Ouch

 

There’s a lump on my back. 

There’s a lump on my back.  It is hard and protrudes out my ribs, under the skin like a shark fin.

Five years ago I walked towards Tower Bridge with snow under my boots and hunkered down in my old duffel coat, the hood pulled tight over my head.  From a high billboard, on the side of a newsagents, David Cameron sneered down.  Remember those adverts?  They were the ones that sold the Conservative Party on the back of their supposedly modern, compassionate leader; a man more adept at hiding his less savoury characteristics than many of his colleagues.  Those posters promised many things.  This one assured us that the NHS would be safe in Tory hands.

“No more top down reorganisation of the NHS,” he pledged.  He talked about the dedication of the doctors and staff who had cared for his terminally ill son.  Maybe, we thought, this is a Tory who understands the value of a free and accessible to all health service.  His praise was almost certainly genuine, but it has been trampled by what has come since.

No top down reorganisation?

The 2012 Health and Social Care bill introduced by Andrew Lansley was the biggest, most fundamental reorganisation of the NHS, from the top down, since its inception.  Healthcare in the UK has been radically altered and aligned with the ideological priorities of the market rather than advice from professionals.

The bill is a confused combination of localism and centralisation.   It has abolished the strategic health authorities leaving just NHS England and a few associated bodies hanging onto the reins, therefore centralising strategy.  Simultaneously it has abolished the network of Primary Care Trusts which, amongst other things, purchased their area’s health services through the internal market.  The intention was for the purchasing power to go extremely local, into the hands of GPs who would make direct decisions about their patients.

This, as one would expect of this government, ignored the fact that all those people employed by the old PCTs were doing something with their days.  The Daily Mail likes to paint the picture of bloated NHS managers, civil servants and local authority employees collecting salaries while working reduced hours and messing around on the internet.  The reality is that the vast majority of people going to work do actually engage in work, and often have specialised skills, like contracting and health service commissioning.  These are skills which GPs, professional doctors who have spent their working lives caring for the sick and not getting to grips with how to put together a multi-million pound contract for cancer care, do not have.

Consequently around most of the country we find Clinical Commissioning Groups, units carrying out the actions of the powers granted to GPs.  Similar to the PCTs, but more under-resourced and less strategically clear of what they should be doing, a centralisation of a localised service.  Five years – just the latest five years, but five tense years none-the-less – of continual structural realignment has seen some of the best and brightest talent flee the NHS for a more stable working life.

This lump on my back has been there for a long time.  Maybe as long as fifteen years.  It’s clearly a fatty cyst of some sort, but in recent years, when I lost weight, it has felt more prominent.  Maybe it’s grown somewhat.  It rubs on my shirt and gets second glances.  It juts, like the peak of an iceberg, making me wonder what’s below the surface.

January 2014, and I finally decide to see my GP about my lump.  He suggests a scan and that it should probably be removed to be on the safe side.  While I’m there, my first visit for years, I update my address.

The hospital sends my appointment details to my old address.  Eventually, I go in for an ultrasound scan.  There’s a follow-up consultation where they seem uncertain by the ultrasound and recommend a CT scan.

Labour, in attempt to create a realisation of the true cost of healthcare services, created an internal NHS market whereby, essentially, one area of the NHS, for example a PCT, needing access to services delivered by another organisation, such as an acute hospital, purchased or commissioned that service.  The commissioning process allowed bodies to purchase based on value for money and quality standards while working collaborative to drive the later up and maintain the former.  Arguably, it was a flawed idea, but you can see where they were going.  In any sector, even a publically funded one, cash is still king.  Having the option to move to an alternative service provider, and thereby cut the income of your existing provider, is a powerful tool.

The Conservatives have, however, taken it one step further with the introduction of any willing provider into the mix.  This means it is no longer an NHS internal market, but one in which any organisation offering healthcare services may bid to be awarded a contract, often successfully so by offering unrealistically low costs.  Make no mistake, these companies are not in healthcare to ensure the future well being of the local population.  It is, quite simply, to make a profit, because that’s what the private sector has to do.  Make money.

The assumption was that the NHS was flabby, inefficient, unnecessarily expensive and over-staffed.  Any private contractor would simply have to cut back some non-essential staff, create some systems that were not bogged down by public sector bureaucracy and, once related services had been acquired, efficiency savings could be made by streamlining.  The reality has not been so smooth.  Many have found that the previous NHS service was running about as efficiently as a system with unpredictable outcomes could be.   Staff were already stretched and over-worked, propping up the system by good will.  Unsurprisingly, that good will falters when you cut wages and reduce annual leave. 

