Tag Archives: NHS

The Complex Commodification of Healthcare

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Not the most eye catching title, but bear with!

I’ve been thinking quite a bit about what on earth has happened and is happening to healthcare, particularly in the UK, but globally, also. My musings are being particularly influenced at the moment by the writings of William T Cavanaugh, Georgio Agamben and Michael Foucault. More from WTC and GA another time (when thinking more about healthcare and the nation state)….

Foucault, speaks of biopower, i.e. the commodification of life itself, so that even what would have been considered within the private sphere of our lives, is now the fodder of the economic machine. Truthfully, healthcare has become utterly commodified and in such a complex way that we find ourselves entangled in a sick web and it takes some major diagnostic work to make sense of what is happening.

Firstly, the system of healthcare has become commodified and is itself driven by economic greed. I have yet to find any clinician who thinks that the top down reorganisation of the NHS in the UK at the hands of Andrew Lansley, (but started by the government of Thatcher and most certainly compounded by Tony Blair’s team) has been in any way a good thing. It has cost literally billions of pounds, and has led to and will lead to more private companies, limited by shares, owning and running the health care services. This is driven by the EU-US trade agreement and is based on an utterly flawed philosophy that competition will improve patient care. Except, it won’t. The problem is that share holders don’t give a toss about the needs of the chronically sick or the marginalised poor. Rather they want to protect and guarantee their ‘income’. So health care will worsen. The WHO recently stated that the NHS is the best health system in the world and yet our government has thought it best to dismantle it! The claim is that the system is costing too much money! The thing is that the NHS is and has been ‘in profit’ for a long time. It isn’t run badly. All the cuts that are being made (which the Tories won the last election by promising they wouldn’t make) are in part due to the fact that many corporations are paying such little tax, and also because we have such an utterly corrupt banking system. The reason that successive governments have not stood up to the banking sector or these corporate giants (and are now cutting public services instead of challenging them) is because they are not really the government! The banks and the corporations are (well they are not either, but they act as though they are)! That is why the healthcare system itself is becoming more commodified! At a corporate level it is simply fodder.

Secondly the patients have become commodities. Do not be deceived. We have a healthcare system based on a Pasteurian philosophy of healthcare. Kill the disease. You are a commodity. Your children are a commodity to the advertising companies, cheap supermarket trash and fast food chains, which are driving up childhood obesity and diabetes, whilst we take exercise out of schools. You are a commodity to the pharmaceutical industry and when you reach 40, if you’re not there already, you will be offered a free NHS health check, which will tell you that your BP, Blood Sugar and Cholesterol are too high, so you will shortly be needing some medication to control it all. But here’s the thing…..it’s mainly too little, too late. What happens in our early life far more affects our health in older age. We need to be majorly cheerleading the promotion of healthy living to our kids, especially our young women, as the health of your mum whilst she is pregnant has a huge impact on your future health, far more so than drugs you take after your mid-life crisis. You are also commodified by the breakdown of the welfare system. We don’t have time or money, apparently, for you to be off sick. We need you back in work to get the economy going. You will notice that most therapies are being extremely cut back – we don’t have time for you to get really healed, we just want you functional……

Thirdly, there is the commodification of the health-workers. Burn out, low morale, tired and flagging. The pressures are mounting and we are not taking care of our staff, and the sad truth is, it will get worse and not better. One reason is that we are becoming increasingly self-centred and demanding as people, due to a multiplied sovereignty in our history, which leaves us feeling like we have the right to behave like mini-emperors. Another is a kind of learnt helplessness due to the breakdown of community. A third is the anxiety driven nonsense we find daily in our media, a kind of chicken-licken hysteria about every mild ailment. And fourthly, there has been little foresight or planning to think about where on earth our workforce is going to come from if we don’t train them. We have a 50% trainee doctor shortage in the Emergency Departments. We will shortly have a national shortage of over 30000 GPs (and yet the government is promising 7 days a week cover, 8-8, just incase you want to discuss your piles on a sunday afternoon), but little thought is given to exactly where we will magic the workers up from. And if we take them from the EU? What then of healthcare in those countries? Ah yes…..multiplied sovereignty, we don’t really care. That’s why we continue to complain bitterly about the health services in this country, and yet we have the same population as South Africa, and ten times as many doctors. How do like them apples? Try being grateful!

