Dr Youssef El-Gingihy, who works in a GP surgery in London's Tower Hamlets, explained in an interview with Sputnik why he believes the response of the British government and the National Health Service to the pandemic does not match the seriousness of the cause.
EDITOR's NOTE: Under the Private Finance Initiatives (PFI's) referenced by Dr. El-Gingihy, a consortium of corporations loan money in exchange for building hospitals. The loans plus interest are then paid back, typically over a 25-30 year period, by the hospital trust. This often leaves hospitals deeply in debt.
Sputnik: What has been your experience as a GP during the COVID-19 outbreak?
Dr Youssef El-Gingihy: At the beginning of the crisis, I was obviously doing some work at the practice. They're now basically working remotely so hardly anyone is being seen except for things like, you know, wound care, immunisations, that kind of stuff.
So it's completely transforming the practice of medicine. Things, problems, that you would have previously reviewed people for physically you're now having to just handle them in a different way.
Sputnik: What are the advantages and disadvantages with the current setup?
Dr Youssef El-Gingihy: The good stuff I think is that, probably there are a lot of issues that could be dealt with remotely or digitally. Obviously we all know that this is about lack of resources and so on, but in terms of the sheer workload, it probably makes the workload more manageable when things can just be dealt with digitally rather than face to face, you know, if it's appropriate.
Obviously there's going to be risks if you're not able to examine people, as you would usually, that obviously [has] potential risks.
Sputnik: You’ve recently published a book called How To Dismantle The NHS in 10 Easy Steps. How has the NHS changed over the last 40 years and why?
Dr Youssef El-Gingihy: It's 'marketisation', in a nutshell. Marketisation and privatisation. Now, the definition of privatisation is hotly debated, as I've discovered. But essentially, in a nutshell, over the past 40 years, from the early to mid eighties, we've just seen a cumulative process of increasing market forces and private sector involvement in the NHS.
Sputnik: Can you bullet point key milestones your book covers?
Dr Youssef El-Gingihy:
- The introduction of corporate-style NHS management, under Margaret Thatcher, of replacing doctors and nurses from hospital boards with people from the business sector.
- The outsourcing of non-clinical services such as catering, cleaning, laundry, those kinds of things.
- The introduction of an internal market [using models of competition and market forces] into the NHS in 1990, creating a kind of limited market within the NHS.
- John Major's government introduced Private Finance Initiatives but New Labour massively expanded PFI. They also expanded outsourcing into clinical services and they converted hospitals into semi-independent businesses, what are called foundation trusts - FTS.
Sputnik: So you have no choice as a hospital trust, those services have to be put out to private tender?
Dr Youssef El-Gingihy: There are rules about what has to be tended out. So that's quite complicated because it's all like kind of legalese stuff. I think it's a contract above a certain value. So there are like EU competition rules about which contracts are meant to be tendered, but it is a huge amount of contracts that are being tended. It depends also on whether it's primary or secondary care as to who does the tendering.
They basically created an obligation, that when a contract - probably of a certain value - expired, that it would need to be put up to tender. And there is no longer this idea of the NHS as a preferred provider [of services].
Sputnik: Can you detail what PFI is, for someone who has no idea?
Dr Youssef El-Gingihy: If you're looking for an analogy, it's like a mortgage, but it's just hideously expensive and it bankrupts the family.
Foundation trusts suddenly get to make a profit, and staying out of debt becomes a kind of a primary criteria. The aim is that all new hospitals will be foundation trusts and certainly the vast, vast majority are already. They are free to make partnerships with companies.
Next is the Health and Social Care Act 2012, under the coalition government. The Health and Social Care did a lot of things. [Among them was that] it removed the Health Secretary’s legal responsibility to provide universal healthcare, and it devolved it to NHS England and other bodies, such as CCG’s.
And outsourcing to the private sector is about doubled from 4 to 8 percent.
Sputnik: What does that mean, in practice, to say something has been outsourced to the private sector?
