Dr Mark Porter is preparing to clash with the government on two fronts: doctors’ pensions and the future direction of the NHS
The new leader of Britain’s doctors names Nye Bevan, the chief architect of the National Health Service, among his political heroes, suggesting he is probably not the biggest fan of the coalition’s hugely controversial NHS shakeup.
Dr Mark Porter describes his personal politics as “progressive, liberal, left as opposed to right, though not dogmatically so” and himself as “somebody who is imbued with a sense of social justice, rather than having the economic imperative ruling everything – a Guardian reader as perhaps opposed to a Telegraph reader.”
The health and social care bill saga and doctors’ dispute over their pensions resulted in regular TV and radio appearances by Porter’s predecessor as the British Medical Association’s chair of council, Dr Hamish Meldrum. With the pensions issue still unresolved – on 21 June it prompted the first industrial action by medics since 1974 – and concerns rising about the NHS’s ability to withstand a cash squeeze, rising demand and a fundamental reorganisation all at the same time, Porter’s low profile will not last long.
As the voice of the doctors’ union, which has 140,000 members, Porter, a 50-year-old consultant anaesthetist in Coventry, faces two main challenges.
First, he has to somehow extract some concessions on pensions from a government that has played hard ball on the issue. Doctors, he says, “remain hugely upset” at ministers’ “arbitrary” decision to push through big changes to an NHS pension scheme that generates a £2bn annual surplus and was reworked in 2008 to make it sustainable.
Second, he has to win a battle for the hearts and minds of the public against the health secretary, Andrew Lansley that will only increase in intensity until the next election in 2015.
The growing pressures on the NHS, its unique place in British life and its significance to all three main parties’ prospects in 2015 mean the public will be able to choose between the very different Porter and Lansley visions. Neither claims the NHS is in a crisis. Both agree the NHS in England is doing surprisingly well given that more people are seeking its services just when it is facing flat budgets after the long years of Labour largesse, the job of delivering £20bn of efficiency savings by 2015 and the upheaval of yet another restructuring.
Lansley paints an optimistic picture of stable waiting times, patients’ greater choice of where to have treatment driving overdue improvements in quality of care, and groups of GPs taking charge of commissioning £60bn of healthcare from next April – the centrepiece of his reforms – benefiting doctors and patients. In his view, the bill was painful medicine the NHS had to swallow in order to help it provide better value for money, give patients greater control and use competition to drive up standards. Porter, by contrast, is worried. He fears that what he repeatedly calls the NHS’s founding principle of “social solidarity”, the concept of it as “good for society [and] a comfort and security for society”, is being eroded by a combination of growing rationing of treatment, greater use of competition, more and more NHS services being provided by private firms and the service’s struggle with the biggest cash squeeze in recent history.
The imminent requirement for “any qualified provider” to be allowed to provide services such as physiotherapy and children’s wheelchairs will threaten the future of existing NHS services and enable firms such as Virgin Care to make further inroads into the NHS’s £110bn budget. Porter worries that an NHS run for 64 years on the basis of “social solidarity” is being replaced by one which is “a series of transactions rather than a service that holds together”. He asks, why deliberately create a market in health services in an area when none currently exists?
As he sips a Diet Coke in his office on the third floor of the BMA’s grand headquarters near Euston station in London, Porter draws a series of ideological faultlines with coalition policy. Greater competition is not just unwelcome – the BMA wants to retain an NHS that is both publicly-funded and publicly-provided – but also “unnecessary because there’s no particular evidence that having a system which is pluralist – part-private – is necessarily better.” Forsaking the principle of social solidarity would mean that “you end up in a system like the United States, which many British doctors look at with a degree of trepidation”.
That is a dramatic, arguably fanciful, comparison from a man who rarely seems to lend himself to florid, exaggerated prose. The UK and America’s health systems could not be more different. Porter’s argument is that, if certain damaging policies are allowed to continue, the NHS could end up resembling its counterpart across the Atlantic, where access to healthcare is not universal, citizens cannot necessarily access every kind of treatment and where charges creep in.
Denying patients access to operations or drugs their GP believes would benefit them means that already “there’s lots of areas where bits of the NHS have been taken out of the offer [and] it’s no longer a comprehensive service”, he says. Taking aim at ministers’ repeated professed aim of maintaining the NHS, this passionate advocate of the health service adds that despite its constitution guaranteeing comprehensive, universal healthcare “the idea of social solidarity is gradually being chipped away at, by the actual actions which are said to be supporting the continued existence of the NHS.
“The BMA is not blessed of a special forecasting ability. But we are made up of most doctors who work in the NHS, which is how we see what’s happening. It’s not that [the BMA believes] the entire system’s going to fall over in a few months. But it’s quite apparent that the nature of the offer to the public is changing and the pace of change is picking up under the dual impact of the current reforms and the spending restrictions.”
Porter was born into a working class, Newcastle-under-Lyme family in 1962 and was the first member of his family to go to university – “like Neil Kinnock”.
He is fond of quoting Labour veteran Denis Healey’s dictum that every politician needs a hinterland. His, according to BMA News, includes “a love of classical history, particularly that of the Roman empire, science fiction and political dramas”. The last of those should stand him in good stead for the inevitable tussles ahead.