NHS Chief Quits, Calls Austerity a Weapon to “Dismantle the State”

6.7.12

Dr. Gabriel Scally, who resigned in April, also talks of “a very deliberate policy across all of the public sector to roll back the achievements that have been made in this country since the second world war,” and “a systematic downgrading, if not destruction, of civil society in England” by the Tory-led coalition government, as well as speaking about “the circling birds of prey of the private sector seeking to make big profits out of healthcare.” 

For those hoping to keep the government’s malignant NHS reforms under the spotlight, the Guardian‘s interview this week with Dr. Gabriel Scally is important. Dr. Scally held a senior position in the Department of Health, as the regional director of public health for the south-west of England, but he resigned in April “as a direct result of his alarm at the coalition government’s health policies,” and “because he wanted the freedom to oppose them,” as he told Denis Campbell in his first interview since resigning.

“The time had come for me to step outside the formal system and do things in a different way,” he said. “My job is helping people live healthier lives in healthier communities, and there are better ways of doing it than participating in the changes that are taking place in the public sector in England.”

He also said, “Since 1993, I’ve been restructured and reorganised eight times, I think, and that’s enough really. Throughout these restructurings I’ve seen a loss of talent, of momentum and of coherence, in both the NHS structures and public health structures.” He added, crucially, “This one [Andrew Lansley's fiercely opposed Health and Social Care Act] was the final straw.”

As Campbell explained, the upper echelons of NHS management contain many senior figures who are dismayed by the government’s NHS reforms, but, significantly, “contracts that forbid criticism of official policy have meant that, despite widespread doubts internally, no one working in the service has been able to publicly voice the concerns that many hold privately.”

That, of course, is a disgrace, as enforced silence can be taken to signify consent, and as a result Dr. Scally, described by Campbell as “an articulate and passionate defender of the NHS,” who is “[n]o longer muzzled,” is “set to become a thorn in Lansley’s flesh, and a key voice in the debates about public health issues, such as obesity, tobacco control and public health’s impending transfer from the NHS to local government.”

As Campbell also noted, his expertise and experience — having worked for 16 years as a regional director of public health — means that he has been sought out by thinks-tanks and universities. He is now an associate fellow at the Institute for Public Policy Research, and a visiting chair at Bristol University and the University of the West of England, which “will provide further platforms for research and policy development.”

Moving on to the specifics of the NHS reforms, Dr. Scally said that he believes that the government’s changes are “part of a planned enfeebling by the government of public services generally.” As he explained, in a powerful indictment of the artificial age of austerity imposed by the government for ideological reasons:

I think there’s a very deliberate policy across all of the public sector to roll back the achievements that have been made in this country since the second world war — including the NHS — and that financial austerity is being used to pursue an agenda aimed at dismantling the state.

He also said, “At the end of the war this country was hugely indebted but within a couple of years had free healthcare and free education for everyone – what an achievement! This government is putting a huge price on education, especially young people seeking to go to university, and is in the process of dismantling the NHS.”

Rejecting Andrew Lansley’s claim that the NHS will be “liberated” by “abolishing primary care trusts and strategic health authorities (SHAs) and handing control of £60bn of patient treatment budgets from next April to clinical commissioning groups (CCGs),” he also said, importantly, “What we’re going through now is a systematic downgrading, if not destruction, of civil society in England with a de-layering of structures and organisations and, at the same time, a huge amount of responsibility being handed to the local level, especially to local authorities, at the same time as their budgets are being cut.”

Dr. Scally added that the abolition of regional development agencies, government offices in the regions and SHAs was “all part of the same process,” and also said, “To many people that sounds great, like we’re getting rid of bureaucracy. But this is a very big country and cannot be run by a very much smaller civil service in London and a huge, disparate patchwork quilt of local authorities all pulling in different directions.”

