Delivering a vision for the people’s NHS

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Our message to the Shadow Front Bench

This article was first published by Labour Outlook
By Tony O’Sullivan, a retired NHS consultant paediatrican and
Co-Chair Keep our NHS Public

Over 500 people died in the last year before getting any treatment linked to ambulance delays of up to 15 hours. Tens of thousands of people are avoidably dying in a single year. This is not acceptable – it is a political choice bordering on social murder.

The model of a universal, free-at-the-point-of-use NHS works. When our ‘healthcare for all’ model – publicly owned, provided, accountable, universal and free to all who need it – has been funded to succeed, the NHS has been ranked amongst the very best healthcare services in the world.

The NHS model has not failed the population; it is the Government that has failed the NHS. The NHS founding principles were, and remain, sound but the steady privatisation and defunding of our NHS has led to the worst crisis and worst performance in its history. The Government’s failures of state have led to one of the worst Covid outcomes amongst rich world nations. We must change course before the service collapses completely. 

This Summer, 7.68 million are waiting for investigation, assessment and treatment, 96,000 waiting over 15 months. In August 29,000 people waited on trolleys over 12 hours in A&E at ‘winter crisis levels’ before a hospital bed could be found. 37% of cancer patients waited over two months for their treatment. For months this year, 500 people were dying avoidably every week due to delays in the acute pathway of care from arrival at A&E to admission to a hospital bed and treatment. Over 500 people died in the last year before getting any treatment linked to ambulance delays of up to 15 hours. Tens of thousands of people are avoidably dying in a single year.

This is not acceptable – it is a political choice bordering on social murder. Add to this the disgrace that is social care, the shocking impact of woefully insufficient mental health care with long-distance NHS admissions to private hospitals, and the lack of access for 50% of children to NHS dentistry. The Government entered a pact with private healthcare during Covid and gave them a £10 billion 4-year contract in 2021 in preference to NHS investment. The Right – from the Institute of Economic Affairs (IEA) to ex-Health Secretary Sajid Javid and numerous media articles and interviews – are delightedly chorusing the final demise of the NHS model.  

Our message to the Shadow Front Bench

So, what do we expect of a government in waiting?

Private sector parasite or public service investment

A publicly provided NHS works: invest in it and you invest in a healthy population and economy. Do not boast that you will use private sector ‘spare capacity’ more efficiently than this Government. Recognise that there is no spare capacity in the private sector that does not further undermine the NHS – the private sector relationship with the NHS is entirely parasitical. It is disingenuous to refer back to the disruptive, ineffective, and heavily subsidised independent sector treatment centres imposed on the NHS by Labour in the 2000s, ostensibly to address waiting lists. It was the growth of NHS capacity that solved the waiting lists inherited from the Tory Government in 1997.

We say end private involvement, stop the diversion of £billions to private hospitals and fund the NHS to succeed.

NHS as preferred provider

The weakness of Labour policy of ‘the NHS as preferred provider’ will be that the NHS has been left in such an undermined state (very different to 2009 after a decade of investment) that Integrated Care Boards and NHS England will continue to use the private sector as long as the NHS trusts and primary and community services remain starved of funding and sufficient staffing to deliver – an NHS underfunded to fail.

Driven by underfunding and accompanying dictats from Government and NHS England to use the private sector, NHS trusts spend even more of their services on outsourcing than the commissioning bodies of the Integrated Care Boards (ICBs). Our examination of the spending of NHS funds in the 42 Integrated Care Systems (ICBs plus NHS trusts) shows that already as much as 35% goes to private companies (North East London ICB). A great deal of this is clinical, such as cataract and orthopaedic surgery, hearing aids, pharmacy, specialist imaging etc.

We say bring outsourced services back into NHS provision and invest in the NHS.

Community-based care

Policy drawn up by McKinsey for New Labour calling for a refocused priority on community-based care has been around for 30 years. It is premised on an unevidenced claim that 30% of hospital care can be looked after in the community. The policy is aimed at driving down public spending and accompanied by efforts to close one in three A&Es and acute hospitals. Without a cast-iron commitment to build back the capacity of hospitals and the resources of GP and primary care, ‘care in the community’ will be used as a smokescreen for refusing to invest in hospitals.

We say a comprehensive and safe NHS absolutely needs well-funded hospitals in partnership with well-staffed community, GP and mental health services. When that is achieved, we can truly talk about safe community-based care.

Priorities: AI and big tech or NHS staff

We question the policy assumption that the ‘solution’ to NHS capacity is technology. The quality, safety and effectiveness of the NHS is founded primarily on its staff. AI and data systems must serve the needs of patients and staff, not the monetising intentions of major tech and data corporations at the expense of NHS skilled staff. The priority is to build back respect for NHS and care staff and halt the haemorrhaging of workforce away from the NHS.

We say pay justice is urgent to deliver for all health and care workers. Bring back the NHS student bursary.

Restoration of staff morale could not be more critical.

Social inequalities and public health

The lethal impact of health inequalities was laid bare alongside the risk to the population exposed fatally by Covid.

We say re-invest to recreate a strong national and local public health service. And commit urgently to rebuilding, restoring and expanding our NHS.

And we say the disgrace that is social care and the assault on the rights and benefits of disabled people must be addressed by creating a national care, support and independent living service.

Invest in the future: invest in public services

A change of government is possible at the next election and opposition parties will have a real chance to improve the lives of everyone in society.  

A commitment to funding, restoring and expanding the NHS, alongside investment in social care and education, would strengthen our economy and re-establish our country as one of the best health care providers in the world. Failure to do so will let the population down. It will hasten further undermining of the NHS model, perhaps beyond repair. Failure to do so would be a betrayal of LP Conference policy. It would be aiding and abetting the demise of the NHS as a public service. We will not accept that.

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