Feature

The NHS: why defend the indefensible?

The call has gone out to ‘save the NHS’. But why, and for whom, asks Mark Ponnampalam

On every occasion there is mention of further cuts in the health service, the predictable knee-jerk reflex response is heard: ‘Save the NHS!’ Perhaps instead we should be asking: ‘What are we saving, and for whom are we saving it ?

What people require is a truly democratic health service that is responsive to the needs of, as well as accountable to, the community it serves. The NHS has never fulfilled this role.

The fact is that Atlee government nationalised the healthcare delivery system in the same manner it nationalised the railways and the coal industry. With coal and the railways, the owners were financially compensated and were asked to stay on as the new managers. A basically similar process occurred in the new NHS.

The NHS is no more egalitarian or democratic than the society it serves. It replicates the same barriers of class, race and gender that characterise British society and these are reflected in the patterns of occupation, status, pay and conditions of employment.

The aristocrats of the medical profession who, for all practical purposes wield power over the hospitals side of the NHS, are the hospital consultants. A self-selecting lot, they come largely from the upper-middle classes.

The medical scientists, physicists, biochemists, statisticians and administrators come from the middle classes, generally; and the nurses (mostly female) from the middle and lower-middle classes.

The ancillary workers (mostly female, many black), laundry workers, canteen and cleaning staff come from the working class and are amongst the poorest paid in the country.

Over the years, successive governments have played off one section of the NHS staff against another in order to forestall massive and united protest.

Black health workers have functioned as a reserve army of labour in the NHS. As junior, temporary, and low-paid staff, often in the ‘Cinderella’ services of the NHS, they have enabled white staff to go ahead and obtain their promotions, work in academia, or compete successfully for career posts.

Having said this, the excuse frequently given by politicians, that the infinite health demands of the population mean financial limits must be established on essential services, must not be allowed to go unchallenged.

For several years, certain big business interests have regarded the NHS as a source of rich pickings. These are pharmaceutical companies and the medical supply industries.

During all the talk of financial stringency in the NHS, the silence maintained over the operations of these companies, and their exploitation of the NHS funds, has been quite deafening. Yet it has been demonstrated time and time again, that in egalitarian societies the costs of a free, basic and yet comprehensive healthcare delivery service for all the citizens need never be prohibitive.

When the cry goes up again: ‘Save the NHS!’, the reply should be: ‘we need a better health service for all!’ The NHS, as it stands, is riddled with secrecy (which has nothing to do with confidentiality), professional cliques, racism, sexism, ageism and yes, corruption.

Only those who have been successfully socialised in the values and attitudes of the privileged and dominant groups in society are appointed to high office in the professional and administrative tiers of the NHS.

Those groups in the population that are most vulnerable — the very young, the elderly and those with disabilities — are also those groups that are most vulnerable inside the NHS.

I am reminded of a senior orthopaedic surgeon who was in the habit of hastily discharging back to the psychiatric ward, elderly enfeebled patients who had been admitted to his care for surgery. After a major surgery for a broken hip, these elderly patients had their intravenous drip infusions taken down; they were then put into an ambulance and taken back to a psychiatric ward without facilities for acute nursing, when, in fact, what they needed was several days of care in a fully-equipped orthopaedic ward.

Incidents such as these are only the tip of the iceberg.

During the 40 years of its existence, the NHS has benefited the privileged more than the disadvantaged and top doctors more than patients. It would now do for us to ask ourselves ‘Do we want to save the NHS?’ The people of this country deserve a better and a more equitable health service; they do not deserve the kind of health service they have had to put up with for the past 40 years.