In fact, he stressed, the coalition government’s entire commitment to local power is “a sham,” and he described “the creation of the new NHS Commissioning Board, which will oversee the local GP-led commissioning groups” as “part of another worrying trend, the centralisation of power in the hands of political appointees.” He explained, echoing one of the core criticisms of the NHS reforms — along with privatisation by stealth — “GPs are not the right people to commission health services.”

“I trained as a GP and I know that it’s no part of a GP’s training to deal with tens, and in some cases hundreds, of millions of pounds’ worth of commissioning budgets,” he said. “It’s not what most GPs want to do, so handing them a huge amount of commissioning power doesn’t bode well for the future of the NHS.” He added that postcode lotteries are inevitable when the clinical commissioning groups (CCGs) take control of that £60bn budget next April.

Dr. Scally’s disappointment with the government’s treatment of the health service manifested itself on my fronts: his staff were cut from 50 to nine; he was dismayed by Lansley’s feeble “responsibility deal” to tackle obesity and alcoholism; he was also dismayed by “the disappearance of the regional public health observatories, which provided independent research and data collection”; and by the creation of Public Health England, the new Department of Health agency, whose establishment “helped to persuade him to get out.” He explained that NHS policy has deliberately contributed to what he called “the circling birds of prey of the private sector seeking to make big profits out of healthcare.” he added, importantly, “That’s less money for patients.”

In conclusion, contrasting David Cameron’s lies about claiming to love the NHS with “the dedication of those working in it,” he said, “Healthcare professionals see an ethos coming into government policy and permeating the new [NHS] organisations being set up that is not in keeping with the ethos of vocation NHS staff — that they go to work not just to earn the salary but to help people who need their help who are sick or troubled.”

That spirit of service is hugely important, but is ruthlessly ignored by politicians who see everything in terms of money — and opportunities for private companies in which profitable investments can be made — and fail to understand how many people who work in health, education and other public services cannot have their working lives measured solely through a prism in which all work becomes a commodity, for which, moreover, the final intention is for the whole of the state provision of services to be transferred to the private sector.

Speaking of this, Dr. Scally noted that what he calls the “binding glue of the NHS” is, as the Guardian described it, “at risk from a new era in which one hospital is now run by a private company, more services are being outsourced, and private firms will be helping many CCGs to run their operations.” As he explained, “It’s hard to know what the NHS is going to be in the future. There’s a real danger it becomes nothing more than a brand — that blue and white logo.”

Nevertheless, he remains optimistic that the struggle for the NHS — which involved many health professionals and members of the public, even if, eventually, the specific battle against the reforms was lost — will continue. As he said, “There was an awakening among health professionals and the public that their NHS was under threat. The task over the next couple of years is to use all of that concern, interest and commitment as part of a rich debate about how we put the NHS back together again, when the opportunity arises. The NHS will only be destroyed if the people of this country let it be destroyed.”

Those of us who care about the NHS need to take Dr. Scally’s words to heart, and to find ways to bring healthcare professionals and concerned citizens together to stop the destruction of the NHS and to work towards reversing Andrew Lansley’s reforms as soon as the opportunity arises.

Andy Worthington is the author of The Guantánamo Files: The Stories of the 774 Detainees in America’s Illegal Prison (published by Pluto Press, distributed by Macmillan in the US, and available from Amazon — click on the following for the US and the UK) and of two other books: Stonehenge: Celebration and Subversion and The Battle of the Beanfield. To receive new articles in your inbox, please subscribe to my RSS feed (and I can also be found on Facebook, Twitter, Digg and YouTube). Also see my definitive Guantánamo prisoner list, updated in April 2012, “The Complete Guantánamo Files,” a 70-part, million-word series drawing on files released by WikiLeaks in April 2011, and details about the documentary film, “Outside the Law: Stories from Guantánamo” (co-directed by Polly Nash and Andy Worthington, and available on DVD here — or here for the US). Also see my definitive Guantánamo habeas list and the chronological list of all my articles, and please also consider joining the new “Close Guantánamo campaign,” and, if you appreciate my work, feel free to make a donation.

