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Brother Mark is a pseudonym of The Reverend Dr Robert Jaggs-Fowler, a clergyman, physician, writer and poet. His biography can be found at: www.robertjaggsfowler.com

Thursday, July 19, 2012

Standing up for more than a Principle


The medical profession is not usually considered to be a militant organisation. Frequently  coming high on the list of those members of society who the public holds to be honest, reliable and worthy of respect, doctors are generally considered to have a learned and caring vocation, whose voice is willing listened to with politeness and interest, even if only out of curiosity. In turn, the profession usually recognises and appreciates this esteemed status and, through the General Medical Council’s code of conduct, does much to ensure that the public trust is not undermined.  

That today, the 21st June 2012, has been declared a day of industrial action by doctors is therefore of great significance. Of course, ‘industrial action’ is not necessarily the same as a ‘strike’; but the mere fact that it is happening at all is of great importance, with all the implications that it has to threaten the aforementioned public good-will.

The official reason given for the industrial action is the Government’s recent action in respect to the NHS pension scheme; action which effectively renegades on negotiations and an agreement in 2008 which was supposed to ensure the future viability of the pension scheme. Be that as it may, there is much more behind the situation than is immediately apparent. However, before I expand on the unwitting testimony, it is worth clarifying a few misconceptions that the Government is keen to promulgate.

First, the NHS pension scheme is not funded by the tax payer. The scheme is supported by its members; the doctors, nurses, ancillary staff and administrators who make the NHS work. The ultimate pension is in effect deferred pay, and has historically been on decent terms in recognition of the lower pay and substantial good-will of health workers; many of whom spend years of arduous training and contribute many unpaid hours to the good of society.

Second, is the fact that the NHS pension scheme currently returns a surplus of around £2billion per year to the Government; money that the Government then happily puts into the general coffers. Despite this, the Government argues that the situation is not sustainable and that, with the rising number of retired members, the scheme will not be able to support itself in future. However, that is what the negotiations of 2008 were all about. At that time, the medical profession, along with most healthcare workers, willing worked with the Government to bring about changes which would secure the inherent viability of the scheme and avoid it becoming a drain on the tax-payer. Nothing has changed since then to undermine those calculations; not even the change in the economy. Instead, the Government is set on unashamedly fleecing the NHS pension scheme whilst hiding behind flawed arguments and shameless lies, and that is what has angered the medical profession.           

Nonetheless, the institutionalised theft of people’s pensions is only the final straw of the unbearable load that has broken this particular camel’s back. As a body, doctors are tired of successive Governments meddling with the NHS, introducing badly thought-through policies, ignoring the profession’s opinion, increasing the workload to unsustainable levels whilst inappropriately raising public expectation of what should be achievable, and then publicly blaming the doctors for when it all goes horribly wrong. The profession is exhausted by inflated demands, frustrated by the focus on irrelevant outcome measures, weary of being the scapegoat, and demoralised by the determined destruction of the NHS. The theft of people’s hard-earned pensions is just a small part of this Government-built mountain of unrest.  

Today, for the first time in almost 40 years, some doctors will stop doing routine work for 24 hours. Urgent patient care will continue, and no patient should suffer as a consequence. That said, many of us will carry on as normal, strongly supportive of the need for action, but unable to put our own well-being ahead of those we have trained to help and serve. No doubt the Government will again ignore us and the popular press will vilify us. However, the population as a whole should take note. When a venerable profession is moved to such extremes, there is something very wrong with our world in general and its politicians in particular.

(First published in the Scunthorpe Telegraph, Thursday, 21st June 2012.)

Saturday, July 14, 2012

Humble Pie and Drawn Swords


One of the biggest rewards for any writer is knowing that the end product of hours spent slaving away in a draughty garret is actually being read by someone. I was therefore heartened to receive feedback from two eagle-eyed readers a couple of weeks ago, who noticed that Henry V (1386-1422) could not possibly have been responsible for the Apothecaries Act of 1815 without, as one put it, receiving divine intervention. How right you are, and you have my apologies for a spot of poor editing. What I had intended to convey was that, in order to suppress the quacks, Henry V issued a variety of decrees which ultimately became enacted, during the reign of George III, in the form of the Apothecaries Act of 1815.

Having now returned from an evidently much needed vacation, I am reminded of the words of Alfred, Lord Tennyson, who wrote ‘For man is man, and master of his fate’. Sadly, his optimism would seem misplaced today when it comes to the fate of doctors, with another of his lines being more apt: ‘So all day long the noise of battle rolled’. So it would seem from the recent headlines in the medical press. For example, GP Business informed us that Andrew Lansley is ‘launching his charm offensive’; surely a multi-layered contradiction in itself.

Elsewhere we are told that the Secretary of State for Health says ‘GPs have an ethical duty to cut costs’. Now, of course we understand that finance needs to be considered, but for us medical chaps that rather awkward ethical duty to treat patients keeps cropping up and getting in the way, Mr Lansley; but I guess that isn’t a concern that troubles you too much, as long as the budget breaks even. Whilst we accept the need for transparency in the way tax-payers money is spent, I am equally sure that tax payers do not want to be sold short when it comes to receiving the best treatment for their illness. If what I can offer my patients doesn’t equate to what I would find acceptable for a member of my family, then I am not fulfilling my primary role as the trusted physician. It is no coincidence Mr Lansley, that, when placed in alphabetical order, patients come first, physicians next and politicians last; and thus it should be so in terms of providing care.

Whilst I have been away, it has also been decreed that ‘practices must provide online booking by 2015’. Now, that is one where I am sure the proven ability of the NHS to come up with suitable computer software and associated security will not be found wanting. I jest of course. Seeing is believing, but I wouldn’t hold your breath just yet.

That the Department of Health has agreed to a 20% rise in GP training places by 2015 is obviously good news at face value. Nonetheless, it will take a further four years for those doctors to come out of the system as fully-fledged GPs. At present, the number of GPs is down to 1999 levels. With 8% of GPs leaving the NHS in 2010, 22% now being over 55 years, and consultations set to rise to 433million per year by 2035, there may be light at the end of the tunnel in terms of training, but it is still presently a very dark place at the coal-face, and that needs to be promptly addressed to avert a significant manpower crisis. So, unless something is done now to attract trained GPs back into the NHS, or to stop us older ones from running with the remnants of our sanity for the exits earlier than necessary, the current national shortage of GPs will continue for the next decade.

The one delightful piece of news ironically comes from an obituary for a paediatrician in the USA, who only retired at the age of 103. She died in April at the grand age of 114, which lends a hearty boost to my much-publicised intention to hold a 120th birthday party in January 2080. Keep that date in the diary; though at this rate, I may have to couple it with a retirement party. 

(First published in the Scunthorpe Telegraph, Thursday, 7th June 2012.)