Witney GP: "Nobody supports the NHS changes"

Senior GP in David Cameron's own constituency tells New Statesman "things are going to fail, hospita

In an exchange over the government's controversial health reforms at Prime Minister's Questions last Wednesday, David Cameron cited "a supportive GP . . . who hails from Doncaster [Ed Miliband's constituency]".

In this week's New Statesman (on newsstands tomorrow), Sophie Elmhirst travels to David Cameron's own Witney constituency in West Oxfordshire, where a senior partner of a local GP practice tells her:

"I would say very few GPs are happy with [the NHS reform] at all . . . Not a question of supporting it, it's a question of going along with it."

"In my practice, nobody supports the changes . . . people think there should be more clinical involvement in commissioning. But I don't think many people think that GPs are the right people to commission. They need input into it - but if we wanted to be managers we would have trained to be managers, not doctors. "

The GP adds:

"Most GPs are incredibly worried about conflict of interest. How can you be a patient's advocate and look after the money? A lot of people think the whole thing's designed to fail so they can bring private providers in. It's the one big bit of the economy that hasn't got private money in it."

Of the effects to patients from the health service overhaul, the Witney GP says:

"The public have just got no idea what's hitting them . . . Things are going to fail, hospitals will close, because the money's not going to be there. Things will get taken over. And if you're going to have to make a profit out of it, you're not going to have the same service."

In the same report, Elmhirst speaks to Dr Paul Roblin, the chief executive of Berkshire, Buckinghamshire & Oxfordshire Local Medical Council, which covers Cameron's Witney constituency. Speaking about the health and social care bill, currently working its way through the House of Lords, Roblin, a retired GP, says:

"It's a major change which is quite experimental at a time when the NHS is trying hard to save money. The timing doesn't seem to be good. Among GPs there's a huge spectrum of enthusiasm from those that think commissioning will work to those who think that think it's another fad in the NHS and will soon pass."

"There is a large bulk in middle just watching events, and waiting to see what happens. [They are] slightly perturbed - they didn't go into medicine to do that sort of thing [commissioning] and it's a distraction from actually seeing patients."

"Many GPs are fed up with continual NHS restructuring.... The actual job... takes a back seat for many years while the restructuring is taking place. It's a very wasteful process."

Roblin issues a personal message to the prime minister:

"Produce an environment where people within the NHS can concentrate on what really matters which is patient care rather than structural reorganisation. Because continual change is draining and wasteful. They describe it as modernisation. I think they should stop using that political euphemism."

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The Randian Republican who could rein in Trump isn’t a coward – he’s much worse

Paul Ryan's refusal to condemn Trump is not caused by terror or fear; rather, it is a cynical, self-serving tactic.

Poor ol’ Paul Ryan. For a few brief hours on 27 January, a week after the inauguration of Donald Trump, the Wikipedia entry for “invertebrates” – which defines them as “animals that neither possess nor develop a vertebral column (commonly known as a backbone or spine)” – was amended to include a smiling picture of the Republican Speaker of the House of Representatives.

The online prank reflected a growing consensus among critics of Ryan: confronted by a boorish and authoritarian president plagued by multiple conflicts of interest, the House Speaker has behaved in a craven and spineless manner. Ryan, goes the conventional wisdom, is a coward.

Yet as is so often the case, the conventional wisdom is wrong. Ryan’s deafening silence over Trump’s egregious excesses has little to do with pusillanimity. It’s much worse than that. The House Speaker is not a coward; he is a shameless opportunist. His refusal to condemn Trump is not caused by terror or fear; rather, it is a cynical, self-serving tactic.

Long before Trump arrived on the scene with his wacky “birther” conspiracies, Ryan was the undisputed star of the GOP; the earnest, number-crunching wunderkind of the right. He was elected to Congress in 1998, aged 28; by 2011, he was head of the House budget committee; by 2012, he was Mitt Romney’s running mate; by 2015, he was Speaker of the House – and third in line for the presidency – at the grand old age of 45.

