‘Talk NHS’: Professor Stephen Hawking demolishes Jeremy Hunt over the ‘weekend effect’, and highlights the NHS trajectory towards a US-style insurance system.
On Saturday 19th September 2017 the Royal Society of Medicine hosted a meeting “on the past, present and future of the NHS” under its public engagement programme, in conjunction with ‘Discourse’, a body organising public debates on key political issues “seeking to widen perspectives through increasing participation . . . . by bringing major thinkers and doers together for open discussion”. The debate was billed as a forum for “discussing the circumstances and decisions that have led to the current state of the NHS, and what action is needed to ensure that the NHS sustains its founding principles in and beyond its 70th year”.
A wide range of speakers from different disciplines were invited, including social work, doctor in training, Patients Association, conservative MP, Royal College of Nursing, legal experts, Nuffield Trust, General Practitioner, political Economist, and the President of the Royal College of Paediatrics and Child Health; the audience provided lively questions and commentary.
Speakers recognised that the important fundamental principles of the NHS were under huge pressure from rising demand, workforce deficiencies, and underfunding. The importance of integrating health and social care was emphasised, with the role of social work including a focus on the needs and rights of citizens at a time when austerity was undermining social justice and half a million fewer people were able to access adult social care than just a few years ago. Although the NHS is staffed by dedicated and compassionate workers, the current requirement to deliver £22bn in savings is making it impossible for them to deliver a quality service. With 6,000 too few doctors and 40,000 nurse vacancies in England, staff are increasingly demoralised by being unable to deliver the quality of care to which they aspire, a situation exacerbated by a government in a state of denial.
Sarah Wollaston insisted that Simon Stevens is keen to move away from the internal market, and would like to end wasteful contracting rounds in favour of area based commissioning. However, she did not believe that we were moving to an insurance based system, but were in fact retreating from privatised care. Other speakers and members of the audience were quick to point out that statistics show the precise opposite, with increasing involvement in the NHS of private companies, and new contracts for Accountable Care Organisations clearly expected to attract large international private providers. Louise Irvine, Chair of Health Campaigns Together, pointed out that the government was not seeking to repeal the Health and Social Care Act with its mandate for competition actively encouraging further privatisation.
Tony O’Sullivan, co-chair of Keep Our NHS Public commented that there would be £40 bn extra a year for health care if we spent as much as some other European countries, and that the 30,000 excess deaths highlighted in a recent study from Oxford was an outcome measure of the effects of austerity in the UK. In contrast, the US Commonwealth Fund report (although favourable to the NHS) was based on a survey of opinions, and actually indicated that death and morbidity outcomes for the NHS are relatively poor. It was therefore unaccceptable for Jeremy Hunt to seize on this report as evidence that his leadership has made the NHS the best health care system in the world. Wendy Savage (President of KONP) added that Oliver Letwin and John Redwood articulated the Tory party position on the NHS as far back as 1988 by enthusiastically promoting privatisation and an insurance based system, a philosophy subsequently echoed by Jeremy Hunt.
Claire Gerada castigated those who had not stood up against the Health and social Care Bill, including the Royal Colleges and those in the medical profession who, out of fear or ignorance, had colluded with politicians in the naïve belief that those in positions of authority must be right. Richard Murphy, a political economist, said that the NHS was a practical manifestation of our inbuilt empathy and the fruit of a post-war political will to utilise Keynsian economics in the transformation of society by spending. The neoliberal philosophy that markets are always the right mechanism for distributing resources is a core philosophy of the Tory party, and some other parties, and since 1980 achieved dominance in the NHS. Neoliberals characteristically work by subterfuge, for example promising that they will not reorganise the NHS and then doing the opposite. There is no economic reason for austerity, since the government can print money without limit and claim it back by taxation. Shrinking the size of the state is a key neoliberal principle; organisations are then set up to fail as this is fundamentally necessary to operating a market. The NHS we have is the result of political choice, and a publicly funded NHS is counter to market interests and hence the target of neoliberals.
The keynote speaker of the day was Professor Stephen Hawking. His speech had already been publicised and drawn savage criticism from Jeremy Hunt who urged Professor Hawking to “examine the evidence” and desist from spreading “pernicious falsehoods”. Professor Hawking gave a moving presentation in defence of the NHS, outlining his personal experience of care and his interest beyond this in protecting a service that represented a civilised society. He reflected that his survival in the face of serious illness would not have been possible if it were not for the NHS. In fact, his medical care, personal life and scientific lives had become very much intertwined, so that the question ‘what needs to be done to protect the NHS?’ was one of great importance to him.
Professor Hawking took issue with Jeremy Hunt over seven day working while conceding that this might be of benefit to patients. He went on to emphasise that policy making should be based on evidence, so that “any change like this must be properly researched. Its benefits over the current system must be argued for, and evidence for them presented; and the implementation must be properly planned and costed and the necessary resources provided . . . Hunt has cherry picked research. Speaking as a scientist, cherry picking research is unacceptable. Citing some studies and suppressing others to justify policies that they want to implement for other reasons debases scientific culture.”
He also raised concerns about increasing privatisation, stating: “When politicians and private healthcare lobbyists claim that we cannot afford the NHS, this is the exact inversion of the truth. We cannot afford not to have the NHS. A publicly provided, publicly run system is the most efficient and therefore more cost effective way to provide good healthcare to all.”
In considering what might be done about the present state of affairs, Professor Hawking said that the direction of travel will depend on the relative strength of different forces acting in pursuit of conflicting interests. The multinational companies are driven by profit motive, and the direction of travel currently in the UK is towards a US type insurance system as the balance of power now lies with private companies. On other side is the force of public opinion and democracy, with polls showing that the public agree with his concerns and continue to support the core principles of NHS. This provides hope for the future.