Show Hide image

NHS is heading for the "perfect storm"

Hamish Meldrum, head of the BMA, says Andrew Lansley is forcing unworkable, unprecedented “efficienc

The tall, slim career GP with a clipped grey beard and smoothly parted hair who greets me in his spacious offices scarcely resembles the union baron of popular imagination. He is urbane rather than confrontational, he speaks in measured sentences and seeks to emolliate not agitate. But Dr Hamish Meldrum, who spent much of his career at a medical practice in East Yorkshire and is now resident in Edinburgh, is the head of what has been called the most powerful union in Britain - the British Medical Association (BMA) - and his assessment of the coalition government's reform programme is devastating, all the more effective for being delivered with the calm of a doctor seeking to reassure a particularly anxious patient.

Meldrum knows that - unlike politicians and indeed journalists - doctors, his members, largely retain the respect and admiration of the public. He would agree with Nigel Lawson that "the NHS is the closest thing we have to a national religion in this country". And he knows that BMA members, denounced by many ideologues on the right as reactionary and unwilling to embrace necessary market reforms, are more powerful than any other interest group when they choose to mobilise against what they consider to be unnecessary and dogmatic interference by politicians.

Mission impossible

He is anxious that the principles of "universality" and "comprehensives", on which the NHS was founded, are imperilled by the fantasy of the Health and Social Care Bill and the creation of a utopian marketplace in which private providers compete with state care. "We are facing a perfect storm, or should that be an imperfect storm," Meldrum says as he sits perfectly still in a stiff-backed chair in his dimly lit office at the BMA's headquarters in Tavistock Square, central London. The "perfect storm", as he outlines it, is this - "impossible efficiency savings being forced on the service", the biggest reorganisation in the NHS's history, "rising medical unemployment", "pay cuts for doctors", "increased waiting lists" and the fear that the strain on the service will lead to more disasters such as the one at Mid Staffordshire NHS Trust.

“The health-care system is being asked to make £20bn of efficiency savings," he says gravely. "In real terms that's savings of 4 per cent year on year, which has never been done in one year before, far less four years in a row. And you've now added into the mix a major structural reorganisation, with lots of people either losing or changing their jobs; or their minds being focused on the reorganisation rather than on making the savings. We are facing various levels of impossibility."

He says even Andrew Lansley has conceded that "the substance of what he wanted to do could have been done without legislation. But in choosing to have legislation, and such permissive legislation - this was to be the legislation to end all legislation - he set a huge number of hares running, some intentionally, some unintentionally, and those who were most against his reforms were given a field day . . . They were able to say that he wanted a market red in tooth and claw, to let competition run rife, to bring private providers in from all over the place . . . ."

Should the Health Secretary resign or be reshuffled out of the cabinet? Even Lansley's supporters believe that he could have been smarter, more pragmatic. His "big bang" reorganisation need not have been so permissive; he could have acted as Michael Gove has done with education. After all, the free schools and academies reform programme is merely a continuation of what was started under New Labour: evolution rather than revolution, with Gove recast as a more zealous (and Scottish) version of Andrew Adonis.

“The policies have to change," says Meldrum of the hapless Lansley, self-styled all-knowing impresario of NHS politics. "Even if the only way the policies change means the current incumbent goes - they have to change."

The good doctor continues: "The Lansley reforms are a folly in terms of health-care issues but politically they are a huge folly as well . . . Leaving aside the reforms, because of the present economic and budgetary pressures, there's no doubt by the time of the next election, if not before, there will be increased waiting lists, [for which] everybody will blame the reforms."

Fewer young people are applying to study medicine at university, perhaps because of the introduction of higher tuition fees. "Will it lead to a shortage?" Meldrum asks. "We are educating and training more doctors than we used to, but can we afford to employ them? In the UK we have below-average numbers of doctors per head of population compared to Germany, France and others. On average every GP looks after about 2,000 patients. As people live longer, have more complex and long-term conditions . . . I think that ratio is wrong. Do we need more doctors? Yes. Can we afford more? Much more difficult."

Overworked, understaffed

Meldrum worries about the "potential for medical unemployment. In the past, we have scandalously relied on doctors from overseas, often from countries that can least afford to give them to us, to back up the gaps . . . We are already seeing [the impact of not having enough doctors] - consultants taking on more of the work that junior doctors used to do; that in some places the time available for continuing education and continued training is being limited and that can only be bad, not only for doctors but for patients.

