RK on social media wrote (with a little editing):
An item on the news, said that teacher assistants were increasingly being used to teach full classes, some up to 30+ hours. PCSO staff are taking over much more of the standard police work and someone I know has just left a job taking bloods on wards, after little training, left alone to do the job on her own… and paid the same wage as a hospital porter.
I believe that by stealth, fully trained, higher waged professionals and semi professionals are being weeded out of many working environments.
Perhaps (just as nurses are taking over some doctor tasks) we will eventually only find the fully qualified in executive positions and barely trained, poorly paid staff will be undertaking most of the work.
Is this part of Hunt’s plans for the NHS, with doctors supervising a collection of underpaid individuals to deliver our health service?
We are fast heading to a worker bee situation, where cost cutting determines a very basic Health Care, Education and security for the masses except for those that can afford to pay. The rich will have the very best of care, education and security… further dividing an already horrendously divided nation.
This constant undermining of skills has been happening in industry for decades, where apprenticeships have ended and Mickey Mouse schemes qualify someone in a trade, after a six week course in a tech college.
It’s the bottom line that always matters most under capitalism. Skill, pride in workmanship, ethical standards of delivery, knowledge of the tasks, are all obstacles in the way of maximising profit. Perhaps that’s why we have so little of our industrial base left.
The argument is always: ” If we can’t be competitive, then we will take our manufacturing abroad to the third world”.
They can’t do that with health, welfare and education, so it has to be de-skilled to make it competitive. It’s also an attack on organised Labour, good pension schemes and secure employment. We all have to live in fear of the sack, or a wage freeze or as Public sector workers have long known, the gradual drip of outside tendering, ripping up of service agreements and eventual wage cuts and overtime payments.
While the working population is under increasing attack, there is a mirror image… one of unbridled growth in profits, bonuses and executive pay, for those that are ruining our nation.
I fully recognize the point RK is making and I think most of us could add even more examples of de-skilling of the workforce, whether in the public or private sector. However, he specifically puts the question:
Is this part of Hunt’s plans for the NHS, with doctors supervising a collection of underpaid individuals to deliver our health service?
Dr Bob Gill provides an answer:
The reality is that more qualified staff are being driven out in preparation for the de-skilling that is always part of healthcare privatisation and corporate takeover. For the UK, this is mapped out in the Five Year Forward View by Simon Stevens, the head of NHS England. Stevens used to be an executive of the US based private health care company, UnitedHealth.
Motions at the BMA conference raised similar concerns that the future training plans could reduce the standards of patient care and safety; that by de-skilling doctors, de facto ‘sub-consultants’ would be introduced who could be paid less, and be subject to more rigid terms and conditions of service; that unacceptable power would be given to local hospital managers to determine training and workforce planning; and limit the career aspirations of many hospital doctors to a sub-consultant grade.
So how does this fit with ‘The Predator State’ of the title?
It is the term used by economist James Galbraith (2008 book) to describe this phase of capitalism in which politicians have colluded with the corporate and financial sectors to privatize public services, using …
‘The state as monopoly collector of taxes and corrupt distributor of the spoils to the private sector.’
This is certainly what is happening to the NHS. Only this week, Richard Branson took over the NHS Children’s Services in Wiltshire. He will be paid by the state for that provision and will doubtless introduce the usual cost-cutting measures to increase its profitability ie reducing the wages bill, weakening union representation and paring the service back as much as possible. Using under or unskilled labour to do the work of a highly trained professional is the obvious way to reduce the wages bill – wages will be the biggest drain on his profits. The UK government will pay Branson for taking on the service (probably with a huge subsidy) and in return, we will get an impoverished service.
So what, where, why?
Aren’t we told that the Tories are all about ‘free-markets’ and competition … but that sounds just like a rigged ‘market’. How can Richard Branson possibly lose? Just as with the banks and care homes for the elderly, if the private company goes bust or gets fed up, the government will have to step in to pick up the pieces. In other words, it is yet again …
‘Privatisation of profits and socialization of losses.’
As Max Keiser pointed out, privatizing health, education and other public services provide great investment opportunities to hedge against more risky speculative ventures. And with another banking crisis predicted for the near future….
So why are the politicians going along with this rip-off of the nation?
