What a brilliant, insightful and compelling read. Although much of what I read confirmed what I already suspected, it still shocked and troubled me. Mostly El-Gingihy’s book (2019) resonated with me because I have lived and worked through the era that he explores; from having my babies in the 70s through the Thatcher years, to working in the NHS for over 30 years. He shed light on my often-asked question as to why, despite the positive rhetoric about choice and control for women, are we ever further away from effective care in pregnancy and childbirth for all mothers and babies? This book does not focus on maternity services per se, but rather the demise of the NHS as an entity, a whole, that also profoundly affects maternity services. As privatisation surges ahead, I know that El-Gingihy’s words are a credible, real discourse about what is going on.
El-Gingihy exposes the scandal of the private financial initiative (PFI) introduced by Grdon Brown and the incalculable harm that private financing has caused to many Trusts up and down the country as repayments have quite literally and deliberately bankrupted services. I know this to be true, as I experienced it first-hand. To erect a shelf in our non PFI hospital, you had a word with the joiner, and it was done. Make the same request in the neighbouring PFI hospital and the costs quoted were eye-watering and the proposed shelf was shelved, as were so many other projects intended, but never realised.
El-Gingihy surmised that, as many PFI hospital-builds have more single rooms, than usual, whilst work-spaces for staff have no windows or natural light, ‘they’ were planning for the future welcome to private patients (p16). Certainly, my experience of a PFI-funded hospital meant that our model of care was dictated by the limitations of the design, rather than the design created to support the care we aspired to provide. This was a continued frustration and wonder to me, especially as in our other non PFI hospital we had such good working relationships with builders in estates, whereas in the PFI build we were unable to engage in any way with the PFI estate team.
The political narrative about the NHS is that we cannot afford it, we must cut back and make efficiency savings. The population is getting older, fatter and poorer. It’s all OUR fault that the NHS is imploding under the pressure. Current health services are said to be unsustainable. Like Alison Pollock (2005), El-Gingihy exposes how this false narrative is trundled out, using ‘transformational’ ‘innovation’ and ‘integrated’ language to mask the truth. Policymakers artfully obscure the reality of neoliberal market-force strategies to bring in corporate business/insurance companies to take over so called ‘failing services’ who all along have been starved of the resources that once made our NHS one of the greatest and most efficient and cost effective health services in the world.
Unlike public services El-Gingihy points out that,
‘private companies only have one legal obligation which is to
their shareholders…their aim is to maximise profits usually through cutting staff and other costs… and so can be seen to be more
At the millennium I led on work for a feasibility study to set up a new birth centre in Yorkshire (Shallow 2003). I interpreted the NHS plan as a way forward for so-called ‘intermediate care’ for well women accessing birth centres in local maternity services. I believed the language of transformation and innovation; never for one-minute realising that all the changes afoot were to prepare for the biggest sell off in a century. Like so many, I was seduced by language that hid the real truth. Policy makers are deliberately, but covertly undermining services and setting the NHS up to fail. North Staffs and Northwick Park were all portents of the real truth behind cost efficiency savings and unsustainable services. No wonder as beds and hospital disappeared at alarming rates. Where were patients to go?
We started to hear of Alternative Providers of Medical services (APMs) (p.23) as Virgin took over sexual health services in our area and very soon nurses were made redundant. Not the progress we envisaged, and which El-Gingihy exposes, as the inevitable take-over of NHS services for profit, and not the good of the people. What El-Gingihy weaves in this book, are the threads that bind politicians, businesses, global markets and so-called auditors such as KPMG and Deloitte, together in a web of secret deals and sell offs. He clearly demonstrates the vested interests of each to the other and the underhand and unforgiveable way we have all been hoodwinked. Our NHS is NOT safe in their hands.
I vividly remember the representatives from an American integrated managed care consortium called Kaiser Permanente who visited our service to introduce us all, using very clever rhetoric, to improving patient safety. At the time I knew nothing about an ‘integrated managed care consortium’, what they were or what their aims were, so why would we not get on board with improving safety? What we did not know was how their own company are, ‘infamous for dumping patients in down-town Los Angeles, when their insurance policies have expired’ (p.25). At these events, I felt an ever-present unease that we were being duped but I could not quite put my finger on why I could not trust these people, who were intent on winning our favour by sweet talking us into reciprocal visits to the US. Suffice to say, I did not go.
