‘May you live in interesting times,’ or so the well-known Chinese proverb is purported to read.
Perhaps less well-known is the fact that this saying is intended not as a blessing but as a curse.
The political and economic landscape the NHS inhabits is certainly what could be termed as ‘interesting’.
Chronic under-funding, a crisis-level staffing shortage and the substantial uncertainty and instability posed by issues such as Brexit.
The UK’s exit from the EU threatens not just health services but the entire status quo of the UK’s existing arrangements on trade, regulation and international relations.
With the prospect of a no-deal still a possibility, there is a growing concern among many health professionals that the NHS will be ‘on the table’ of any future trade negotiations, something inflamed in recent weeks by comments made by the US ambassador to the UK and the president himself.
For medical student Faisal Yousif, the chilling realities of realpolitik cast an ominous shadow over the future of the NHS.
He urged the BMA to lobby politicians against including the NHS in trade talks, resist further privatisation and oppose the sale of patient information for commercial purposes.
‘The reality is that the current global political climate and the narrative about the future of our trading relationships around the world will be governed, if we don’t stop it, by three things: free trade; reduced regulation; and the sale of public services to international corporations,’ he told the BMA annual representative meeting.
‘Our proud, and publicly owned health service is being used as a bargaining chip to appease our cousins across the Atlantic. If this goes through we will be in the arms of both big pharma and big health.’
Concerns closer to home also heard at this year’s ARM was that of the effect of the private firms that provide medical services.
With their tendency to cherry pick the most lucrative contracts, while leaving the NHS with the most burdensome, private providers are increasing the pressure on public services, and they are also not subject to the same standards of scrutiny when recording and reporting patient-safety incidents.
In a worst-case scenario, warned histopathology consultant Anne Thorpe (pictured below), private firms can just walk away from their commitments, leaving patients high and dry and the NHS to pick up the pieces.
In backing calls for private healthcare firms to be subject to the same scrutiny as the NHS and to be required to take on varied case mixes of patients, she warned that flawed contracts between the Government and private sector had damaged public services.
‘One of the worst problems with private providers of NHS services is when there’s a catastrophic failure of the contract; when a provider goes bust, like Carillion, or withdraws from a contract mid-term, like Virgin healthcare,’ she said.
‘It’s a running theme in such catastrophic failures that there’s been a fundamental flaw in the contract.
‘They [private firms] push risks to the limit and beyond and then the contracts are not properly monitored and audited. As a result, public services can deteriorate and collapse.’
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