalist system. As usual the
capitalists will try to make the workers bear the brunt. So at a time
like this the workers need the strongest, most assertive and demanding
unions – not a bunch of compromisers and class collaborators who cannot
use an advantage when it falls in their lap.
If you find these articles from the New Worker
Online interesting and useful them why not subscribe to our print
edition with lots more news, features, and photos?
Must see!!! Powerful Flash animations from Eric Blumrich "War Crimes" or "Victory!" and Anti-war 2" Must see!!! Anti-war
music video
"War Song" by Smile Empty Soul (Use RealOne Player .
Write to us for more information