“This is why I fight”

Mike Stafford tells us why a public NHS is indispensable for all of us.

I picked up my prescriptions again last week. Every time I visit the doctors, I’m reminded of my most dramatic trip there back in late 2010.

I’d been having bouts of illness for several months. Fatigue to the point where walking across the room was a challenge, frequent vomiting in the mornings, and endless feelings of dehydration. I was working from home but still managed to end up too ill to work for seven days during the year.

Then, in October, I was taken out of action for a whole week. I spent four days on the sofa, wrapped in a fleece and a blanket, shivering to my bones. On Wednesday, my wife dragged me to pester my GP again; they took blood tests and called me back on Friday. By Thursday night, it took me three attempts to walk up the stairs, and I was mumbling deliriously as I did so.

On Friday, they called me in to discuss my results. After months of suffering with this mystery illness, just to hear it given a name was a huge relief. That name was Addison’s Disease. Invariably fatal at the time Dr Thomas Addison first discovered it, these days it’s medicated with steroids and has no effect on quality of life or life-expectancy at all. I was in the midst of an Addisonian crisis, the stage of the disease that comes just prior to death by circulatory collapse. Pleasant, eh?

I was taken to the Medical Assessment Unit at the Royal. Given the state I was in when I got there, the nurses informed me that the Intensive Care Unit had been notified of my arrival. It’s all of about sixty feet from the main doors of the Royal to the corridor off towards the MAU. Walking that distance was one of the most physically strenuous things I’ve ever done.

At the MAU, I was hooked up to a drip, given anti-vomiting drugs, injected with steroids and talked through the process by a medical staff whose bedside manner was invariably superb. At each stage, they let me know what they were doing and why they were doing it. From being on the brink of death on Friday morning, and having had half a Pot Noodle to eat all week (it’s funny what you can get down when you’re ill), by tea time I was in a fit state to eat, and enjoy, a whole meal. By Saturday morning, after a sleep in my own en suite room, I was ready for release. Walking through the lobby 24 hours earlier had been like climbing the north face of the Eiger. Leaving, I strode across it easily, and when I got to the car park did some Dick van Dyke heel clicks for my wife’s amusement. It was the fittest I’d felt in years.

The staff of the NHS saved my life that day, and did it with smiles on their faces and decency radiating from them throughout. As I type this I still feel a profound sense of gratitude.

When all this happened, I had less than fifty quid in my bank account. I’m a father of three; I’m not poor but I’m not exactly flush with cash. When I hear plans bandied around suggesting we need to abandon the founding principles of the NHS in order to save it, my blood begins to boil.

It takes a long time to diagnose Addison’s disease. Several trips to the GP, in fact. How many trips could I have afforded if plans to charge for GP visits had been approved? When I arrived at the hospital, what standard of care could I have expected on a ward run by the cheapest possible provider? As soon as she made the diagnosis, my GP was on the phone to the hospital to give them a heads up I’d be arriving. Could I have expected two rival private firms to co-operate so freely and effectively?

It goes deeper than that though. The NHS cured me because I am a member of the community, because I was sick and needed to be made well, nothing more. This is not the remit of a private firm, nor will it ever be. Only a publicly-funded, publicly-run health service can be trusted to place the patient at the heart of everything it does.

You can read more from Mike Stafford on his blog, ‘Returning the Favour‘.

Why Abolish Tuition Fees?

Until 1998, there wasn’t such a thing as a fee for going to university. Higher education was free and accessible to all, regardless of economic background. Then things changed.

Although the inquiry into tuition fees was launched by John Major’s Conservative government, it was a Tony Blair’s Labour government that voted to introduce fees of up to £1,000 per year. Future Mayor of London Ken Livingstone reportedly accused Labour of “whipping away a ladder of opportunity which they themselves had climbed”. Labour stated in their 2001 manifesto that they would “not introduce top-up fees”, but in 2004 raised the fee limit to £3,000 per year. And while it was the Conservatives and Liberal Democrats who subsequently raised the limit to £9,000 in 2010, they acted on the findings of a report commissioned by Gordon Brown’s Labour government.

