The Language of Liars: David Cameron and the “7-Day NHS”

Yesterday in Prime Minister’s Questions, which should at this point be renamed Posh Yobbos Drag British Politics to its Absolute Nadir, David Cameron’s phrase of the day was this: “Are the Labour Party in support of a 7-day NHS?”.

There are two problems with this question:

Problem number 1: It implies that the Conservative Party are facilitating a greater expansion of services and resources within the NHS, which the Labour Party are refusing to support. Of course, this isn’t true; the Conservative Party are desperate to be seen to be attempting to improve the NHS, while they actually stretch the service’s already depleted resources and already overworked staff, so they can eventually declare the situation untenable and then hand out NHS contracts to even more private firms. We’ll talk about this below.

Problem number 2: We already have a 7-day NHS.

Remember when your uncle had a heart attack on Saturday afternoon? Remember when your mum went into labour with your sister at 4am on Sunday? Remember all those other times you chipped your tibia or broke your hand or had an asthma attack or stupidly gave yourself concussion by headbutting a buttress on a holiday with friends? (Is that last one just me?) Remember how you went to the hospital and it was closed, because there’s no NHS on the weekend?

Oh. No. It was open. Because the NHS is 24/7.

So why does David Cameron keep implying that it isn’t?

Proof by Assertion

What the Prime Minister is doing here is engaging in a logical fallacy called Proof by Assertion. This is an informal fallacy, meaning that the argument’s premises fail to adequately support its conclusion, and it is typically used as a form of rhetoric by politicians. David Cameron in particular loves it; any time he uses one of his “buzzwords”, this fallacy is likely hiding somewhere amongst it.

The Proof by Assertion fallacy is at work when a proposition is stated and restated regardless of contradiction. In other words, when a statement is simply repeated over and over, without evidence, and often in opposition to evidence that shows it to be false. A lot of the time when used by MPs, this technique works; people come to believe the assertion and indeed start to repeat it themselves (consider the “fact” that most UK laws are made in Brussels, or that weird myth, framed in a hundred different ways, that a pub somewhere had to take down their Union Jack flag because it was in some way offending immigrants. Haven’t you heard these both a million times?). Put in succinct terms, if you repeat a lie often enough, people will believe it.*

By arguing this way, the Prime Minister can (and often does) convince the general public of something that is not the case. Here, he’s being extra sneaky because he’s not claiming outright that the NHS isn’t a 7-day service. Rather, he’s implying it. This means that, if criticized, he can state that he never actually said that the NHS isn’t a 7-day service. And he’d be right, in the same way that if you hold your fist out while someone’s running towards you, you can say that you never actually punched them.

If called out on this, he’d likely change the phrase, briefly, to “a truly 7-day NHS”. The core is still there; the implication still arises. People hear this enough and they begin to absorb the implication.

The great failure of the Labour Party is that they allow these sorts of logical fallacies to be used again and again without tackling them head on. The more often David Cameron uses the phrase “7-day NHS”, the more likely it is that the general public will come to believe that the NHS is not available to them 7 days a week.

But why does he want this?

The Lie

The Tory Manifesto states that the Conservative Party is committed to making sure that everyone can see a GP seven days a week, and that hospitals are “properly staffed” (whatever that means) on weekends. They claim that thousands of people die every year because of inadequate staffing levels on Saturdays and Sundays:

According to an independent study conducted by The BMJ, there are 11,000 excess deaths because we do not staff our hospitals properly at weekends.
– Jeremy Hunt to the House of Commons

However, this claim is based on a study that does NOT say what Jeremy Hunt is trying to make it say. The study in fact states that “11,000 more people die each within 30 days of admission to hospital on Friday, Saturday, Sunday or Monday, compared to the other days of the week“. It makes no claims about why this is. As many have already written, there are a number of factors at play here. One theory posits that because routine procedures are not scheduled for the weekends, the people who do go to hospital on weekends are in need of more urgent care; in laymen’s terms, they’re sicker, and therefore more likely to die. However, this is not clear. As the authors of the study stated:

It is not possible to ascertain the extent to which these excess deaths may be preventable. To assume they are avoidable would be rash and misleading.

Non-partisan fact-checking charity FullFact agrees:

The research doesn’t say that either 6,000 or 11,000 deaths are caused by not having a seven-day service, or otherwise what the causes are. We’ve previously asked the Health Secretary to correct the parliamentary record on this point and are pursuing it with his office.

In fact, the Department of Health itself, in leaked emails to the Guardian, said that the department:

…cannot evidence the mechanism by which increased consultant presence and diagnostic tests at weekends will translate into lower mortality and reduced length of stay.

So why exactly is it that the Conservatives are pushing this manifesto point so aggressively, when neither the authors of the study nor Jeremy Hunt’s own department say it would help save lives? In a service that is massively underfunded and stretched to its limits, wouldn’t it be better to commit efforts and funds into improving the service in its current state? The NHS deficit is £2.26 billion for this financial year already, and 53% of trust finance directors say that quality of care in their local area has worsened. We don’t need GP service on the weekends, nor routine operations available on Saturdays. Why don’t we spend more money making the NHS work before trying to expand it?

Because the Conservative Party is trying to sell a solution to a problem that doesn’t exist.