The body length tray glides into the narrow tube of the CT scanner.  UB40 sing through the headphones I’m wearing.  My shoulders, scalp and the tip of my nose all touch the walls.  It’s hot and uncomfortable.  My arm throbs where a drip pumps dye into my blood.

‘Red, red, whiiiiine.’

The scanner roars to life, like a jumpjet taking off, drowning out Ali Campbell.  The rattle pounds at my brain.  The screech is relentless and in my claustrophobic tube there’s no way to even try to block it out. 

After what feels like an hour, the thunder grinds to a halt.

‘I’ll stand by you,’ sings Chrissie Hynde in my headphones,‘I’ll staaaannd by yew.’

The hospital sends the follow up appointment to the wrong address again. 

In the next consultation the surgeon says it is just a cyst, but the radiologist is uncertain.  The picture from the scanner is unclear.  They decide to refer me to a specialist cancer centre.

Private companies are already proving to be a failure.  Hinchingbrooke, the first NHS hospital to be given private management has been placed under special measures and Circle Holdings, the US company bought in to save it has fled.  Serco have defaulted on several multi-million pound clinical contracts leaving the Trusts to swoop in a pick up the pieces.  This happens, because healthcare, in this country, doesn’t make a profit.  The NHS makes a loss in the internal market system and because they’re all, ultimately, part of the same organisation it just about stumbles along.

And that’s fine.  Good will and dedication hold the whole thing up and, frankly, it shouldn’t be any other way.  What Labour – and the Tories – failed to understand is that care and compassion can be more important than cash.

This week the 2015 election campaign has been dominated by the leaders’ debate, not least for the fact that David Cameron pulled himself from out behind the sofa and actually took part.  I suspect that viewing figures were lower than last time around, not only because of the lack of novelty, tedious will they/won’t they soap opera build up and mildly confusing seven way battle, but it was broadcast on the Maundy Thursday, the equivalent of a Friday night.  Most of the nation will have been out drinking.  My wife and I, though, were off cycling around Normandy the following day and so had a quiet evening in swearing at the television.

As proved by Cleggmania turning into a net loss of seats last time around, it is foolish to read too much into these things, but there some intriguing indicators, and rarely around anything anyone actually said.  The trending google search during the debate was, apparently, “what’s wrong with Nigel Farage’s face?”  Indeed, Britain’s most famous xenophobe looked particularly sweaty and pale, with a tendency to roll his head around on his neck, swivel his eyes (in a fashion currently prohibited of UKIP members) and have an elastic mouth which contorted regularly into a upside down moon, much like Sam the Eagle from the Muppets.  From out of said mouth came the expected barks of a worn down record failing to find anything which couldn’t be blamed on a single issue.

Alas, Nigel wasn’t the only one to have an unfortunate physical tick.  Ed Milliband’s pinched fingers being thrust towards the camera at every opportunity was pure Blair, but the Blair that Harry Enfield was mocking as long ago as 1998 in the St Albion’s sketches.  I like Ed.  I think he’d make an excellent Prime Minister, even though I intend to vote Green, but he struggles on stages such as this.  Maybe that’s okay.  Maybe we’re tired of the too slick and overly polished politician, but I suspect most people will find it problematic.  He looks old, grey, jowly and haggard compared to the fresh faced young kid who barged his brother aside five years ago.

Cameron and Clegg’s sniping came across like parents bickering in front of the kids.  It was a little demeaning, as both struggled to take credit for the government’s mild successes and to divert blame for most of the crap (although, in fairness, Cameron shoved most of it on the previous Labour administration, an argument which is, surely, becoming a little tired – if he does win a second term, will he try to do the same in five years time, a decade after coming to power and twelve years after the economic implosion of 2008?).  None of it was very convincing and they seemed to both be refusing to shoulder responsibility while arguing semantics and whose fault it was they left the heating on while they went on holiday.

Frequently, though, the debate descended into men in similar grey suits yelling at each other leaving it to the women leaders present to return the discussion to the meat of the question posed and to provide something of substance.  Leanne Wood at times looked shell-shocked to be on the national stage, but gained applause, in our house at any rate, for telling Farage he should be ashamed at his lack of humanity.  Natalie Bennett, unfortunately, still seemed short of confidence following her brain fade earlier in the year.  She was the only leader to obviously refer to notes in her opening and closing remarks, and yet she had a clear and decisive handle on the detail when speaking off the cuff.  Confidence is, however, important in these matters.  Even with some excellent contributions she was unable to steer the discussion to the elephant in the room of the crumbling environment, her only opportunity being when she was able to voice her opposition to fracking when a heckler raised it.

