Cut throat competition threatens NHS

I WAS sorry to read in The Socialist 537 that Peter Taaffe has a pain in his big toe. His difficulty in getting to see his GP is all too common. Government imposed targets mean frustrating phone calls to book appointments.

Jon Dale

In some practices you can only get an appointment by phoning at 8.30 in the morning - and often by the time your call gets through the queue every slot has gone.

But often GP visits are not for acute illness but to monitor long-term conditions, get test results, or review treatment, so could be planned ahead. Many people are forced to travel long distances to work, so the polyclinic idea can find some support. Workers who have to take a day off work to see their doctor are seriously inconvenienced. Their bosses are furious!

That's why the CBI backs the government's polyclinic plans. These large walk-in centres mean workers can nip out from work, see a doctor and then get straight back.

People who see their GPs most often, however, are the elderly, parents with young children and the chronically sick. They will be seriously disadvantaged by polyclinics, miles from home. After struggling to get there they will be confronted by receptionists, doctors and nurses who they may never have seen and who know nothing of their family and home backgrounds.

GPs in a polyclinic run for profit could come under pressure to carry out unnecessary tests, with each test making more money for the shareholders. It is also possible that necessary tests might not be done if deemed 'too expensive'. This is the American model of health care. Profit, rather than patients' needs, influences decisions.

Significantly, the doctors' organisation, the British Medical Association (BMA), is campaigning against Labour's attacks on the NHS. As Peter pointed out, the BMA strongly resisted the NHS's founding 60 years ago. The leaders of the BMA were vehement in their opposition to state control of medicine, and in particular control over their right to choose where to practice and to accept fee-paying patients.

However, they did not speak for the entire medical profession. Doctors with the time to lead the BMA were mainly GPs in well-off areas. GPs in working-class areas were spread thinly on the ground, often on-call 24 hours a day, seven days a week and quite poorly paid themselves, depending on the little their patients could afford to pay.

They did not attend the frequent and increasingly hysterical meetings the BMA held in its London headquarters. But they depended for information on this leadership who were in semi-permanent session.

Also many younger doctors had seen military service during the war and were less opposed to the idea of state planning of medical services. Surveys of medical students showed a substantial layer of support for the NHS. Hospital consultants were unpaid for their 'charity' work in the pre-NHS voluntary hospitals.

In fact, it was consultants and not GPs whose "mouths were stuffed with gold" by Aneurin Bevan, the Labour minister who brought in the NHS. Their organisations subsequently backed his plans.

Birth of the NHS

In January 1948 BMA members had voted 40,814 against the NHS Act and 4,734 for. By April, when a second ballot was held, the vote was 25,842 against and 14,620 for. Above all, the mood of the working class was overwhelmingly for the NHS. On its first day - 5 July 1948 - three-quarters of the population signed up with GPs. Within a few months 97% had registered. This pressure removed any possibility of a boycott by GPs, as BMA leaders had considered.

Although Bevan negotiated brilliantly with the doctors' leaders, identifying points of support and dividing his opponents, he never tried to mobilise the working class. Their mood had not just supported a national health service but was for root and branch change throughout society.

Instead Labour left the levers of power in society with big business. The NHS was thus born with many weaknesses that increasingly undermined it in later years, preparing for eventual Tory and New Labour assault.

The only connection between Bevan's Labour of 1948 and Brown's of 2008 is the name. A new workers' party is now needed to forge an alliance between health workers and communities fighting to defend local services, linking these into a national campaign.

The BMA's role today compared to 1948 shows some doctors could also be recruited to such a party. In 1948 they opposed state control to defend their status as self-employed professionals. Today they oppose big business control to defend their status as public servants (although GPs are still not directly employed by the NHS).

Privately-run polyclinics are only the latest demolition tool smashing the 1948 achievement of free health care available to all. In a socialist health service, there would be convenient walk-in clinics as well as local health centres. Staff would have the time and facilities to provide the services required, where they are needed. There would be co-operation between general practice, community services and hospitals, rather than the cut-throat competition now developing.