Labour are supposedly promising to cut fees to £6,000 per year, but if Nick Clegg’s previous empty pledge not to raise tuition fees is anything to go by then we shouldn’t hold our breath. Regardless, the National Health Action Party believes that the government should end tuition fees entirely, as has already been done in Scotland and in Germany. But why should we abolish tuition fees? Here are a few reasons:

  • Equal access – if you believed what some Tory candidates have said in the past, then your children apparently need to come from a rich, private school background in order to get a university place. Historically this has been complete nonsense, with a combination of free higher education and grants for poorer students allowing everyone access to university. Now, an Ipsos Mori poll has found that the increase in tuition fees is putting off the majority of students from disadvantaged backgrounds from applying. To have a strong, healthy society, higher education cannot be the preserve of the rich – universities must be accessible to all.
  • The graduate premium – it is often claimed that graduates from university enjoy an overall increase in lifetime earnings of up to £100k, thanks to their increased earning potential. This ‘graduate premium’ is calculated based on various assumptions – that the student spends three years in university and then gets a job commensurate with their degree on leaving university. There are many obvious exceptions, such as medics and vets who spend at least five years at university, and teachers and nurses whose starting salaries may not reflect their level of education. Even for those who enter a high-earning job straight out of university, the graduate premium is already shrinking thanks to rising fees and competition from an ever-growing body of fellow students. Is it really fair to sell students a dream of a better future, then leave them saddled with debts while they struggle as an over-qualified employee of the catering or retail sector?
  • Affordability – as mentioned, fees didn’t exist in the UK until 1998, and Scotland has already done away with them entirely. And believe it or not, it was a conservative government in Germany who abolished fees after only a brief flirtation with the idea of charging. Both countries recognise that free higher education is entirely affordable, and that charging students to go to university is both unfair and deeply unpopular.

Should Clive Peedell be invited on Question Time?

The BBC’s Question Time has a well-known panel format – since 1998, a panel of five has been invited for each episode. Usually this includes a representative for each of the ‘big three’ parties, often augmented by a leading figure from a smaller party. The remainder of the panel are non-partisan.

The BBC has been criticised, and not infrequently, for inviting UKIP to the panel a disproportionate number of times – 21 appearances since 2009, compared with 11 for the Greens. George Galloway’s Respect party, the SNP and Sinn Fein have also featured, and there was even the occasion back in 2009 when the BBC invited the BNP to appear, resulting in protests at the studio gates.

Given that the format is open to smaller parties, it begs the question – should Dr Clive Peedell be invited to at least one episode of Question Time between now and the 2015 General Election? We give our reasons below:

  • Subject matter: the NHS is a key election issue. An Ipsos Mori poll in September found healthcare to be one of the leading electoral issues (29%), second only to immigration (30%) and the economy (31%). Clive Peedell’s area of expertise is thus as important to voters as Nigel Farage’s beloved immigration issue.
  • Balance: with the new ‘big four’ parties all offering similar neoliberal policies, it would bring much-needed balance to the panel to have someone speaking against the privatisation of public services.
  • Quality: Clive Peedell has a known ability to provide good copy on national media, including Sky News, Channel 4 and Radio Five Live. His opinions are well-researched and where possible based upon current evidence.
  • Variety: it may well be refreshing to have someone who isn’t a career politician appear on the Question Time panel. Equally, it might be a break from the norm to invite someone who doesn’t just want to debate populist topics like immigration.

Loss of Representation in the Two Party System

The UK’s political system, as it currently stands, is a two party system. This has been in large part due to the First Past The Post (FPTP) system, in which only those voting for the winning party in their constituency are actually represented in parliament. If your favoured candidate doesn’t win, then your vote is essentially discarded.

Contrast this with proportional representation such as used for European Parliament elections, where constituencies are larger and elect a small batch of MEPs. In this system, the winner still gets the most seats, but the second and even third place parties are also rewarded in proportion to the votes they receive. If your favoured party doesn’t win, you don’t automatically lose your say on who gets elected – and more voters are actually represented in parliament.

As a result of First Past The Post, it’s common for the two largest parties to gain a disproportionately large number of seats in parliament. Worse, most of these seats are ‘safe’ to varying degrees, meaning they are unlikely to change hands. The outcome of each election depends on a small number of ‘marginals’ where undecided swing voters decide which mainstream party gets to have an MP in that constituency. Whoever wins back the greater number of marginal seats wins overall power (unless of course there’s a tie, in which case either a hung parliament or a coalition government will emerge).

