By the time the Health and Social Care Bill passed into law, becoming an Act, on 20th March, it had garnered almost universal condemnation, with unprecedented agreement between the medical Royal Colleges, the British Medical Association, the Royal College of Nursing, the Royal College of Midwives, and many others – not forgetting nearly 180,000 signatures on the ‘Drop the Bill’ Government e-petition (the second-most signed petition on the site) and nearly 600,000 signatures on 38 degrees’ ‘Save Our NHS’ petition.
The Bill, from a government that had promised ‘no top-down reorganizations of the NHS’ at the last general election, represented a glaring democratic deficit. But how did such widespread opposition fall on deaf ears?
At a meeting of the Peoples’ Health Movement in London last Saturday, health activists met to discuss where to go from here. Dave McCoy, a long-standing activist of the Peoples’ Health movement and a lecturer at UCL, suggested that there were two views of the Bill: a convoluted, bumbling mess of legislation that was forced through to save political face; or, more sinisterly, a masterfully crafted work of double-speak, where its much-vaunted strengths – handing power over to GPs, cutting levels of bureaucracy, increasing ‘choice’ – bore no relation to the content of the Bill, which remained so impenetrable as to be impossible to criticize directly.
This obfuscation meant that united opposition, albeit late in the day, was largely confined to professional organisations – the Royal Colleges and trade unions. Where was the public voice? Why were citizens not out on the streets in their hundreds of thousands? Clearly, people cared for their NHS – as evinced by the petitions above – and some did come out onto the streets. But what was lacking was a channel by which citizens and the public could engage with the inaccessible reforms. What was needed was a grassroots health movement.
The Peoples’ Health Movement may represent such an opportunity – a chance to regain the initiative from the current political paradigm on health, inevitably moving towards an insurance-based system, and to articulate a reaffirmation for the founding principles of the NHS.
Though it was officially launched at the Peoples’ Health Assembly in Dhaka, Bangladesh in 2000, the Peoples’ Health Movement has its roots stretching much further back, to the 1978 declaration of Alma Ata, at which health ministers across the world committed to the goal of ‘Health for All’ by the year 2000, through the principles of Primary Health Care. By 2000, this goal had slipped far down the agenda, to be replaced by the Millennium Development Goals: a disturbing shift of priorities, away from the WHO’s 1948 definition of health as ‘a complete state of physical, mental, and social well-being – and not simply the absence of disease’ to a very definite focus on eliminating disease, rather than on building healthy communities. Other activists at the meeting highlighted the parallel with the 1960’s peace campaigners, whose agenda has been hijacked and subverted by politicians to a focus on ‘security’.
The meeting on Saturday brought together individuals interested in building momentum for the Movement in the UK. Three speakers set the context: Dave McCoy, in 20 minutes, covered an entire MSc course in Global Health, emphasising the influence of politics and economics on health; Ravi Narayan, from the Peoples’ Health Movement in India, described the background of PHM and where it was today; Gay Lee, a nurse and long-standing advocate for the NHS through the ‘Keep Our NHS Public’ campaign, gave the local context, of the fight to keep the NHS a publicly-owned and publicly-provided service.
Since the Peoples’ Health Assembly in 2000, bringing together 1500 delegates from 92 countries, there has been a second in Ecuador in 2005, and the third Assembly will be held this summer in Cape Town. Concurrently, PHM-UK will be holding an Assembly in Nottingham on July 10th-11th. This weekend’s meeting aimed to begin the groundwork for this UK Assembly, to identify the issues to be covered and the networks to reach out through. With a good showing of Medsin members, including half of the National Committee, we hope that Medsin will be able to engage the student body in this Movement.
Where disease is the domain of healthcare professionals, health is all about citizenship. As Ravi wryly suggested, if economics is too important to be left to economists, health is far too important to be left in the hands of healthcare professionals. He described how in India, in the run-up to the election in 2005, the Peoples’ Health Movement, through village meetings in nearly 20 states, came up with a Peoples’ Health Manifesto, which they presented to parties from across the political spectrum. When a coalition government was formed, many of the smaller parties adopted messages from this manifesto, claiming them for their own, but, importantly, ensuring that these messages made it into policy. Now that the Health and Social Care Bill is an Act, perhaps we should move away from fighting it, and regain the initiative with a Peoples’ Manifesto. A group of healthcare professionals plan on standing at the next general election in the UK to defend the NHS, giving a platform to promote such a message. PHM-UK could have a role today of mobilising grass-roots movements to allow people – citizens – to engage in health, without barriers between patients and professionals.
Meanwhile, there is a greater need than ever to build social solidarity in health. The Health and Social Care Act, by removing the responsibility of Primary Care Trusts for contiguous geographical areas, and replacing them with Clinical Commissioning Groups (CCGs) which are responsible only for individually registered patients, makes it much easier to slip between the cracks – for example, undocumented migrants and homeless people who have not registered with a GP, and, therefore, are no one’s responsibility. Likewise, this represents a move towards ‘individual health budgets’ – inevitably a staging post on the way to an insurance-based system, and a move away from a national, public system to one that pits patient against patient. The healthy will see the unhealthy as ‘taking’ their budgets from them – in stark contrast to a national system that ensures that, whoever gets (or is already) ill, they will be entitled to care.