It was Nicola Sturgeon, though, who whipped everyone.  An established politician in the way that Wood, Farage and Bennett are not, Sturgeon was witty, engaging, forthright and determined not to take any bullshit.  I may be a strong believer in the need for Scotland to stay in the United Kingdom, but if the SNP were standing in South East London I’d be sorely tempted to vote for them: a clear message of society being improved for the masses with an articulate and principled leader.

Unsurprisingly no-one, not once, said “I agree with Nick.”

The cancer centre promptly makes an appointment for me, but this is my legal wedding day, so I call to rearrange.  While my wife and I are in Wales immediately following the nuptials, the consultant reviews the images and decides that it is definitely a cyst.  The cancer centre refers me back to my local hospital.

Except they don’t.  Somehow they manage to refer me to myself.  A letter arrives suggesting that I remove the cyst myself and if there’s any concern to drop the cancer specialist a call.

I go back to the GP.  I get referred to the hospital again.  The hospital sends my appointment details to the wrong address.

I go back to the GP yet again.  Somehow my notes from the CT scan now say that I am suffering from second stage bowel cancer with liver metastases.  As I otherwise in perfect health and the CT scan was now nine months ago, we assume this is a mistake and move on.

Aside from the infringement of the private sector, the NHS is creaking at the seams.  The failure of many Trusts to meet Emergency Department waiting times hit the news over the winter.  Short-term investment was thrown at it to make the problem headlines go away, but while the NHS budget hasn’t had the same mauling as many other departments, in real terms it has been reduced.  Inflationary rises, a growing and aging population, harder targets and diminished resources mean that the system has suffered the biggest funding cut in twenty years.  A drive for more care in the community, for people to be cared for in their homes rather than lingering for weeks in another ward is admirable and, possibly, cost-effective but reconfiguring the staffing mix will take longer than the system shift is allowing for.  It takes years to train healthcare professionals, not less than a parliamentary term.

Before Labour came into power in 1997, the NHS was a mess.  Hospitals appeared to be dirty, were often falling apart and the harried and maligned staff struggling to keep the lights on.  Labour turned it around; turned it into something for the country to be proud of, but it only did by pushing unprecedented levels of funding through.  And that’s it.  Health costs.  And so it should. 

Nor should we mind paying for it through universal taxation that ensures it is there when we need it regardless of our circumstances.

So, the big questions become:  Did Cameron not know?  When he promised the electorate that there would be no significant changes and that he would safeguard the NHS, he either had no idea what Lansley was planning or he lied.

Neither of which is very appealing.

In early 1974 the latest in a series of miners’ strikes plunged the country into darkness.  The mines were still state controlled, power and electricity generated by burning coal fell under the auspices of the government, but miners have always had a bad deal and strikes over pay and working conditions were common.  Edward Heath, sitting Conservative Prime Minister and arguably the rudest man to hold the top office, had been trying to break the effectiveness of the unions for the duration of his parliament.  Union power was probably out of control, resulting in a stumbling economy and industrial walk outs for the smallest affront.

Heath’s radical response was not to back down, but to introduce the three day week.  All non-essential electricity use was to be reduced to three days a week, including the majority of businesses, and domestic use was strictly limited.  Even on the active days, the country went to bed at ten-thirty.

After three months, with an increasingly hostile and bored population (and an expected high birth rate for the end of the year), Heath called a snap-election for February 1974, with the three day week still in place.  He ran with the slogan: “Who governs Britain?”

The electorate responded, “not you, mate” and Harold Wilson found himself back in Downing Street with a minority government.

The lesson here:  there are essential services, core infrastructure which should be free from political arguments.  Thatcher sold most of them off, but health (and education) still remain with the state.  They are too important to play ideology with, too fundamental to our well being to continually reorganise, restructure purely for a new health secretary to say they’ve done something.  A steady hand, more money and time to get to grips with the challenges our wellbeing throws up should be a big enough job in itself.

Fifteen months after starting first going to the GP, I still have a lump.

The retention of my lump is not the fault of the NHS.  It is a failure of money.  Greater investment in support systems which would mean that staff weren’t under-resourced and appropriately trained, talented people would take administrative tasks away from clinical staff.  In the Leaders’ Debate, Cameron referred derogatorily to NHS managers as people with clipboards getting in the way of doctors and nurses healing the sick.  But he misses the point that clinical and non-clinical staff are not mutually exclusive.  They’re all part of the same system.  The NHS is the envy of the world, one of the finest, most cost-effective healthcare systems anywhere.  It just needs a little bit of help.