Youssef El-Gingihy: I fought to save the NHS - now I'm battling cancer
When GP and campaigner Youssef El-Gingihy discovered a lump he suspected Hodgkin's lymphoma. He tells Richard Godwin how being treated for the disease renewed his passion for free healthcare
Back in August, the doctor and NHS campaigner Youssef El-Gingihy was taking a shower when he found a lump above his right collar bone. His lymph nodes had swollen to the size of a walnut. As a GP, he could make a good guess as to what it meant. “I didn’t know a great deal about Hodgkin’s but the monograph I remembered from medical school was enough,” he says. “I was like: ‘What the hell else could it be?’”
He took a blood test, spent an unrestful week in France with his girlfriend Jana, and then cut his holiday short by phoning the hospital for the results. His training didn’t fail him. It was Hodgkin’s lymphoma. He’s 34. “The only consolation is that if you’re going to choose a cancer, this is the one as it’s treatable.” But first, his life would “shift on its axis” as he entered a long phase of chemotherapy, radiotherapy and self-doubt. He initially blamed himself for the strain he had put himself under during a year serving his patients at the Bromley-by-Bow health centre in Tower Hamlets, while doing his utmost to warn the public of what he sees as the mortal threat to the NHS.
Like an increasing number of British doctors, El-Gingihy has gone through disbelief, anger and radicalisation at what he sees as the inexorable privatisation of our public health service, which began with Mrs Thatcher’s NHS review of 1987, expanded with New Labour’s market-based reforms and public finance initiatives, and found its full expression with the Health and Social Care Act 2012. (Whose author, Andrew Lansley, has since retired as an MP to act as a “strategic health adviser” to management consultancy firm Bain & Company).
In 2013, El-Gingihy contributed to a documentary called Sell Off: The Abolition of Your NHS. Earlier this year, he published his own book called How to Dismantle the NHS in Ten Easy Steps (Zero), an attempt to translate the changes into plain English. “Although nobody has told you this, the NHS has been effectively abolished,” he writes in the introduction. He believes the Tories’ ultimate aim is the introduction of a US-style insurance system, and that Labour is too implicated in the process to provide proper opposition. The Health Secretary Jeremy Hunt stresses that he is simply trying to deal with a “triple whammy” of financial restrictions, an ageing population and rising consumer expectations — but his reassurances have not calmed the medical profession. If you’re friends with doctors or nurses, you’ll know the Facebook screeds and creative misspellings of “Hunt”.
In 2013, El-Gingihy contributed to a documentary called Sell Off: The Abolition of Your NHS
El-Gingihy’s account is enlivened by his experience as a GP serving some of London’s poorest patients, as well as his family history — his father was an NHS psychiatrist in Warwickshire, where Youssef grew up before studying medicine at Oxford. When he was writing the book, the most serious medical problem he had suffered was a ruptured Achilles sustained while playing football. Now he’s gazing from the Guy’s and St Thomas’ oncology ward over the river to the Houses of Parliament relishing the not-very-amusing irony. “It’s all changed for me now,” he says. “My message to David Cameron is: ‘This time it’s personal’. As a cancer patient with the privilege of receiving state-of-the-art treatment in a centre of excellence, the idea that in the future this could be lost to a nexus of corporate interests is horrendous.”
He stresses that the care he has received has been excellent — as is the care received by most British patients, he believes, despite headlines about the winter beds crisis and A&E departments stretched to their limits. He believes this is largely spin. “All you hear about in the media is this perpetual state of crisis. There’s no analysis of why the problems are there — and that’s really helpful to the vested interests in health at the moment. It’s hard to believe because on the surface nothing has changed. But this has basically allowed the Conservatives to get away with murder.”
We talk just as he’s finished his first round of treatment — he’s getting his scan results in Monday. “It’s a bit like Whack-a-Mole,” he says. “You surface then they whack you with the drugs again.” He counts himself lucky that his girlfriend is a personal trainer, while his medical training means he can administer his own syringes. But it hasn’t helped with the baroque range of side-effects, from his mouth filling with ulcers to his low-white blood cell count which leaves him at heightened risk of infection. An oncologist friend told him to expect good and bad days. “I remember sitting down with Jana and saying ‘I wonder what he means by bad days?’ Now I know.”