Dr Youssef El-Gingihy: Clinical wise, again, it's going to be the low hanging fruit. We call it high volume, low risk stuff like elective surgery, you know, physiotherapy, that kind of stuff, right? That's the stuff which is quite lucrative. [Private companies are] not going to be interested in, for instance, emergency medicine, intensive care, that stuff, which is expensive and risky.
But that's very problematic, because it leads to something called un-bundling, which means that you basically unpick the entire fabric of the concept of how a comprehensive universal healthcare system is meant to work, because now, as a trust or as a hospital, you lose income from those things. That income is now being siphoned off permanently - or at least for the duration of the contract - to Virgin or whoever it is, as profit. And that money would have previously been reinvested into the system.
The last bit is what's happened since the Conservative majority in 2015. The present predicament is this drive now towards a US style of integrated health care, which, in a nutshell, means that instead of the smaller tenders that we were talking about previously, these will be tenders for whole chunks, they've divided up the NHS into 44 footprints or areas and it'll be contracts to run each of those four kind of regional health and social care.
So there's a multi-billion-style contracts over many years, up to 10 years.
So that's all happening, because of austerity, because at the time when it started, because obviously now the coronavirus crisis, you know there's a lot of cause of expediency, a lot of this stuff is happening very slowly. It's going to be a transitional phase, it's accompanied by a program of long standing cuts, closures, etc.
We also have far fewer physicians and beds per 1,000 people compared to other industrialised countries. Even lower than some Eastern European Countries such as Romania.
Sputnik: How would you describe the response from the UK government to the COVID-19 pandemic?
Overall in terms of health policies? Pretty shambolic.
Sputnik: Why?
Dr Youssef El-Gingihy: We delayed a lockdown - that was catastrophic you know - but in a nutshell [the lockdown] should have happened much earlier.
Sputnik: Has it gone any better over time?
Dr Youssef El-Gingihy: I don't know how to answer that, to be honest. I don't know how you can measure the specific response over time. I mean, we're weeks into the crisis and there's still a massive shortage of PPE, personal protective equipment.
Sputnik: How do you explain why both the NHS, as the Department for Health more generally, appears to be having so much difficulty in dealing with this crisis?
Dr Youssef El-Gingihy: According to The Sunday Times long read analysis, which was the biggest story last weekend, they were preparing for an influenza pandemic. And that, for a long time, post-9/11, was the number one risk. And then, because of austerity, because of the Brexit talks, negotiations dominating everything, it kind of fell by the wayside. And so the preparedness for a pandemic became a much lower priority.
I think that that probably makes some sense. The Sunday Times's saying there's a lot of just shambolic incompetence. I'm sure there is, but personally where I critiqued that analysis is, I think a lot of this is about ideological expediency, as well.
So I think when you're looking at things like public health care resources, you're looking at beds, you're looking at ventilators, equipment, medicines, testing. That is a huge logistical exercise in terms of producing the tests, the reagents, the labour power needed to trace people, and so on.
When you take all of that together, you need massive state intervention and that's not something that really fits with within the neoliberal deregulated free market ideology. And so if this is a 'war effort', what should have been done is that you need central government or state controlled and directed, production distribution of all of this stuff from industry. Which is what you are doing in a war. You would take over factories and re-purpose them to produce weapons and whatever's needed.
Sputnik: What could they have realistically done to be better prepared for this eventuality? Is it realistic to expect governments to plan for a global pandemic just because it might happen?
Dr Youssef El-Gingihy: They have. I think governments across the world take the possibility of a flu pandemic, they've taken that possibility very seriously for a long period of time. So it's not speculative or something that we're postulating about. It is something that, as we said before, was considered the number one threat.
We know that pandemics happen don't we? And we've had multiple warnings with SARS and MERS and Swine Flu and so on. So, it's not like it's completely unexpected.
And what could have been done better? What I think it's just the opposite of everything we've talked about, isn't it? Number one, it's the damage that was done to the NHS through all the stuff we talked earlier in the interview: marketization - reversing that - cuts, you know, austerity, all of that.
And then, specifically, it's about much more of a planned approach rather than a kind of chaotic free-market approach to production and distribution of what's needed.
This interview was conducted over the phone and was edited for clarity and concision.