As a result, we see a system where one party will have a clear majority, and will be able to push more or less anything they want through the Commons. To make sure that their MPs all vote the ‘correct’ way, each party will have up to fourteen MPs nominated to be party whips – so-called because they whip their fellow MPs back in line. Failing to follow a party whip’s instruction can lead to an MP being expelled from their parliamentary party, so they will usually toe the line. With the exception of free votes and outright rebellions, MPs will therefore vote the way that their party tells them, rather than doing what their constituents want.

NHS England and the £30bn Funding Gap

Simon Stevens (pictured) of NHS England will shortly be unveiling an NHS roadmap of sorts for the next parliament. Looming large is the matter of the claimed £30bn funding gap, an artefact of the Tory policy to stagnate NHS funding rather than commit to real-terms growth. As you’ll recall, the coalition government already subjected the NHS to £10bn worth of ‘efficiency savings’, the majority of which came from pay freezes and cuts to staffing and acute beds.

As Dr Clive Peedell puts it:

[Stevens] must make the point that flat funding of the NHS is a policy mistake […] per capita spend on the NHS has fallen under the coalition. Efficiency savings are effectively cuts and they have gone too far. Patient care and patient safety is at risk. The NHS clearly needs more investment and it needs to be at least a 4% increase year on year. This could be funded by addressing the […] internal market, that is estimated to cost the NHS at least £5bn per year.

We know from economic studies that an increase in healthcare funding would have a multiplier effect on the economy. That’s to say that for every extra pound put into the NHS, we’d see the overall economy benefit by several pounds. That’s because healthy people are productive people – investing in preventative measures and treating patients in a timely manner will help our economy recover. With the NHS currently one of the cheapest healthcare systems in the western world, we can clearly afford to fund it properly; in fact, with the benefits to people and to the economy so clear, we can hardly afford not to fund the NHS properly.

EDIT: Here’s further reaction from Clive Peedell to Simon Stevens’ report:

Stevens is a long way from securing the £8 billion extra by 2020 that he admits is needed to make ends meet even after extraordinarily ambitious efficiency savings of £22 billion.

None of the three main political parties is committed to raise NHS spending by anything like as much as £8 billion: the Tories are sticking rigidly to their planned further five-year freeze to 2021, the Lib Dems have offered two related injections of £1 billion from 2017, and Labour has promised £2.5 billion also in 2017 – by which point the financial crisis already brewing in the NHS will be boiling over into cuts and closures.

The Scotland debate showed how much voters value the NHS

This article by Rufus Hound was originally published in the New Statesman on 9th September 2014.

Whatever else it has done, Scotland’s referendum debate has finally woken many south of the border to the once-creeping, now-galloping privatisation of their own NHS. Hell, even Andrew Marr talked last weekend, on prime time Sunday morning TV no less, about the dangers of TTIP – a trade partnership between the UK and US – for the health service. So THANK YOU. Thank you Scotland for shining a light on the pillaging of our national health service.

When I stood as a candidate in the Euro elections in May, I found that while most people supported the NHS, most were pretty much in the dark about what this government – and, sadly, the Labour government before it – have done to undermine the principles that hold the NHS together. I spent a lot of time convincing voters – and sceptical journalists – that what is happening is actually happening. It shouldn’t be hard, what with all the provable facts, but it’s all so unbelievable that most people prefer the comfortable lie to the horrifying truth.

It’s not surprising. Politicians haven’t told us the truth about the NHS and their plans for it for years. When someone is planning to stab you in the back, they don’t look you in the eye. To the Scottish, watching from the sidelines as NHS England has been pulled apart, the view has been clearer – hence their fear of following England’s road. And the debate has given the English a view of their own NHS through Scottish eyes (‘Och eyes’ ?).

Realising that the future of the Scottish NHS was going to be the clincher for many undecided voters must have hit all three party leaders like a wet blancmange. Politicians don’t blanch at the prospect of the Big Lie – but the standard practice (whenever the subject of the NHS comes up) of pointing at one another and saying, “Look! Over there! He’s the liar!” wasn’t going to work this time. This was going to have to be synchronised lying.

“Look! Over there! He’s the liar,” they cried, with one accord.  Naughty Alex Salmond was hiding £450 million in cuts that he’s planning to spring on the Scottish NHS once the dust has settled, and they had the documents to prove it.

Even then, the poll numbers didn’t slide significantly No-wards. It was time to bring up the big guns. Someone in a tartan hazmat suit was given the secret combination, the silo was unlocked and out rolled Gordon Brown. Better Together was going nuclear.