The Americans are on the threshold, waiting to claim the spoils post-Brexit. I never anticipated then, that I would now actually feel fear about our future health service as a result.
El-Gingihy talks about the revolving door (p.30) as he shows the connection between politicians and big business. Countless cabinet ministers having executive positions in businesses especially health-insurance companies. When their political tenure is over, they invariably return to their lucrative executive roles and so the door keeps revolving.
The Tories knew they could not overtly ‘touch the NHS’, so their plans to decommission the NHS had to be carried out ‘by stealth’ (p49),
‘The mother of all reconfigurations was unveiled in the white paper
‘Liberating the NHS’’.
Any doctor or midwife or nurse can tell you that the health and social care bill has been an unmitigated disaster. Fragmented care has flourished. After an acute admission, an elderly person may be moved multiple times, not only from ward to ward, but also from hospital to hospital in misguided and cruel attempts to stop the vulnerable and frail elderly patient ‘bed-blocking’. Again, the elderly are to blame, not the policy makers who have enforced savage cuts and closed wards and hospitals. Yet the public narrative remains one of health and quality improvement and that care has never been so good.
The Health and Social care bill ‘Liberating the NHS’ (DH 2012) was, ‘nothing less than a smokescreen for the implementation of free market reforms’ (p51).
The clinical commissioning groups (CCGs) unlike their predecessor the Primary Care Trusts (PCTs) will, ‘not have to provide health services for everyone in their area…this is an important distinction and allows for exclusion of patients’ (p53) and so we are now hearing of Trusts where treatments are refused unless patients lose weight, stop smoking or can somehow make a special case for their worthiness. Consultants and GPs are no longer free to use their clinical judgement about the best course of treatment for a patient, as they are forced to make the patient’s case to the CCG where, if certain criteria are not met, they can be refused. Refused by administrators who know nothing about health and illness but are focussed solely on the cost per case. El-Gingihy noted that in some areas, cataract treatment is being limited to just one eye.
I had recent personal experience of referral to a musculoskeletal service after presenting to my GP with a very painful knee. The MSK service was an ‘any other provider’ and I soon detected that the purpose of the MSK ‘triage’ team were to keep me away from the surgical specialist with the expertise to treat and help my recovery. My referral to the physiotherapist was far in to the future, and I was struggling to put any pressure on my right knee, when walking. I was eventually forced to seek out a private physiotherapist who after treatment and an exercise regime, confirmed I needed to see a specialist. In short, a direct referral by my GP to the physiotherapist and then specialist would have been more cost effective and timelier for me. The current system of hurdles that patients must negotiate, results in frustration, delayed treatment, increased pain and worsening symptoms. How can this new modern ‘preventative’ health care possibly be effective for anyone?
As I turn the pages of El-Gingihy’s book, looking at the copious notes I have made, I am aware of my sadness and real shock at the prospect that our NHS is not safe, or secure and the NHS as Bevin envisaged in 1948 no longer exists. My husband an NHS consultant himself, has wryly concluded that the NHS has become a ‘totalitarian state and deserves as such to fail’ (Mueller, in conversation 2019). I find that quite shocking until I reflect on what we have experienced as NHS employees over 30 years with increasing autocratic leadership, resulting in a bureaucratic, meddling and destabilising attack on our ability to provide the quality of care which we were educated and inspired to provide.
As a state visit by the American president looms large, watch carefully as those in power bow and scrape and cosy up to the very politicians who ensure that whilst US health outcomes deteriorate, their profits soar, and the American insurance companies wait eagerly to steal the spoils of the great NHS sell off (Naylor Review 2017).
Yousef El-Gingihy’s book should be read by every single thinking adult.
DoH. (2012). "The Health and Social Care Act", D. o. Health, (ed.). City: Stationary Office: London.
El-Gingihy, Y. (2019) How to Dismantle the NHS in 10 Easy Steps: The bluep[rint that the Government does not want you to see Zero Books Winchester UK Washington USA ISBN 978-1-78904-178-1