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4 July 2008

Happy birthday NHS

As Britain's greatest institution celebrates its 60th birthday, Jonn Elledge reports on a health se

By Jonn Elledge

Blow up the balloons, break out the bunting: this week the NHS turns 60, and Britain is rejoicing in the miracle of free healthcare.

The medical profession, though, is in little mood for celebrating. Newspapers echo with claims that polyclinics are the end of the life as we know it. Doctors’ forums are packed with vicious attacks on the government, and threats to jump ship to Australia at the earliest opportunity. And at a recent BMA conference, a GP proposed a motion calling on the BBC’s Torchwood to ride to the rescue, on the grounds that only a group of fictitious alien crime fighters had any hope of saving the NHS.

The odd thing is, in 1997, doctors were ready to welcome a Labour government with open arms. And from the outside, they look to be one of the big winners of the last decade. In 1999, a top-end consultant was paid £61,000; by 2006 the average pay was £111,000. Over the same period, GP pay climbed from £50,000 to £102,000 (although some say it’s fallen since). Yet a recent BMA poll found that 97% of Britain’s GPs had no faith in the government.

So if it’s not about money, how did the affair turn sour? Partly it’s simply exhaustion after a decade of change and contradiction. Since 1997 the government has reorganized the NHS seven times; Lord Darzi has just concluded another review, described as a ‘once-in-a-generation’ opportunity. The government scrapped the Tories’ hated ‘internal market’, only to re-brand and resurrect it six years later. It pledged to end privatization, yet spent billions on PFI hospitals and invited American corporate giants like United Health into the NHS.

The result is that everyone feels they’ve spent the last ten years running round in circles on ministerial command. ‘They say there’s a grand design and there isn’t,’ complains Dr James Kingsland, chair of the National Association of Primary Care. ‘It’s all done on the hoof.’

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Another problem is the target culture. Where once doctors could decide the urgency of a case themselves, they now have a barrage of government directives to consider. This emphasis on standard processes over personal care can have some nasty side effects. One London oncologist says that, while the system has its strengths, ‘It’s so streamlined that it’s not uncommon for patients to go from test to test, without anyone actually telling them they have cancer.’

Perhaps the biggest reason for the falling out, though, is a feeling that the profession just isn’t respected as it once was. It’s more tightly regulated, in the wake of Harold Shipman. Its views are often ignored by a government convinced it knows better (nearly a year after the new junior doctor recruitment system left thousands without jobs, you can still hear the cries of ‘we told you so’). And after ministers underestimated the cost of the new contract, there are suspicions that they’ve been briefing against the profession to help them claw it back. ‘There’s a growing sense that there’s a deliberate ploy during pay negotiations to denigrate the profession through the media,’ says Dr Kingsland. ‘It’s left a lot of my colleagues feeling bruised.’

In fairness, doctors have seen generous pay increases over the last ten years – and tabloid journalists are capable of being bitter about it without prompting from the government. Nonetheless, the result is that doctors feel under siege – by government, the private sector and a hostile media – and morale is at an all-time low. More than two-thirds of NHS doctors now say they wouldn’t recommend a career in medicine.

Those searching for a new champion are turning to David Cameron. He’s been saying all the right things, praising doctors and warning that Labour has been ‘blinded by the private sector.’ And polls show that they’re now six times more likely to plump for the Tories than Labour.

But, quietly, the party remains committed to open competition in the NHS. And behind closed doors, senior Tories are reassuring commercial health companies they have no intention of rolling back the private sector. This won’t be the last unhappy birthday the medical profession sees.

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