Historically, we need to go back to Margaret Thatcher’s election in 1979, and even further back to Hayek on Mount Perelin in 1947. Put simply, Margaret Thatcher couldn’t bear the Welfare State and wanted Britain to resemble Churchill’s wartime fantasy of pre-WW2… The Austrian economist Hayek and his book ‘The Road to Serfdom’, offered her a political philosophy and economics that was an intellectual vehicle for her dreams. The fact that his ideas were so diametrically the opposite of the Welfare State and a mixed economy meant that there were limits to how fast radical dismantling/restructuring could occur without provoking riots. The ‘Boiling frogs’ strategy was adopted (put frogs in saucepan of cold water and gradually increase the heat – the frogs don’t notice until it’s too late).
The annual release of Margaret Thatcher’s Cabinet papers after the 30y rule confirms all this, and it is notable that this year, Cameron has stopped the release of a majority of the minutes from 1986.
But Margaret Thatcher was egged on and undoubtably manipulated by much bigger vested interests than her dreams of an England fit for Miss Marples and Agatha Christie. The City of London provided experts and consultants who saw the opportunity to return wealth and power to its ‘rightful heirs’ (and themselves) – those who we now call the 1% but more properly should be called the 0.1% or even the 0.001%.
It is highly significant that after the Great Depression, and in that short window of 1945-1979, the rich were not so rich and that has now been reversed back to ‘normal’.
Sadly, the LP lost its way in the 80s and bought into the idea that there was no alternative (TINA). Many actually believed in The Third Way. However as Tony Blair said recently, he had seen his role as to build on Margaret Thatcher’s achievements, and ironically, it seems that New Labour politicians continue to believe in ‘the wisdom of the markets’ when it is quite clear that George Osborne and the Republicans in the US do not.
James Galbraith insists that the original Monetarists like Milton Friedman were serious economists but after deregulation, market solutions were abandoned in favour of Crony Capitalism ‘in all important areas of policy-making’.
For them, [a market solution] now serves as nothing more than an enabling myth, used to hide the true nature of our world. Ironically, only the progressive still takes the call for “market solutions”
In other words, we’re being spun a load of economic lies (like austerity, the deficit drama and competitive efficiency) which are intended to persuade us that the impoverishment of the next generation, to benefit the global over-class of super-rich, is unavoidable. And as it happens, we have a government of Old Etonians and aristocrats who belong to that over-class, as do their cronies, friends, relatives and future employers.
‘Cameron himself went to Eton, and the many Old Etonians in his inner circle include Oliver Letwin, minister for government policy; Jo Johnson, head of his policy unit; Ed Llewellyn, chief of staff; and Rupert Harrison, George Osborne’s chief economic adviser.’
“What did the new class… set out to do in political terms? The experience of the past decade permits a very simple summary explanation: they set out to take over the state and to run it — not for any ideological project but simply in the way that would bring to them, individually and as a group, the most money, the least disturbed power, and the greatest chance of rescue should something go wrong. That is, they set out to prey on the existing institutions of the [ ] regulatory and welfare system.”
So where does this leads us with regards to the junior doctors’ contract and Jeremy Hunt?
Jeremy Hunt’s behaviour really doesn’t make any sense if he wants a ‘seven day’ NHS. No-one can imagine that it is feasible, not without more doctors, more hospital porters, nurses, radiographers etc… and expecting 20bn worth of cuts to the NHS budget at the same time? The old adage is that if something doesn’t make sense, ‘Follow the Money’.
After the last 5y of Lansley’s Health and Social Care Bill reorganization and cuts, it is no surprise that hospital doctors feel demoralized, undervalued, over worked and now they are being threatened with a substantial pay cut. Hunt’s imposition of the new contract on the Junior doctors is particularly criticized for driving doctors to work abroad.
Thousands are set to quit the NHS in protest over plans to shake up hours… more than 6,000 requests have been made for the paperwork needed to practise medicine outside the UK.
Well, the resulting shortage from a mass exodus of doctors would be a perfect reason for using under-skilled staff … and it could be even be spun as unreasonable doctors, disloyally abandoning the NHS. Hence, the conditions of the NHS could be harmonized with the expectations of private health care providers. And all who could afford it, would be tempted to go for private treatment… as in the two tier system of the US.
Hunt has good reason to want to upset and alienate the Junior doctors. It seems all too likely that he would love the awkward squad to go. Then he can move on to the consultants…
As James Galbraith writes:
There is no common good, no public purpose, no shareholder’s interest; we are the prey and governments as well as corporations are run by and for predators. The “failures” enrich the proper beneficiaries even as they “prove” government is no solution.
Fortunately, we’re not told the truth about how the economy really works… and there is no economic reason why a new courageous state could not (in time) restore the NHS to being an improved, truly nationalised service…. And it just so happens that Jeremy Corbyn supports full re-instatement of the NHS. Fingers crossed.