“Also you get trusts that try to stretch rotas or stretch the staffing of wards too thinly - well, then accidents will happen and people will fall through the gaps and you may see the sort of things that happened in Mid Staffs, where part of the problem was the failure to attract enough doctors and nurses to cope with the work that was being asked of them."

What is most worrying for Meldrum and the medical profession he represents is that the Lansley reforms have made it much easier for opponents of the NHS to say that "it's the system that's bust rather than the funding of it, [and we will] see increasing pressure for co-payment or top-up payments, for limiting the scope and comprehensiveness of the health care provided by the NHS, and . . . it will be done on the wrong premise".

Jason Cowley is editor of the New Statesman. He has been the editor of Granta, a senior editor at the Observer and a staff writer at the Times.

This article first appeared in the 23 January 2012 issue of the New Statesman, Has the Arab Spring been hijacked?

Photo: Getty Images
Show Hide image

No, IDS, welfare isn't a path to wealth. Quite the opposite, in fact

Far from being a lifestyle choice, welfare is all too often a struggle for survival.

Iain Duncan Smith really is the gift that keeps on giving. You get one bile-filled giftbag of small-minded, hypocritical nastiness and, just when you think it has no more pain to inflict, off comes another ghastly layer of wrapping paper and out oozes some more. He is a game of Pass the Parcel for people who hate humanity.

For reasons beyond current understanding, the Conservative party not only let him have his own department but set him loose on a stage at their conference, despite the fact that there was both a microphone and an audience and that people might hear and report on what he was going to say. It’s almost like they don’t care that the man in charge of the benefits system displays a fundamental - and, dare I say, deliberate - misunderstanding of what that system is for.

IDS took to the stage to tell the disabled people of Britain - or as he likes to think of us, the not “normal” people of Britain -  “We won’t lift you out of poverty by simply transferring taxpayers’ money to you. With our help, you’ll work your way out of poverty.” It really is fascinating that he was allowed to make such an important speech on Opposite Day.

Iain Duncan Smith is a man possessed by the concept of work. That’s why he put in so many hours and Universal Credit was such a roaring success. Work, when available and suitable and accessible, is a wonderful thing, but for those unable to access it, the welfare system is a crucial safety net that keeps them from becoming totally impoverished.

Benefits absolutely should be the route out of poverty. They are the essential buffer between people and penury. Iain Duncan Smith speaks as though there is a weekly rollover on them, building and building until claimants can skip into the kind of mansion he lives in. They are not that. They are a small stipend to keep body and soul together.

Benefits shouldn’t be a route to wealth and DWP cuts have ensured that, but the notion that we should leave people in poverty astounds me. The people who rely on benefits don’t see it as a quick buck, an easy income. We cannot be the kind of society who is content to leave people destitute because they are unable to work, through long-term illness or short-term job-seeking. Without benefits, people are literally starving. People don’t go to food banks because Waitrose are out of asparagus. They go because the government has snipped away at their benefits until they have become too poor to feed themselves.

The utter hypocrisy of telling disabled people to work themselves out of poverty while cutting Access to Work is so audacious as to be almost impressive. IDS suggests that suitable jobs for disabled workers are constantly popping out of the ground like daisies, despite the fact that his own government closed 36 Remploy factories. If he wants people to work their way out of poverty, he has make it very easy to find that work.

His speech was riddled with odious little snippets digging at those who rely on his department. No one is “simply transferring taxpayers’ money” to claimants, as though every Friday he sits down with his card reader to do some online banking, sneaking into people’s accounts and spiriting their cash away to the scrounging masses. Anyone who has come within ten feet of claiming benefits knows it is far from a simple process.

He is incredulous that if a doctor says you are too sick to work, you get signed off work, as though doctors are untrained apes that somehow gained access to a pen. This is only the latest absurd episode in DWP’s ongoing deep mistrust of the medical profession, whose knowledge of their own patients is often ignored in favour of a brief assessment by an outside agency. IDS implies it is yes-no question that GPs ask; you’re either well enough to work or signed off indefinitely to leech from the state. This is simply not true. GPs can recommend their patients for differing approaches for remaining in work, be it a phased return or adapted circumstances and they do tend to have the advantage over the DWP’s agency of having actually met their patient before.

I have read enough stories of the callous ineptitude of sanctions and cuts starving the people we are meant to be protecting. A robust welfare system is the sign of a society that cares for those in need. We need to provide accessible, suitable jobs for those who can work and accessible, suitable benefits for those who can’t. That truly would be a gift that keeps giving.