This last week I was sat in a meeting with several maternity service users and a splattering of health professionals and managers of varying sorts. We were talking about the enormous deficit that is in our health budget and therefore some of the difficult options that are ahead of us. The government likes to call these options “efficiency savings”, everybody else knows that we are talking about cuts to services.
I always start my presentations by talking about the difficulty we find ourselves in, how we got here (a massive national debt, which all nations are in because our entire economic system is built on debt and none of it is real and they just keep on printing more money to solve it, made far worse by people who get massive bonuses and a >£2billion reorganisation of the NHS that no one wanted or asked for, which had we not had, we would now not be needing to make so many cuts!) and what our options now are.
I then offer a revolution, and other than a few smiles and the odd chortle, no one seems to think this a realistic or viable option….But, if we didn’t reinvest in Trident, or if we did charge greedy corporations appropriate levels of tax, then we wouldn’t need to cut services in the NHS.
Anyhow, I then talk about the fact that no decisions have been made and that we are genuinely in a process of listening (something the government really didn’t do before inflicting this reorganisation on us) and wanting to come to a place of collaborative agreement. But I am fast learning two things. The first is that nobody wants the thing they really care about to be cut or refashioned in any manner. They understand that safeguarding their piece of the pie means that others will miss out, but they don’t actually want to make any sacrifices – I understand that. I also understand more clearly that isolated health budgeting doesn’t work……more on this anon….
The second and starkest realisation I’ve had though is just how dreadful the new legislation voted in by parliament really is.
You see, the Secretary of State for Health now has new powers, never had before to close any services or hospital he/she deems fit, not if they are performing badly, but if it makes better financial sense to do so…..And this is where the rubber hits the road in our public consultations and discussions with patients and service users. If we don’t come up with a solution to cut our services (oh sorry, I mean make efficiency savings – memo to self – stop referring to “efficiency savings” as “cuts”), with the public in some sort of agreement (although they won’t be, because who wants their services cut?!), then what will happen is the government will simply do the following:
They will tell us our sums do not add up, they will tell us that savings/cuts must be made, they will get rid of those of us who are trying to reach a point of agreement with our service users and they will bring in their own board aka Monitor. Monitor do not have to consult with anybody, they will simply cut/burn/slash whatever is deemed necessary and their decision cannot be challenged or overturned!
This is nothing other than bullying. It is what Georgio Agamben talks about when he refers to ‘The State of the Exception’ and with this grim stick of threat held up behind us, it makes our work of trying to reach a collaborative agreement on the redesign of services completely impossible. What are we to do? The challenge is here: how do we subvert the system, making it absolutely clear that we do not play this game, and yet submit back into the system so as to allow love to win the day.
The Powers have shown their strong arm. But they have forgotten that there is a power far more ancient and far more beautiful…….life laid down love……love always wins and it will win in the end in the face of all oppression.
We’re Skint. We need to make some cuts. Apart from scrapping Trident and ‘collaborative working’ – do we have any other suggestions?
HA! Dave, if I didn’t know you better I might accuse you of being a Tory boy!! How the tables have turned!
You’re right though, there are some difficult choices to be made, and the answers are not easy ones. I think the thing I react to more is that there is a whole lot of speak about localism, but trying to do isolated local health budgeting without an eye on the whole local economy is actually quite disempowering….and the rhetoric about economies of scale is not actually very well founded and so shutting units or pushing services into the community does not necessarily make better financial sense.
Also, I object to doing lip service to facilitating conversations about how money can be better spent. In our area, if we make certain choices, the educated and well off will cope fine, but it is those who are already disempowered and marginalised who will struggle. For me, it is vital that they are at the table for the conversations. Generational disempowerment and marginalisation has left them out of the loop. I’m not saying cuts aren’t needed, but I am saying that the bullying from the DoH over both timescales and the nature of the cuts needed is not helping us find a way forward.
I also wonder if we are skint?
When the US was skint, they just did some more “quantative easing” aka printing more money. Apparently we are servicing interest on our debt to a tune of £125 million every day….what does that really mean?!
If we are skint, then it only proves that the way we do economics really isn’t working and therefore an entirely new approach is needed.
The powers are doing a great job at looking to discredit cooperative economics, but that, (along with gift economics) is a genuine alternative to the status quo and a whole lot less raping of the earth’s resources……
Don’t worry Andrew – My thoughts on conservative ideals and Mrs Thatcher remain pretty much unchanged!
We are skint. The way we have managed economic policy hasn’t worked and we probably do need a new approach. However, you & I know zip-all about economics – so we should probably focus our efforts on healthcare…
Whenever there is change – it is those at the bottom that suffer the most. I’m not sure having the disempowered and marginalised at the table would be helpful – but it is vital that we have people who understand their issues and are willing to fight their corner are there.
Making decisions and implementing change is one of the hardest things to do in medical politics. Doctors are keen to point out problems but rarely have solutions and are often too timid to make a decision (we are naturally risk averse). However, one of the biggest issue is that the status quo isn’t working. It’s too expensive. It’s in-efficient.
Our options are simple. Make a change (risky) or stay as we are (riskier). My biggest concern is that we’ll spend so much time discussing the problems, attending endless collaborative focus groups and pointing out the uncertainties – that the current setup will collapse and we’ll end up with either a two tier system – or no NHS at all. And that really is the worse outcome for those at the bottom.