Complicated, huh?

So we and our health are commodified. So what? How does knowing do anything except add to our already felt sense of powerlessness?

Well, we have some choices and some options.

We can choose to subvert the system wherever possible.

We can create some exciting alternatives.

We can protest.

We can radically love Andrew Lansley

We can vote out this government at the next election, though we must press for a new way of doing government, and allow our selves to completely reimagine how we do life.

We could have a revolution.

We can treat patients as sacred beings and refuse to treat them as commodities.

We can treat workers as gifts and not use them or abuse them.

We can be thankful that we have the best health system in the world and change our attitude somewhat.

Healthcare Politics 2b

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2b) I do believe “all knowledge is relational”. On a completely separate tack, I am passionate to see the hierarchy created by knowledge within the NHS broken down. The managment restructuring within the NHS had some great potential to create a more level paying field. But it has amazed me to see the CCG’s in England created with a dominance from doctors, only one nurse on the panel and no other therapists…..

Within general practice, it is rare to find practices where all the partners are not doctors, or if there are others, it is usually senior nurses or practice mangers. There are some exciting models where all members of a practice are partners (Bolton/Tower Hamlets in East London). Such models break down the hierarchies of money and knowledge as power and recognise the amazing contributions and to be made from across a team. Not only so, but data from these places indicates high staff morale, high patient satisfaction rates and good clinical results – a pretty awesome combination! This can work in hospital settings also and gives the hospital team and potentially the wider community the chance to participate in their workplace/heath service more holistically. It brings the possibility of participatory budgeting to the fore which is really exciting model for budgeting and corporate financial responsibility.

To flip power on its head and make it that which allows the mountains to be made low and the valleys to be raised up is at the very heart of kenarchy. Level playing fields – make for a better game!

Healthcare Politics 2a

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2) I do believe “all knowledge is relational”. I wrote to the secretary of state for health in the last government and suggested that we coud join up some thinking between the dept of health and the dept for international development. How often do we hear that the money given through aid has been squandered, wasted or siphoned off into some terrible and corrupt dictator’s pocket? And this then gives UKIP or the Tories scope to try and slash our aid budgets to the developing world. But, we also have a surplus of trainee doctors…..

My idea was this – instead of giving money into situations to help with health, we could give our doctors, nurses and midwives to work on an optional (rolling) basis as part of their training. We have loads of GP, surgical, medical, paediatric, anaethetistic, emergency, nursing and midwifery specialist trainees (to name but a few), who finish their training, or who get to a certain level and then cannot progress further due to a bottle neck in the system. We have some the best trained medical professionals in the world waiting for jobs. We also have, for example, the same population as South Africa, and ten times the number of doctors…….

What about piloting some schemes, where we allow relationships toimgres develop between partner hospitals and communities? We can send some of our best trained people into the developing world, paid for by a joint arrangement between the DoH and DfID. Our trainees would get some of the best experience, with on the job training available and return with richer and more diverse skills. They would build friendships and receive as much as they would give, learning about communication skills in difficult circumstances, reaching through cultural barriers and expanding their knowledge base. The host hospitals/clinics would also benefit from the sharing of knowledge and skills and therefore an increased level of expertise with which to help their communities. There would also be fresh supplies and medicines, homeprovided, for example, by the incredible work of the International Healthcare Partners or the Health Impact Fund. It is vital that such partnerships include community medicine as well as hospitals, because we need a sustainable model for the future. Plus we need to breakdown traditional views of who is ‘qualified’ to be a healthcare professional! Basic signs of illness could be taught to community members, so that the right treatment is given for the right condition. There has been some fascinating work, of late, in helping communities recognise when something is malaria and when it is not – the results have been staggering. It’s a scheme which involves partnership, honesty, sharing resources, using aid budgets in a relational and focussed way and could, I think, be really transformational! Aid that is relational and reciprocal – breaks down some of the power dynamics and utilises resource as gift. Sounds like good stewardship. The british government didn’t think so and were rude and dismissive in their reply!!