(Comments gathered from around the web. All positive views of Hunt’s behaviour have been shamelessly ignored but there were hardly any.)
Most embarrassingly for the government, the daughter of former cabinet minister Andrew Mitchell, herself a junior NHS doctor, has called for Jeremy Hunt to be sacked, accusing the health secretary of misusing statistics and alienating “an entire generation of junior doctors”
Then there is increasing criticism from fellow Tory politicians. For example, Dr Dan Poulter MP, who was a health minister until last May and who led the early negotiations on the junior doctors’ new contract in 2014, described Hunt’s decision on Thursday as “a dark day for the NHS and the future of medicine”.
But most vitriolic are ordinary Conservative voters:
Hunt may have won the battle but has certainly lost the war.
When all is said and done, I think Hunt’s behaviour has been appalling and I don’t think we have heard the end of this.
Could anyone really say they would happily argue for Hunt’s imposition of the contract on the doorstep?
I object to the ham-fisted way in which Mr Hunt has conducted the negotiations and his serious misrepresentation of the deal he has imposed on junior doctors.
Patients and the electorate are not going to believe any politician from any party when it comes to what is and is not in the best interests of patient care. They are going to trust the doctors.
Junior doctors had nothing to do with Mid-Staffs and Morecambe Bay and to suggest otherwise is very disingenuous.
Mr Hunt you always sound extremely plausible when I hear you speak and the deal you have offered does not seem bad to me at all. But so many people accuse you of dishonesty that I do wonder if there’s no smoke without fire? If you have been dishonest in the past please ensure that you have learned your lesson and will be straightforward and honest from now. It is the best policy now and always.
Asking doctors to work anti social hours for, in many cases, a net pay cut. The 13% basic award is designed to distract public opinion away from the reduction in special payments.
The new contract seeks to extend anti social hours of working, without increasing staffing levels, but significantly reduced or eliminated special payments.
The BMA offer (rejected by Hunt personally when NHSE apparently thought it ok) was to cut the basic pay rise to 5.6% (from 11) and keep Saturdays as OOH. It was pay neutral. Doctors think working on Saturdays counts as anti-social. Hunt says not. I’m with the doctors on this one.
The NHS is already dangerously over-reliant on locum doctors who are paid ridiculously large amounts compared to junior doctors. Hunt’s action will increase rather than reduce this over-reliance and will increase the number of doctors who emigrate when they qualify, which is already significant, rather than work in the NHS.
A perfectly fair, cost neutral solution, acceptable to NHS employers was vetoed by Hunt. Crass pigheadedness! And for what gain?
A pay deal that leaves more than a few doctors worse off, not as many as the initial proposals, but still enough to be of concern. I have not had to take a pay cut in my career but I wouldn’t wish it on anyone (except perhaps bankers) let alone doctors who have to work weekends, nights and be on call.
Jeremy Hunt should resign now. He’s a disaster for the whole of the U.K., he has alienated an entire profession. He has caused untold harm for years to come as talented young doctors seriously now look elsewhere. Unless this man is thrown out of office, disasters such as these will continue.
A very sad episode this and not good to see these talented hard working people so angry with the government.
Just go Jeremy and do it soon and allow the next minister chance to repair the damage both to the NHS and us politically before it’s too late
Do the decent thing and resign now Mr Hunt.
Had labour done this we on here, quite rightly, would’ve been slaughtering them, the fact it’s actually us that are doing this is all the more painful
Are we trying to install Corbyn in number 10?
A petition calling for a vote of no confidence in Jeremy Hunt has collected over 133 thousand votes in less than 24h. This means that the petition will have to be considered by a Parliamentary committee and has the potential to end up as a debate in the House of Commons.
But let’s not forget that it was a great surprise when Jeremy Hunt was brought in to replace Andrew Lansley (after what another Tory voter called his ‘£3 billion of pointless reorganisation’). After revelations of Hunt’s dodgy dealings with Murdoch over the failed bid to take over BSkyB, it was expected that he would be quietly dropped not promoted… but there is more …
(Hat tip Tom Pride)
“The BMA has continued to table proposals to settle the dispute. The fact that the Health Secretary is now simply trying to impose his will rather than negotiate, demonstrates a lack of confidence in his own arguments.
Strange but true… it seems that many Conservative supporters are more in tune with Jeremy Corbyn over this, than they are with Jeremy Hunt and their own government.
An open letter to members of the British public from Dr Rob Galloway.