Demonstrators listen to speeches in Waterloo Place during the 'Let's Save the NHS' rally and protest march
Still, for someone so physically depleted, he’s relative upbeat — and encouraged by Hunt’s recent retreat over junior doctors’ contracts. “That’s just one plank of a whole raft of changes. But even the more moderate and Tory-voting medics are becoming radicalised. The same will apply to all sorts of Conservative voters — I suspect if they had any idea what’s going on, they’d be horrified.”
He says that, like a lot of doctors, he was never particularly political — “they don’t teach you any of this stuff in medical school” — but only became so once he began to decipher the 300-odd pages of the Health and Social Care Act, 2012, and realised what it meant for patients.
By his account, the Act essentially abolishes the Government’s direct responsibility for the NHS, instead devolving control of service to Clinical Control Groups, or CCGs (which he believes will eventually be privatised). In the recent past, NHS was legally bound to provide a full suite of services — but the sole legal obligations of the CCGs are to provide emergency care and ambulance services. Moreover, all CCGs are now virtually forced to tender out contracts, or face the risk of litigation suits under EU Competition Law. “At the moment, it all seems to be working as normal. But there is no longer any legal guarantee for most of the services we rely on — including oncology — so at some point in the future they could withdraw everything.”
Piece by piece, El-Gingihy fears the NHS will fall out of public hands and into the hands of corporations whose sole legal obligations are to their shareholders.
But if, say, Virgin Care can do a better job of oncology than the existing NHS providers at a cheaper cost, why shouldn’t it? “I’d have no problem with that if there was a shred of evidence to show they could. There’s always been a role for private companies in the NHS in terms of pharmaceuticals and medical equipment. But in terms of frontline care, the international evidence is that when you bring in market forces and private companies, it costs more and you get worst outcomes. Healthcare relies on collaboration, not competition.”
The main strain on NHS budgets, he contends, comes not from the ageing population, EU migrants, grabby GPs or any of the popular Tory bugbears but from the so-called “efficiency savings” themselves. Among the most wasteful were the private finance initiatives (PFIs) that Gordon Brown introduced as Chancellor to fund hospitals. The Telegraph recently calculated the cost of convoluted deals to be £3,729 per second or £2 billion per year. Then there are the huge administrative costs of running the internal market in contracts, which a 2010 Health Select Committee report found takes up 14 per cent of the NHS budget (more than the costs of every GP in the country). Before the internal market was introduced in 1991, administrative costs made up only five per cent of the NHS budget. Now it’s mushrooming.
“The moment you run an internal market, you run up huge extra costs,” El-Gingihy claims. “The administration costs began to rise hugely under Margaret Thatcher and they’ve continued to rise. It’s counter-intuitive, as it goes contrary to everything you’re told about the private sector. But you need huge tiers of administrative staff; you need processes that didn’t exist before; you need lawyers, auditing, billing.”
I fear for his stress levels as he reels off instances of corporate malfeasance, the “revolving door” between the Department of Health and private healthcare, and charging schemes currently being floated by Right-wing think tanks. Reform has recently proposed charging £10 for GP visits, which he sees as laughably naive. “They tried something similar in Germany and it was a disaster. A £10 charge isn’t much for you or me or Cameron’s Cotswolds circle. But most people who come to my surgery can’t afford that. It might cut demand in the short term but it’s not good for public health, and it leads to more costs long term.”
He also scorns Cameron and Hunt’s vision of a “seven-day” NHS, which he sees as a great idea in principle but a clever diversion tactic in that it makes doctors seem resistant to change while raising patients’ expectations as consumers. “Being a patient is different to being a consumer,” he says. “Getting cancer treatment is not like buying DVDs. The vast majority of patients are not in a position to make an informed decision about their treatment. It even applies to me: I’m a doctor but I have nothing like the knowledge that a specialist does. And once you’re in a situation like this where there is what’s called asymmetry of information, markets start to produce all sorts of perverse outcomes.”
Does he ever fear he’s being paranoid? “Sometimes,” he admits. “I think: ‘Surely they can’t be doing this. They can’t be destroying the NHS.’ And then you see things happening exactly as you’ve predicted. The fact is, none of this is justified or necessary. We spend less money on healthcare than almost every other country. It’s purely ideological.”
He admits it’s hard to stay upbeat when his own body feels as if it is attacking him. But he sees cause for optimism. “With the NHS, the public is already on your side. I don’t think Cameron and Hunt anticipated the level of resistance there is to these changes. As Aneurin Bevan said, the NHS will last ‘as long as there are folk left with the faith to fight for it’.” He won’t be giving up anytime soon.
How to Dismantle the NHS in Ten Easy Steps is published by Zero Books
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