Who couldn’t be moved by the passion with which everyone’s-worst-enemy-turned-new-best-friend declared that, “We can guarantee that the National Health Service will be in public hands, universal, free at the point of need, as long and as ever the people of Scotland want it!”  This was a true: “READ MY LIPS – I will not allow the Scottish NHS to be privatised’ moment.  Masterly stuff from the man who, in office, watched the English NHS swirl down the privatisation plughole.

I could spend hours analysing what Brown’s trenchant statement did, and didn’t, say. But what’s key is that he had to at least appear to say that the NHS privatisation in England would never, ever seep north. He had no choice – any nation that has grown up with a NHS loves it and will want to keep it. That’s why none of the Three Stooges could make that speech. Because they’ve all got to get up tomorrow and say exactly the opposite to the English – and make them think that’s a really good thing.

The problem is, there’s nothing easier to lie about than the NHS.

UKIP are past masters: Fact 1) “I was sat behind some Indian bloke in A&E.” Fact 2) “There was a woman there didn’t even speak English.” Fact 3) “And she had three children.” Statistic: “Health tourists cost the NHS £2 billion a year!” (A steaming pile of lies of course, multiplying the true cost by a factor of between 25 and 35, but you get the idea.)

Anyone can do it. Try believing this. Fact 1) A Labour Government re-organised the NHS on the Tories’ market model, welcomed in the private sector to finance its building plans with private finance deals that came back to bite the NHS on the arse. Fact 2) Before the 2010 General Election, David Cameron scornfully vowed there would be no “top-down reorganisations” if he was Prime Minister. Fact 3) Within months, the Coalition announced the biggest top-down reorganisation in NHS history and, in the name of “patient choice” forcing it to compete within itself and with outside companies for our “business”, instead of co-operating for our health. Statistic: £10 billion a year to run the internal market! £3 billion for the Tory shake-up! Or shake-down, depending on how you look at it! (The costs of the private contracts terminated due to poor performance are only just starting to roll in.)

Hard to swallow, maybe, but sadly true. Everything in the NHS is now up for grabs. Let that sink in for a moment. Not just catering contracts or cleaning, but your operations, your cancer care – everything. Since private contractors can hide behind the NHS logo, you probably won’t know anything about it until things go wrong – when you’ll negatively impact the profit margins of these economic interlopers and be promptly shipped back to the NHS. When you hear statistics about what goes wrong in the NHS, ask yourself where the figures on private medicine’s mistakes and failures go. Behind the wall of commercial confidentiality, that’s where.

But it’s mostly privatisation by stealth: a nudge towards queue-jumping here, a suggestion that we should pay to see a GP there. ‘Why should this or that treatment come from the public purse at all?’, asks the Daily Mail. And one day soon we’ll have a two-tier system with the noble idea that the poorest families can expect the same quality of treatment – the same respect – as the richest families, as dead as the kids with no healthcare.

I hope that Ed Miliband has learnt something from his Scottish foray. He is rumoured to be considering an increase in NHS funding if he wins the next election. That’s good, although tinkering with general taxation would be fairer than National Insurance. But that’s not half enough for the party of Nye Bevan: he must also end the internal market by any means necessary. He must have the courage to admit the mistakes of PFI and put them right.

Hmust, over all, remember what the NHS is. And for that, he could do worse than re-read Nye himself. “One thing the community cannot do is insure against itself,” wrote Nye. “What it can and must do is to set aside an agreed proportion of the national revenues for the creation and maintenance of the service it has pledged itself to provide. This is not so much insurance as a prudent policy of capital investment.”

As for the Tories, the day after the Tory Health Bill was announced, Andrew Neill asked Michael Portillo on This Week, “Why didn’t they tell us?” To which Michael Portillo replied: “Because they didn’t think they could win an election if they told you what they were going to do.” Too bloody right. But now we do know.

That’s why I stood in the elections. I won’t be standing in the General Election, but a bunch of my colleagues will, and I’m looking forward to them causing some upsets. Lewisham Hospital campaigner Dr Louise Irvine is taking on the Health Secretary himself – she’s already beaten him twice in court over the threatened closure of Lewisham Hospital, so, hopefully, she can do the same at the ballot box. I mean, she did grow up in Scotland, and now we know what political ground can be gained when Caledonians defend Bevan’s egalitarian dream.

Fingers crossed it works in Godalming, too.