I am writing for your help in trying to stop the unprecedented damage happening to the NHS. Please read, share, like, tweet and tell your friends.
As someone who has the privilege of working for the NHS as an A&E doctor, I see first hand what is happening. Please trust the real doctors and not the spin-doctors.
The NHS is on its knees and unless things change, it may not survive. It has been attacked, part privatised, demoralised and starved of funds.
We have tried to highlight what is going on; through the media, marches, speeches and endless tweets and face-book posts. But it is not working. Things are getting worse and the NHS, which we all care so much about may soon no longer, be able to care for us.
The only things which might save it is if the British public no longer just accept what is happening – but start to fight back. This is above party politics. This is about what we want our society to be like. Fight back for the greatest safety net we have – the knowledge that as a UK taxpayer if we get sick, then we will be looked after; an envy throughout the world.
The NHS was born on the 5th July 1948. Heroes from World War Two, no longer wanted to accept a society where if you were rich you would prosper and if you were poor you were left to suffer. It was born in a period of great austerity but money was found because health and welfare was made a priority above all else.
The attached letter was sent through the door of every citizen. The opening lines were:
“It will provide you with all medical, dental and nursing care. Everyone – rich or poor, man, woman or child – can use any part of it. “
This promise is one we may soon not be able to keep.
The NHS has its problems and needs refom. But its ethos was what made it great; patients before profits, co-operation instead of competition. But the last few years has seen a determined effort to undermine all that is good about the NHS – its socialised system of working for the good of our patients.
The government have started a process of privatisation. Billions have been wasted on re-organisations and competition and contracting out of services to the private sector which have destabilised the hospitals we all use. Despite this, the NHS kept going because of the skills and commitment of its staff.
So to deliver the politically ideologically driven plan of reducing the size of the state and selling off the NHS to the private sector – the government have started to attack the staff. Destroy the staff, you damage the NHS. A damaged NHS is one which the public would go along with privatising.
If this happens, things will become like the USA where they spend double on health care to what we do, but the money is wasted on profit, beaurocracy and excessive wages and the standards of care are so much lower than in the UK, especially for the poor.
Why are they doing this? It has been their plan all along. The extreme right wing in this country do not believe in working together for the common good. They do not believe in the concepts of the NHS. They believe in individuals floating or sinking. Jeremey Hunt even co-authored a book on this 10 years ago in which the authors said the NHS is “no longer relevant in the 21st Century.”
The new contracts they are proposing for junior doctors will mean an exodus of doctors from the NHS. Without these doctors, standards of care will fall, waits will rise and patients will die.
They have said this about a 7 day working. They are lying. The new contract will harm 7 day working. How do you improve care at weekends if you stop incentivising people to work in jobs with lots of out of hours work by saying evenings and Saturdays are normal working hours.
They have also lied by saying there will be an 11% pay rise. Junior Doctors salaries have a large component made up of supplements because they work so many nights, weekends and evenings. If you cut these payments by 30% and increase basic pay by 11% that is not pay rise.
And you can tell they are lying by simple maths my 6 year old can do. They have said that everyone will get an 11% basic pay rise but the pay envelope will not rise.
So we need the British public’s help in understand what is happening because there is so much misinformation and lies out there spun by the politicians and propagated by sections of the press.
Public opinion matters. There may well be a strike by junior doctors. During the strike consultants like me will be doing what we can to make things safe. No one wants the strike – especially not the doctors. They have said they will negotiate with the government as long as the government say they will not impose a contract. That can only be fair – but the government refuses. A strike will be the fault of the government.
If the doctors strike , it would be to protect the NHS and not to harm it. Protect if by forcing the government into a climb down so that they do not bring in these disastrous policies which will lead to so much damage to the NHS.
But it is bigger than just this issue. We as a society must think about our priorities. Do we starve the NHS of resources whilst having tax cuts for millionaires and multinational businesses? Do we value and protect the bankers and speculators who have harmed this country so much or do we value and protect the doctors and nurses who heal the country?
We must start to fight back. Do what ever you can to let people know what is happening. Campaign on the street, pubs and ballot box. Even if we win the junior doctor battle and even if Mr Hunt is forced to resign, that is only the first war in a generational battle for the NHS .
Remember what Nye Bevan said on the day the NHS was founded. The NHS will last as long at there are the folk with the with faith to fight for it. We as members of the British public need to have the faith and we need to fight for it.
If we don’t, the NHS which our grandparents so proudly formed, will no longer be there for our children. They may never forgive us.
Dr Rob Galloway, A&E Consultant