‘17,000,000 over 5 years 12.3 % of GDP 4 % more than the EEC 35 % up on the USSR 34,000 GPs for every HAS × 19.24 in real terms 9,586 for every FHSA seasonally adjusted 12,900,000 + 54.67 @ 19 % incl VAT rising to 47 % depending on IPR by the IHSM £4.52p NHS safe in our hands.’
In response to which, Dr Gillam said:
‘I don’t dispute the truth of your figures, but neither do I dispute the truth of what I see every day with my own eyes. And the problem is that these two truths contradict each other. Every day I see staff working longer hours, under greater stress, for less reward, and I see patients waiting a longer time, for worse treatment, under worse conditions. These are facts, I’m afraid. They can’t be argued away.’
And Winshaw’s second answer to Dr Gillam was:
‘16 %! 16.5 %! Rising to 17.5 % under a DMU with 54,000 extra for PAYE and SERPS! 64 % PRP as promised in the CIPs and £38,000 = $45,000 + ¥93,000,000 divided by ✓451 to the power of 68.7 recurring! 45 % IPR, 73 % NUT, 85.999 % CFC and 9½ weeks more than under the last Labour government.’
In response to which, Dr Gillam said:
‘My point really is that you can’t make the NHS more efficient by making it more geared to costs. If you do that, you’re effectively trimming its resources, because the NHS runs on goodwill, on the goodwill of its staff, and under the right conditions, this goodwill is potentially infinite. But if you continue to erode it, as you’re doing at the moment, and replace it with a finite range of financial incentives, then eventually you will end up with a more expensive NHS, a less efficient NHS, an NHS which is always going to be a millstone round the government’s neck.’
And Winshaw’s third and final answer to Dr Gillam was:
‘6 °CMOs, 47 DHAs, 32 TQMs, 947 NAHATs, 96 % over 4 years, 37.2. in 11 months, 78.224 × 295 ÷ 13¼ + 63.5374628374, leaving £89,000,000 for the DTI, the DMU, the DSS, the KLF, the ERM and the AEGWU’s NHSTA. 43 % up, 64 % down, 23.6 % way over the top and 100–1 bar. And that’s all I have to say on the matter.’
After that, he left the studio with the victorious air of a man who has finally conquered the medium. And I suppose, in a way, that he had.
October 6th 1987
At long last, another full meeting of the Review Board — the first since Margaret’s victory in June.[34] The first White Paper[35] is finished and work will be starting on a second and third.[36]
The next reforms will be much further-reaching. We’re getting to the heart of the matter, at last. To remind everyone where our priorities lie, I’ve had a large notice pinned to the walclass="underline" it says
FREEDOM
COMPETITION
CHOICE
I’ve also decided to take a strong line with the word ‘hospital’. This word is no longer permitted at discussions: from now on, we call them ‘provider units’. This is because their sole purpose, in future, will be to provide services which will be purchased from them by Health Authorities and fundholding GPs through negotiated contracts. The hospital becomes a shop, the operation becomes a piece of merchandise, and normal business practices prevaiclass="underline" pile ’em high and sell ’em cheap. The beautiful simplicity of this idea astounds me.
Also on the agenda today was income generation. I see no reason at all why provider units shouldn’t impose car-parking charges, for instance, on visitors. Also, they should be encouraged to rent out their premises for retail developments. There’s no point in all those closed wards standing empty when they could be turned into shops selling flowers, or grapes, or all those other things people feel like buying when visiting a sick relative. Hamburgers, and so on. Little knick-knacks and souvenirs.
Towards the end of the meeting somebody brought up the subject of Quality Adjusted Life Years. This is one of my own personal favourites, I must say. The idea is that you take the cost of an operation and then calculate not just how many years’ life it saves, but what the quality of the life is. You simply put a figure on it. Then you can work out the cost-effectiveness of each operation: and so something basic like a hip replacement will come out at around £700 per QALY, while a heart transplant is more like £5,000 and a full hospital haemodialysis will cost a cool £14,000 per QALY.
I’ve been arguing it all my life: quality is quantifiable!
Most of the Board, nevertheless, don’t think the public is ready for this concept just yet, and they may be right. But it can’t be long now. We’re all feeling tremendously buoyant after the election result. The sell-offs have been proceeding at an amazing rate — Aerospace, Sealink, Vickers shipyards, British Gas last year, British Airways in May. Surely the day for the NHS can’t be far off.
Such a shame Lawrence never lived to see it happen. But I shall do his memory proud.
We must never forget that we owe it all to Margaret. If ambition turns to reality, it will be thanks to her, and her alone. She is magnificent, unstoppable. I’ve never known such resolution in a woman, such backbone. She cuts her opponents down as if they were so many weeds blocking her path. Knocks them aside with a flick of her finger. She looked so beautiful in victory. How can I ever repay her — how can any of us even begin to repay her — for all that she’s done?
November 18th 1990
The call came through at about 9 p.m. Nothing had been decided yet, but they were starting to canvass opinion among the faithful. I was one of the first to be asked. The poll findings are grim: she gets more and more unpopular. In fact it’s gone beyond unpopularity, now. The plain truth of the matter is that with Margaret as leader, the party is unelectable.
‘Dump the bitch,’ I said. ‘And fast.’
Nothing must be allowed to stop us.[37]
October 1990
1
‘The fact is,’ said Fiona, ‘that I don’t really trust my GP. From what I can see, most of his energy these days goes into balancing his budget and trying to keep his costs down. I didn’t get the sense that I was being taken very seriously.’
I did my best to concentrate while she was telling me this, but couldn’t help keeping a watchful eye on the other diners as the restaurant started to fill up. It was beginning to dawn on me that I was underdressed. Hardly any of the men were wearing ties, but everything about their clothes looked expensive, and Fiona herself seemed to have been much more successful in judging the mood: she wore a collarless, herringbone-patterned jacket over a black cotton T-shirt, and cream linen trousers, cut a little bit short to show off her ankles. I hoped she hadn’t noticed the worn patches on my jeans, or the chocolate stains which had been ingrained on my jumper for longer than I cared to remember.
34
Mrs Thatcher’s government was returned for a third term on June 11th 1987, with an overall majority of 101 seats and 42.2 % of the national vote.
37
Margaret Thatcher was deposed as leader of the Conservatives on November 22nd 1990. Her successor, John Major, led the party into its unprecedented fourth election victory in 1992, thereby ensuring continuity in health policy. But this was a triumph, of course, which Henry Winshaw would never live to see.