'Financial austerity is being used to dismantle the state'
Dr Gabriel Scally resigned from the Department of Health to voice his fears for the NHS. In his first interview since quitting, he speaks to Denis Campbell
Dr Gabriel Scally, a senior NHS doctor, was until April employed by the Department of Health, but he resigned as a direct result of his alarm at the coalition government's health policies – and because he wanted the freedom to oppose them.
In his first interview since stepping down as regional director of public health for the south-west of England, Scally says: "The time had come for me to step outside the formal system and do things in a different way. My job is helping people live healthier lives in healthier communities, and there are better ways of doing it than participating in the changes that are taking place in the public sector in England.
"Since 1993, I've been restructured and reorganised eight times, I think, and that's enough really. Throughout these restructurings I've seen a loss of talent, of momentum and of coherence, in both the NHS structures and public health structures. This one [by Andrew Lansley] was the final straw."
There is unease throughout the higher echelons of NHS management about the health secretary's shakeup of the NHS in England. But contracts that forbid criticism of official policy have meant that, despite widespread doubts internally, no one working in the service has been able to publicly voice the concerns that many hold privately.
No longer muzzled, Scally – an articulate and passionate defender of the NHS – is set to become a thorn in Lansley's flesh, and a key voice in the debates about public health issues, such as obesity, tobacco control and public health's impending transfer from the NHS to local government. The 57-year-old's expertise and experience means he is in demand. He has become an associate fellow at the Institute for Public Policy Research thinktank, and is a visiting chair at Bristol University and the University of the West of England, which will provide further platforms for research and policy development.
Planned enfeebling
The NHS reorganisation is, he believes, part of a planned enfeebling by the government of public services generally: "I think there's a very deliberate policy across all of the public sector to roll back the achievements that have been made in this country since the second world war – including the NHS – and that financial austerity is being used to pursue an agenda aimed at dismantling the state.
"At the end of the war this country was hugely indebted but within a couple of years had free healthcare and free education for everyone – what an achievement! This government is putting a huge price on education, especially young people seeking to go to university, and is in the process of dismantling the NHS."
Scally completely rejects ministerial claims that abolishing primary care trusts and strategic health authorities (SHAs) and handing control of £60bn of patient treatment budgets from next April to clinical commissioning groups (CCGs), will – to coin a favourite Lansleyism – "liberate" the NHS.
"What we're going through now is a systematic downgrading, if not destruction, of civil society in England with a de-layering of structures and organisations and, at the same time, a huge amount of responsibility being handed to the local level, especially to local authorities, at the same time as their budgets are being cut," he points out.
The abolition of regional development agencies, government offices in the regions and SHAs is all part of the same process, he adds. "To many people that sounds great, like we're getting rid of bureaucracy. But this is a very big country and cannot be run by a very much smaller civil service in London and a huge, disparate patchwork quilt of local authorities all pulling in different directions," he says.
The coalition's commitment to local power is a sham, Scally insists. He sees the creation of the new NHS Commissioning Board, which will oversee the local GP-led commissioning groups as part of another worrying trend, the centralisation of power in the hands of political appointees. Scally, who trained as a GP, says GPs are not the right people to commission health services, contradicting established wisdom in the medical and health policy community.
"I trained as a GP and I know that it's no part of a GP's training to deal with tens, and in some cases hundreds, of millions of pounds' worth of commissioning budgets," he says. "It's not what most GPs want to do, so handing them a huge amount of commissioning power doesn't bode well for the future of the NHS."
So-called postcode lotteries are inevitable once CCGs assume control next April, he says. "That huge disparity in what people can expect from their local NHS is a recipe for disaster." And he warns that local council health and wellbeing boards could end up being just ineffective talking shops. "I fear they will end up as haggling places over who pays for social care, rather than looking in a broad, innovative and energetic way at ill-health prevention," he says.
Scally, whose career as an NHS public health director began almost two decades ago, became disillusioned under the coalition. Cuts to public health – he saw his staff shrink from 50 to nine; Lansley's championing of the so-called responsibility deal to tackle obesity and alcohol misuse; disappearance of the regional public health observatories, which provided independent research and data collection; and the creation of the new Department of Health agency Public Health England helped to persuade him to get out. NHS policy is deliberately assisting what he calls "the circling birds of prey of the private sector seeking to make big profits out of healthcare. That's less money for patients", he adds.
So how could the post-reforms NHS be put back together? He prescribes serious investment in prevention rather than treatment of illness, and the integration of health and social care – which has existed in his native Northern Ireland since 1973, he points out – to help the service cope with rising demand. He also envisages an overhaul of primary care to increase the number of GPs in the most deprived areas.
The Health and Social Care Act is now on the statute books. He contrasts what he sees as David Cameron's false claim to love the NHS with the dedication of those working in it. "Healthcare professionals see an ethos coming into government policy and permeating the new [NHS] organisations being set up that is not in keeping with the ethos of vocation NHS staff – that they go to work not just to earn the salary but to help people who need their help who are sick or troubled."
Just a brand
That "binding glue of the NHS", he says, is at risk from a new era in which one hospital is now run by a private company, more services are being outsourced, and private firms will be helping many CCGs to run their operations. "It's hard to know what the NHS is going to be in the future. There's a real danger it becomes nothing more than a brand – that blue and white logo," he says.
Despite fearing that the government wants to weaken the NHS and open it up to private firms, he is heartened by the opposition that the bill's passage through parliament finally provoked.
"There was an awakening among health professionals and the public that their NHS was under threat. The task over the next couple of years is to use all of that concern, interest and commitment as part of a rich debate about how we put the NHS back together again, when the opportunity arises. The NHS will only be destroyed if the people of this country let it be destroyed."
Scally, for one, does not intend to let that happen.
Curriculum vitae
Age 57.
Lives Bristol.
Family Married, two daughters.
Education St Mary's Christian Brothers grammar school, Belfast; Queen's University, Belfast, degree in medicine; London School of Hygiene and Tropical Medicine (University of London), MSc in community medicine.
Career 1996-2012: regional director of public health, Department of Health; 1994-96: regional director of public health, South and West regional health authority; 1993-94: regional director of public health, South-east Thames RHA; 1989-93: director of public health, Eastern Health and Social Services Board, Northern Ireland; 1986-88: consultant community physician, Eastern Health and Social Services Board; 1984-86: senior tutor in community medicine, Queen's University, Belfast; 1983-84; senior registrar in community medicine, Northern Health and Social Services Board, Northern Ireland; 1981-83: registrar in community health, Eastern and Northern Health and Social Services Board, Northern Ireland.
Interests Cycling, London Irish Rugby Football Club.
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