John Kenneth Galbraith’s “revised sequence”

John Kenneth Galbraith was a Canadian-born Harvard professor of economics who also served as the US ambassador to India under the Kennedy administration. For much of his life he could claim to be the best-known economist in the world. In his 1967 book The New Industrial Estate, Galbraith puts forward the economic concept of the “revised sequence”. Let’s look at what that concept is.

The “accepted sequence” in economics holds that consumers dictate what is produced and sold to them; in essence, that consumers control the market, or that demand controls supply. What Galbraith posited was the idea that, instead, business (producers) exercise control over consumers by convincing them of what they should be buying. This is achieved by marketing, advertising and salesmanship. As Conrad P. Waligorski puts it, the revised sequence:

…asserts that production decisions come from large corporations, and consumers are convinced to want what is produced or provided. Consumer wants reflect what advertising teaches them to want.
– Conrad P. Waligorski in John Kenneth Galbraith: The Economist as Political Theorist

In laymen’s terms, this is inventing the problem in order to solve it. This goes on a lot in the fields of alternative medicine; if someone can convince you that there’s something wrong with you and sell you a cure for that, they’ve created a new market. Galbraith held that the revised sequence only applied to the manufacturing core of the economy, but it’s easy to extrapolate this concept to other applications. For instance, the Conservative Party’s insistent implication that the NHS is not a 7-day service. Put in simple terms, this constant implication is the “advertising and salesmanship” in the revised sequence, and the the product is this mystical 7-day NHS that’s supposed to stop 11,000 deaths per year. David Cameron is convincing us to want what he’s selling.

But why?

If the Conservative Party can convince the public that the NHS needs to offer the exact same services on every day of the week (extending GP hours into the weekend, booking routine operations on the weekend instead of on a week day, etc), then it follows than an already-stretched service becomes even more stretched. As an increasing number of NHS trusts struggle to cope with the demands placed upon them, adding an entirely new pressure will force them to breaking point. The inability of the NHS to fund itself is used by the Conservative Party as an excuse to privatize massive parts of it. According to the NHS Support Federation, between April 2013 and April 2014, 70% of NHS contracts went to the private sector. This drains crucial funding from the public sector and yet again puts public money into private hands – and it turns our healthcare into a commodity.

Eventually more and more NHS contracts will be wrenched away from the public sector and into the private sector, which is supposedly (against all evidence to the contrary) more efficient, and where it is claimed that there are more resources available. The lack of resources in the NHS is the result of a direct political decision made by David Cameron and his party. Under the guise of austerity (an economic theory abandoned across the globe, and denounced by economists), the Conservative Party have refused to adequately fund the NHS, and now they’re using its financial distress to justify privatization.

Let’s think about that again. A party that controls the resources of the NHS will strangle those resources, then divert public money to private interests, using the NHS’s lack of resources as justification. They will exacerbate the problem, then “solve” it by giving NHS contracts to private firms.

And why would the Conservative Party want to funnel public money into private firms?

Because half the firms behind NHS privatization have links to the Conservative Party.

Because companies with links to Tories ‘have won £1.5bn worth of NHS contracts.

Because David Cameron gave a peerage to the nursing and care home tycoon Dolar Popat who has “donated” over £250,000 to the Conservative Party.

Because Iain-Duncan Smith has shares in hygiene technology company Byotrol plc, which sells products to the NHS.

Because George Osborne was paid by Julian Schild, whose family made £184million in 2006 by selling hospital bed-makers Huntleigh Technology

Because Priti Patel used to work for lobbying firm Weber Shandwick, which does PR for big healthcare and pharmaceutical firms.

Because William Hague was given £20,000 by MMC Ventures, which parts owns The Practice plc which runs 60 GP surgeries.

I could go on. The amount of Conservative Party MPs who stand to make massive financial gain from the privatization of the NHS is staggering. You can read the entire list of MPs with links to private healthcare firms here.

Of course, this isn’t just limited to the healthcare field and it isn’t just limited to the Tories. Huge numbers of MPs have financial links to companies that undermine their role in government. The very idea of a democratic system fails when these financial links are in place. Only a reformation of the political system would deal with this issue; we would need reforms to ensure that no one creating legislation has any links to the sector affected by that legislation, and that any conflict of interest means that the MP cannot vote on that legislation. This is basic stuff – or so you’d think.

But we don’t have that. And so Conservative Party MPs will continue to benefit personally from the dismembering of the NHS.

So every time David Cameron says the phrase “7-day NHS”, remember that this isn’t just a harmless piece of rhetoric, nor a frivolous fallacy, nor a mere slap in the face of everyone who works for the health service and mans the battle stations on weekends, evenings, holidays and whenever else they’re needed. It’s all of these things and more. It’s a vicious and merciless piece of political propaganda designed to dull the blade of ever-increasing privatization and brainwash the populace into believing in a problem that does not exist – all so that David Cameron and his friends can make more money for themselves, and claim political success in the meantime.

Don’t let them win.

The NHS will last as long as there are folk left with faith to fight for it.
― Aneurin Bevan

*This is a quote often misattributed to Joseph Goebbels. Any implication of a similarity between David Cameron and Adolf Hitler’s Nazi Propaganda Minister is purely coincidental.

Header image via the BMA (labeled for reuse)