This free public lecture revealed many facts about the decline of public healthcare in the UK. It was delivered from the perspective of someone concerned with the Royal College of Physicians (RCP). The RCP has a social role which is becoming political. It aims to engage in “advocacy, education and research.” In this century, this task has become more problematic due to the privatisation and under-funding of the National Health Service. The difficulties in the sector have been compounded by a social care crisis.
As an analyst of the political context, Professor Tallis acknowledged that healthcare in the UK had never been perfect. However, he cited an international study that showed considerable public satisfaction with the service prior to the Health and Social Care Act of 2012. Furthermore, he pointed out that staff morale was once much higher than it is now. The top-down re-organisation of the National Health Service enabled privatisation, wasted resources, and blurred accountability.
With a willingness to deploy copious facts, Professor Tallis contended that the health service now needs more than what the Conservative Party intend to give it. He pointed to patients stuck in ambulances, key targets being missed, operations being refused, long waiting lists, high bed occupancy, and social care crumbling. He mentioned that GPs are being pushed into early retirement by stress. Vacancies in the health service are far too high and wages are still far too low.
For Professor Tallis, the cuts to healthcare were not necessary. The Conservative government is hostile to the public sector. According to Tallis, the Conservative Party turned a “financial crisis…into a fiscal crisis” with its discourse. The lack of spending contributed to a tepid economic recovery. Shrinking the state has come at the cost of health, happiness, and lives.
The argument of Tallis turned on a sociological point. He suggested that being a doctor is a humane calling. Following the positivism of Emile Durkheim, he reasoned that the profession occupies a point between the individual and the state. The idea is that a doctor can evaluate and respect evidence with precision. However, doctors can be put in an invidious position by the state. If they are obliged to ration care or charge immigrants then they become complicit in activities that may conflict with their own ethics. Not every doctor will have the moral integrity to resist the imposition of a ‘hostile environment.’
Simply calling for an investment of more than 3.4 per cent is not the answer to the healthcare crisis in the UK. Tallis urged that people speak truth to power, but the powerful might not want to know. In addition, the idea that local pressure groups can challenge the national state is an optimistic one. The weakness of the theory of Tallis is that he neglects the transformative potential of trade unions and the Labour Party.
Ultimately, Tallis lacked the ability to engage with his audience. His literary hero A.J. Cronin was an anti-Semite. The work of Cronin was recommended reading in Nazi Germany. Although Tallis may not have erred with his dismissal of crude Marxism as a panacea, it was unnecessary to indulge in red-baiting. While Tallis was given a medal at the end of his peroration, it is not just the dubious literary taste which raised a red flag.
Facts are socially constructed and selected; positivism fails to cut through. We need theories which allow us to understand the complex relations between the British state and fractions of capital. Attacking Integrated Care Systems as a vehicle of privatisation is necessary but not sufficient. We have to have theories that enable us to challenge fascism and neoliberalism. If we fail to understand the world, we cannot hope to change it.