13 Responses

  1. NHS Chief Quits, Calls Austerity a Weapon to “Dismantle the State” | Jason Gooljar | WFPman says...

    [...] via NHS Chief Quits, Calls Austerity a Weapon to “Dismantle the State” | Andy Worthington. [...]

  2. Andy Worthington says...

    On Facebook, Pauline Kiernan wrote:

    thanks Andy. Sharing

  3. Andy Worthington says...

    Thanks, Pauline. Much appreciated.

  4. Andy Worthington says...

    James Brinton wrote:

    The man is absolutely right.
    Tax ‘reform’ -> austerity -> weaker government -> lack of business regulation/enforcement -> inability to afford the duties of government -> rampant privatization as state properties and services are sold to those who will use them to profit.
    Once the idea of lower taxes takes hold, deficits follow, and austerity is forced on government by the banking community. The downward spiral begins and then becomes self-reinforcing.
    Meanwhile, the people circle the drain and gradually fall into it.

  5. Andy Worthington says...

    Very well put, James. What troubles me is wondering how many people will fall down the drain before their fellow citizens pay attention and decide to do something about it.

  6. Andy Worthington says...

    On Digg, k007official wrote:

    This austerity versus state power debate is going to shape our governments for a long time. There are a lot of powerful, wealthy people who no longer believe the state structure is as needed as it once was. There are a lot of not so powerful people (libertarians) who think the same. This has led to the Austerity movement support from many sides.
    If you think you can purchase or be your own support structure – then you probably don’t believe in the state all that much already.
    The questions will be: how are we going to shape the support of the state? Large and inefficient? Smaller more efficient? Smaller and bare bones (useless)? Will new power centers start to arise that are away from the federalist center of these main governments?
    We’re living it people!

  7. Andy Worthington says...

    Thanks, k007. You missed “large and efficient” in your options, btw! Clearly, the details are different in the US and the UK, but the motives of the rich are the same – to destroy the state provision of vital services. I believe that the bigger question is how we can afford to keep those services, and that involves finding ways to tackle the plague of tax avoidance that goes hand in hand with the greed of the rich and the super-rich, and raising questions about whether, for example, the money we have – the government’s revenues – are better spent on war, or on people.

  8. Andy Worthington says...

    James Brinton wrote (in response to 5, above):

    One is too many, especially considering the amorality of the situation.

  9. Andy Worthington says...

    Agreed, James. And that’s why it’s so troubling that people have been conditioned – or have conditioned themselves – not to care about the most vulnerable people in society as a whole. That lack of empathy is truly alarming.

  10. AlanCayce » Blog Archive » NHS Chief Quits, Calls Austerity a Weapon to “Dismantle the State”, "deliberate policy across all of the public sector to roll back the achievements that have been made in this country since the second world says...

    [...] by Anomaly100 to worldpolitics [link] [30 [...]

  11. AlanCayce » Blog Archive » NHS Chief Quits, Calls Austerity a Weapon to “Dismantle the State”, "deliberate policy across all of the public sector to roll back the achievements that have been made in this country since the second world says...

    [...] by Anomaly100 to worldpolitics [link] [30 [...]

  12. damo68 says...

    even the monster thatcher didnt dare fuck with the nhs,it just shows the cruelty and arrogance of these modern day tories the nhs and the welfare state was formed as a thankyou for all the sacrifices the british people made during the second world war the tories back then even thatcher would have been horrified at wot camoron and osbourne are doing[or would she]wot do the want anarchy becouse if that happens they had better flee the country anyone suspected of being a torie..lynched.

  13. Andy Worthington says...

    Thanks, Damo. Depressing indeed that “the post-war consensus” is finally being torn up by these Tory clowns. As for what Thatcher would have thought, I guess it’s difficult to know, because what was unthinkable then has now been normalized, but we shouldn’t forget that she was the one who first started to sell off the state, leading us to the ever-darkening world we inhabit today.

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