Trouble in Thatcherland

...During her 1987 campaign for a third term as prime minister, Thatcher promised that the NHS would be safe in her hands...

...Although the government has greatly increased the sums being spent on the NHS, they remain insufficient because people are living longer and understandably expect access to modern, expensive health care equipment...

...Thatcher is rumored to have abandoned the idea of introducing a nationwide private medical insurance scheme to replace the NHS after she was persuaded that it is too much of a national institution to be scrapped...

...It is as if Thatcher had a Pandora's Box stowed away in the attic at Number 10 Downing Street and suddenly its lid has been forced open to turn loose all sorts of furies...

...Marks warns, "The articulate middle-class patient will do very well out of the new system...

...But the unfortunate inarticulate patients will not be able to buck the system...

...That would presumably compel them not to be wasteful in offering services and medicines to their patients, and to shop around for hospital services when patients need specialist or prolonged care...

...The waiting time for nonacute surgery in NHS hospitals is sometimes years long...

...That is about when the next national elections are due to take place...

...Thus for those who cannot afford or choose not to subscribe to private health insurance—and that means the overwhelming majority of the population—comprehensive health care would not only remain free but actually be more accessible than it has been of late...

...It asks what would happen if a patient is admitted to a newly specialized hospital, then is discovered to need treatment of another kind as well...

...And residents in parts of London are angry and confused about Department of the Environment intentions to push several new high-speed traffic arteries through the capital, past their homes...

...Marketplace controls would thus be introduced into the workings of the NHS...

...An AIDS patient, for example, might be seen as a budgetary drain...

...At the same time, the government has come under sharp criticism for failing to adequately inform the public about the pollution of some British rivers...

...Another troubling development is the sizable foreign trade deficit...

...If approved by the Tory-controlled Parliament, as seems likely, the NHS reforms would begin to be felt in roughly two years...

...Everyone agrees the NHS needs reform, but the general reaction from doctors and others to the proposed changes has been sharply negative...

...The litany of current complaints about Whitehall actions or omissions goes on and on...

...The long-term health of thousands of persons in certain parts of the country is believed to have been seriously affected by drinking water from kitchen faucets...

...But a newly announced plan for its total reorganization has aroused widespread suspicion that its basic principles are on the verge of being canceled out...

...Onaverybasic level, the fact that interest rates have almost doubled since this time last year has financially embarrassed great numbers of individuals who bought houses and flats just before the climb began...

...Nevertheless, it is feared that they would be reluctant to devote sufficient attention to difficult cases— as they can at present without being penalized...

...To economize, critics say, some GPs might refer patients to "cheaper" hospitals far away from their homes for necessary treatment...

...Assurances have been given that NHS practitioners would receive special allowances, over and above their proposed prescribed budgets, to deal with geriatrics and patients suffering major illnesses...

...The BMA is also worried about the impact of the Thatcher scheme on NHS hospitals, and on the relationship between hospitals and budget-conscious doctors...

...Careful scrutiny by the Health Ministry, they contend, will guarantee modifications of the plan where they are seen to be necessary as the new procedures are put into effect...

...Next to the Prime Minister, Clarke is the most articulate member of the government...

...Health Minister Clarke vehemently denies it, yet the Thatcher plan could result in placing the emphasis on how cost efficient the NHS is, rather than how good...

...Still, by making private health insurance accessible to many of the elderly who could not normally afford it, her government would further strengthen the inequitable twotier health system that already exists in Britain...

...The reason for this feeling can be gleaned from the main points of the government's proposal: 1. NHS general practitioners (GPs) would for the first time be allotted set budgets, based on the number of patients they have...

...A series of fatal train crashes has led to charges that the government has persistently ignored poor safety standards on the railroads...

...2. NHS hospitals, now governed and financed by regional public health authorities, while remaining part of the Health Service, would be encouraged to go independent...

...Those attributes, indeed, probably explain his having been chosen for the thankless job of pushing through the NHS revisions...

...Though not on the scale of America's trade imbalance, it has aroused much nervousness in London's financial markets...

...Much existing medical administration is obstructive rather than useful...

...Unlike Thatcher, he is charming, and in other government positions he has shown himself to be highly competent and hard working...

...As things stand, most doctors appear to limit standard consultations to at most 10 minutes...

...Quite independently, hints have also been emerging of scandals that may soon rock some eminent financial institutions—perhaps along the lines of the one last year that cost a lot of retired people the investment of their life savings...

...Norman Gelb writes regularly for The New Leader on British affairs...

...Induced by tax advantages to participate in Prime Minister Margaret Thatcher's own-yourown-home culture, rather than scrounge for public housing, they are now having trouble meeting their flexible mortgage payments...

...John Marks, the BMA's chairman, says that given budgets keyed to the number of patients on their lists, doctors would be anxious to increase their incomes by recruiting more patients and would, as a consequence, have less time for each...

...It is possible, therefore, that Health Minister Kenneth Clarke is right in maintaining that the " reforms" would restore the NHS at a critical period of growing inefficiency...

...They argue that it is an illusion to believe the NHS' continuing deterioration can be prevented without firmly introducing cost consciousness, since the system has been ailing for years because of chronic, built-in wastefulness and underfunding...

...Defenders of the government say this sort of criticism is facile, unfair and downright hysterical...

...Many have had to sell out and take losses, because formerly soaring prices have leveled off...

...In addition, there are concerns about the failure of the proposals to make specific allowance for teaching, now largely the province of the large, comprehensive teaching hospitals, and for medical research...

...Sustained outrage is being voiced, meanwhile, over the likelihood that plans to privatize the publicly owned electricity and water industries will lead to substantial increases in utility charges...

...It is similarly feared that hospitals, once urged to specialize in order to capture a particular segment of the health market, would no longer be able to offer their communities the wide range of medical services they do now...

...In view of the other difficulties confronting the government, the health care issue could very well be decisive in determining whether or not, after three terms in office, Margaret Thatcher is finally levered out of Downing Street...

...3. Tax relief on private health insurance premiums would be introduced for the elderly, promoting wider use of private health facilities bypeoplewhowould otherwise use those of the NHS...

...Yet he may suffer serious personal political damage before the task is achieved...

...The BRITISH Medical Association (BMA) has come out firmly against the NHS plan...

...And what will the GPs' response be to situations usually described as preventive medicine, where patients are simply seeking checkups and require no immediate treatment...

...They would finance themselves by, in effect, selling their services to GPs and local health authorities, who would be seeking the best hospital for their patients at the lowest price...

...Even former government minister Norman Tebbit, until recently a political intimate of the Prime Minister, has not hesitated to sound off about her policies, particularly their "inept presentation and muddled execution.' Of greatest concern, however, is the future of the National Health Service (NHS), created some four decades ago to provide the best available health care to all British subjects free of charge...

...They insist, too, that a market-oriented approach would guarantee the focusing of resources on aspects of the Health Service that best serve the needs of the public...

...The government has been condemned by a Parliamentary committee, too, for failing to cope promptly with a nationwide food scare that erupted when a junior minister said mistakenly that most of the country's egg production is infected with salmonella...