The Wisconsin congressman has been hailed in the conservative media as the “man with a plan”, the “intellectual leader of the Republican Party”, the “conscience” of the GOP. Yet, again and again, in recent years, he has been singularly unsuccessful in enacting his legislative agenda.

And what kind of agenda might that be? Why, an Ayn Rand-inspired agenda, of course. You know Rand, right? The hero of modern-day libertarians, self-described “radical for capitalism” and author of the dystopian novel Atlas Shrugged. As one of her acolytes wrote to her: “You have the courage to tell the masses what no politician told them: you are inferior and all the improvements in your condition which you simply take for granted you owe to the effort of men who are better than you.”

Ryan is an ideologue who insists on giving copies of Atlas Shrugged to interns in his congressional office. In 2005 he told a gathering of Rand fans, called the Atlas Society, that “the reason I got involved in public service, by and large, if I had to credit one thinker, one person, it would be Ayn Rand”.

Rolling back the evil state while balancing the budget on the backs of the feckless poor, in true Randian fashion, has always been Ryan’s primary goal. Even Newt Gingrich, who served as Republican House Speaker for five years in the 1990s, once decried Ryan’s proposals to privatise Medicare ­– the popular federal health insurance programme that covers people over the age of 65 – as “right-wing social engineering”.

These days, Ryan has a useful idiot in the White House to help him pull off the right-wing social engineering that he couldn’t pull off on his own. Trump, who doesn’t do detail or policy, is content, perhaps even keen, to outsource his domestic agenda to the policy wonk from Wisconsin.

The Speaker has made his deal with the devil: a reckless and racist demagogue, possibly in cahoots with Russia, can trample over the law, erode US democratic norms and embarrass the country, and the party, at home and abroad. And in return? Ryan gets top-rate tax cuts. To hell with the constitution.

Trump, lest we forget, ran as an insurgent against the Republican establishment during the primaries, loudly breaking with hard-right GOP orthodoxy on issues such as infrastructure spending (Trump promised more), health-care reform (Trump promised coverage for all) and Medicaid (Trump promised no cuts). It was all a charade, a con. And Ryan knew it. The Speaker may have been slow to endorse Trump but when he did so, last June, he made it clear that “on the issues that make up our agenda, we have more common ground than disagreement”.

A year later, Ryan has been vindicated: free trade deals aside, Trump is governing as a pretty conventional, hard-right conservative. Consider the first important budget proposal from the Trump administration, published on 23 May. For Ryan, it’s a Randian dream come true: $800bn slashed from Medicaid, which provides health care to low-income Americans, plus swingeing cuts to Snap (the Supplemental Nutrition Assistance Programme, aka food stamps), Chip (the Children’s Health Insurance Programme) and SSDI (disability insurance).

In Trump, Ryan and his fellow anti-government hardliners in Congress have found the perfect frontman to enact their reverse-Robin Hood economic agenda: a self-declared, rhetorical champion of white, working-class voters whose actual Ryan-esque policies – on tax cuts, health care, Wall Street regulation and the rest – bolster only the billionaire class at their expense.

Don’t be distracted by all the scandals: the president has been busy using his tiny hands to sign a wide array of bills, executive orders and judicial appointments that have warmed the cold hearts of the Republican hard right.

Impeachment, therefore, remains a liberal fantasy – despite everything we’re discovering about Russia, Michael Flynn, James Comey and the rest. Does anyone seriously expect this Republican-dominated House of Representatives to bring articles of impeachment against Trump? With Paul Ryan in charge of it? Don’t. Be. Silly.

Mehdi Hasan is a broadcaster and New Statesman contributing editor. He is based in Washington, DC

Mehdi Hasan is a contributing writer for the New Statesman and the co-author of Ed: The Milibands and the Making of a Labour Leader. He was the New Statesman's senior editor (politics) from 2009-12.

This article first appeared in the 25 May 2017 issue of the New Statesman, Why Islamic State targets Britain

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