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Truth and Lies

Medicine Balls

Phil Hammond

Tuesday, 12 May 2015

Election pledges_85725193.jpgHumans are very good at lying. Just as politicians lie to us, we lie to pollsters to deceive politicians about where we planned to plant our pencil. And we lie to others all the better to lie to ourselves. Our own stories are all masterclasses in spin as we edit out memories like a Wikipedia page, air brushing out or exaggerating our behaviour to fit our life circumstances, ego and world view. Others can even edit our memories for us, but no one knows the whole truth about anyone. We only reveal what we choose to reveal. We all have shocking thoughts, secrets and fantasies hidden away.

You can tell the electorate deceived the Conservatives into believing they wouldn’t win a majority by their rather lavish, perhaps even desperate pre-poll pledges. If you’re anticipating a coalition, you know your more outlandish promises can be ditched on the altar of compromise, but if you win outright, you’re expected to deliver on everything. The Liberal Democrats may have been lambs to the slaughter in this election, but the last laugh may go to us in holding this supposedly numerate government to account. £8 billion for the NHS by 2020 will just about keep the lights on, but where will the extra money come from for a seven day service, with GP appointments available across England every day from 8am to 8pm, and everyone over 75 guaranteed a same day appointment? Even if the money were available, it’s hard to see where we’re going to get the GPs, given that 30% of vocational training places lie empty for what is currently one of the toughest and most unpopular public service jobs. Perhaps the private sector are waiting in the wings with swathes of imported physician assistants.

Our heir apparent George Osborne has landed himself with a big financial hangover across the board. As well the uncosted health spending, he has to fund a £1 million inheritance tax threshold for couples and new right-to-buy rules that allow 800,000 housing association tenants to buy their properties at a discount.  The personal income tax allowance is going up to £12,500 and the 40% tax threshold is going up to £50,000. And there will be a new law to prevent rises in VAT, income tax and national insurance in the next 5 years. Remember too that rail fares must not rise by more than inflation and all three and four-year-olds will get 30 hours of free childcare.

Given our massive budget deficit (at 4.8% of GDP, it’s much higher than Greece’s), there are going to have to be some massive U-turns in pre-election promises or massive cuts elsewhere. The ill-defined £30 billion of cuts over the next three years will have a substantial effect on the NHS, wherever they cuts fall, and the £12 billion of welfare cuts will be a particularly bitter pill to swallow. For the NHS to thrive, as well as survive, it needs to be built on collaboration, compassion and honesty at every level, informed by rigorous evidence. Is seeing a GP on a Sunday afternoon both necessary and a good use of scare resources? Only a proper trial will tell us. Has the market system of the Health and Social Care Act delivered better care and value for money? Look at the data. Is there less bureaucracy or simply fewer bureaucrats? Do personal health budgets do more good than harm? Are the new models of care effective and efficient? We need proper science, rather than rhetoric and spin, coupled with the honesty to admit uncertainty and complexity, own up to policies that don’t work and change tack according to the evidence.

The Conservative victory makes the Five Year Forward View – and its author Simon Stevens – even more powerful, but not necessarily more likely to succeed. It’s a view with very optimistic costings and highly reliant on those improvements in public health and self-care that Derek Wanless articulated 13 years ago. Scotland prides itself on the most collaborative NHS in the UK, but its citizens have the lowest life expectancy. It has huge inequalities in wealth and health. Whether the health and wealth of Scotland would improve by a divorce from the rest of the UK but a continued marriage with the EU only the Scottish people can decide. In time, the evidence will tell us.

Whatever the answer, Scotland will always have some of the most stunning scenery and walks in the Western world. Indeed, walking to and from the polling booth may have done more for your health than where you put your cross. The truth is, whoever won this election, we would struggle to provide a universal, high quality health service for all when not only life expectancy is increasing, but more people are living for decades with multiple illnesses and poor health. 70% of what we can do to prevent or delay illness is down to lifestyle and life circumstances, not medical intervention. Political choices can help or harm your circumstances but even in the poorest, indigenous populations in the world, self-responsibility is the key. Humans should be the carers of everything on this planet, but to succeed we first need to care for and love ourselves – whoever happens to be in power.

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Phil Hammond

Phil Hammond is an NHS doctor, journalist, author, broadcaster, speaker and comedian. He qualified in 1987 and worked part time in general practice for over 20 years. For the past seven years he has worked in a specialist NHS team for young people with chronic fatigue. He presented five series of Trust Me, I’m a Doctor on BBC2, encouraging patients to be more involved, assertive and questioning. Phil is Private Eye’s medical correspondent; in 2012, he was shortlisted with Andrew Bousfield for the Martha Gellhorn Prize for Journalism for ‘Shoot the Messenger’, an investigation into the shocking treatment of NHS whistleblowers. In 2013 and 2014, he was judged to be one of the top 100 clinical leaders in the NHS by the Health Service Journal. As a comedian, Phil was half of the award-winning double-act Struck Off and Die, with Tony Gardner. He has done five solo UK tours, appeared on several TV shows, and has written five books.
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