GP minister: ‘The health system is Ponzi-like: we need honesty’
Justice minister and GP Dr Phillip Lee talks to Alex Matthews-King
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Dr Phillip Lee holds a unique position in UK political life. He is the only practising GP in the Government. You might think that would make him a shoo-in for a health brief, but instead he is ensconced in the Ministry of Justice, overseeing youth justice, female offenders and prison health.
Yet despite his role in the Government, he seems happy to speak freely about the state of the health service. After the Conservative Party Conference, Dr Lee’s reported comments that Britain is ‘too selfish to care for its elderly’ and that the NHS is a ‘Ponzi scheme’ that is ‘about to collapse’ were plastered over the newspapers’ front pages.
Those words were sensationalised, he tells Pulse as we interview him in the Westminster canteen, but he remains adamant that we need a national conversation about the challenges of caring for the elderly and the role of primary care. It is hard to disagree with that sentiment.
Have you seen the pressures in general practice improve in your time in Government or as an MP?
The demand for healthcare in general continues to grow year on year. Everybody knows this. The Government, like every other one before it, has continually increased its budget and invested significant sums of money.
We have an ageing society so it is not surprising that the health service and social care have got challenges to meet.
It’s not easy discussing the NHS, because it is an emotive topic and any discussion attracts a disproportionate amount of attention. The party political knockabout on the subject doesn’t help healthcare provision. I have tried to be candid and straightforward and will continue to do so.
Does your frontline experience affect your position in that respect?
Yes, and I have a network of medical schoolmates, GP colleagues and everyone else, who talk to me.
So you recognise the pressures they bring up?
I am one of ‘them’.
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Do you bring these issues up with your MP colleagues? How about with Jeremy Hunt?
Of course, but Jeremy Hunt, and indeed every health secretary before him, has this really big challenge of maintaining healthcare standards and provision for an ageing society.
When I was at medical school they didn’t really do many knee replacements, because it didn’t work so well. Now we do them routinely. It’s a welcome development, but with these changes comes an expectation cost. Every doctor knows this.
You can come forward with different party political positions on how you meet that challenge. But I don’t need to tell the Department of Health about it.
The task for politicians of any hue is to have a balanced and informed debate about how we can sustain decent healthcare services in an ageing society.
Do you discuss GP-specific pressures with the DH as well?
Of course I do, and I get asked all the time. Ever since I arrived here people have asked me for my opinion on all manner of different health issues.
But I step back and look at the bigger picture, and don’t get sucked into little details.
There is a discussion to be had about the service, how it improves and is sustained through the next 10, 20, or 30 years. A cohort of individuals born between 1945 and 1955, broadly 20% of the population, are going to be hitting their 80s.
And we enter this stage with challenges in the system across the board, despite Labour having doubled spend over 10 years and all the other measures taken, we are where we are.
We need an informed debate with the public and they are up for that more than most people realise. They look at their families and see ageing parents, grandparents, aunts and uncles and recognise that it needs to be discussed in an honest way.
This is the case for all parts of the system; in prisons there is an ageing population – we’re going to need services like palliative care in prison.
One headline said you referred to the NHS as a ‘Ponzi scheme’. But a lot of GPs recognise the sentiment and the demographic issues you mention.
First, I didn’t actually use the acronym NHS in the meeting where I supposedly called it a ‘Ponzi scheme’. We have a full transcript.
My point was about health and welfare and younger people voting for the Conservatives. The system is Ponzi-like in that it relies on people in work paying for people to receive the care once they retire. As a taxpayer, you are going to think ‘is it going to be there for me when I need it?’
The social contract in Britain, where you pay in and receive, is fraying. We need honesty about how this works for people who are in work paying the tax. How do you get them to buy in to the system used predominately by older groups?
That was twisted by the some of the reports of me saying the service is about to collapse. That’s not what I said.
But everybody I have spoken to says ‘You are right, keep it up’. So I don’t retreat from the comments, but the context wasn’t there.
GPs feel they’re a catch-all for NHS work and unmet social needs. Is the NHS too reliant on GPs, and do you think the general public needs to be better equipped to self-care?
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I have always thought the primary care model is a good idea, and I think most places around the world wish they had a similar gatekeeper model. We need to protect that.
But the patient/doctor relationship is no longer what it was in Dr Finlay’s days. Things have changed and we really do need to protect the value of primary care because ultimately it’s a cost-effective and decent model of care.
Do you think continuity is core to that?
Continuity can be provided by decent data input. That’s what I do as a locum. I am quite verbose in my entries in patient notes, because other healthcare staff need to know what I am doing, and why. But yes, there is heavy demand being placed on primary care, again driven by ageing populations.
This is why I made my comments: we have to ask what is the best way to look after our vulnerable. I didn’t say – as the front page of the Daily Mail claimed – that society is selfish. I asked a rhetorical question around how Western society has developed over the past 30 to 40 years and where we outsource care.
Outsource care, as in to care homes?
Traditional communities look after their elderly within their own families. And we seem to have followed the path that we will pay tax so that somebody else looks after them.
Aren’t today’s smaller families part of that?
Yes, and how we have decided to live, with family members living and working in different parts of the country. Is that necessarily the way we have to go?
I have two living grandparents in their 90s and my parents are in their 70s. We have just had a baby. I am not alone in being in that situation.
Delivering decent care, decent lives for everybody may require us to rethink how we do things. Despite the Mail’s sensationalised headline, we have been getting some very interesting correspondence from the public. People are beginning to understand.
How are you dealing with the generations in your family?
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I don’t look after my elderly relatives; I volunteered that but it didn’t actually make the article. Is it because my wife and I both have to work to pay for the mortgage? That’s a modern phenomenon, so why has it happened?
We are seeing this play out among GPs. The younger generation is essentially saying the rewards are not sufficient to take on a partnership and aiming for a better quality of life through portfolio careers and the like. Is that a good adjustment?
It’s just an adjustment to the reality of being young. It is an adjustment to the reality of being 35 or being basically told you can afford a shed on two salaries.
They are adjusting the same way – saying, ‘maybe I won’t go for the biggest salary’. The primary care system is a good model, and I think we should try to protect it and defend it. But does it need to evolve to modern times, of course it does.
Do you see bigger practices as part of that evolution?
I am nervous about ‘big is best’, because you need a bit of a feel for your community.
What do you see as the pressures for prison GPs? Have you been on visits?
I am going on a visit tomorrow. There are real challenges over providing appropriate mental health care and we are aware of this and engage the DH on this on a regular basis. Addiction, and particularly the use of ‘spice’ – a synthetic cannabinoid – is a real problem because we don’t really know what it’s doing to people’s brains.
These are people who are quite vulnerable already, some with mental health problems, and you are throwing in a psychoactive substance. It makes life extremely difficult for everybody concerned.
The staff are doing an amazing job given the circumstances. We are working extremely hard to improve the situation both in the community and in custody.
Graduated from St Mary’s Hospital Medical School, London
Various junior doctor hospital positions
Full-time locum GP in Berkshire and Buckinghamshire
Part-time locum GP in Berkshire and Buckinghamshire
Elected MP for Bracknell
Appointed justice minister
Travelling, skiing (water and snow), football and rowing