The very future of the NHS is threatened

John Lister
Health Campaigns Together
Co-editor The Lowdown

In fighting to stem the erosion of real terms NHS pay, and ensure pay scales that can recruit and retain the expanded NHS workforce we need to deal with rising levels of need for health care, we are fighting for the very future of the NHS.

---

Everybody who knows anything about the NHS knows this is true. But one reason why the unions have found it so hard to win the response they need in their ballots is that for some reason the crisis in the NHS has not resulted in the kind of mass public anger that we saw a couple of weeks ago in Madrid, for example, where upwards of half a million filled the streets in a regional protest.

Many health workers feel they have to fight a heartless, hostile government on their own.

An article in politics.co.uk – one of many on the continuing government turmoil, points to the problem of Rishi Sunak keeping control of a party in which so many of his MPs are revolting – in every sense of the word. Factions are fighting Sunak on all kinds of fronts – but one topic conspicuously missing from the list is the state of the NHS which is an issue that affects literally everyone.

Campaigners need to recognise this. We need to up our game, and find ways to reach out beyond the comfortable circles of supporters we have already built up, to build a genuinely broad and mass movement for the NHS, big enough to counter the bile, lies and distortions in the NHS-hating right wing media – the Telegraph, The Daily Mail, Express and Sun.

We need to find ways to cut through the pathetic government claims of ‘record levels of spending’ etc that are tamely read out by lazy BBC hacks at the end of stories on ambulance delays, crises in emergency admissions, mental health, GP services, waiting times, etc.

The fact is even the Telegraph admits that in 2010, after a decade of investment, the NHS was doing fine, with a maximum 18 week wait for elective care, 4 hour wait in A&E, etc. when Cameron’s government took over. Then George Osborne slammed the brakes on spending and imposed a disastrous austerity policy – and the performance on almost every measure has been declining ever since.

We have seen the meanest-ever decade in real terms NHS spending in England.

The waiting list has almost trebled, from 2.5m in 2010 to 4.5m in 2019 and 7.1m in 2022.

Acute bed numbers have plunged by 9,000 to below 100,000 – of which 5,000 are currently filled with Covid patients and 13,000 with patients who can’t be discharged for lack of social care: almost one in five front line beds not available for emergencies or elective patients.

It’s this lack of capacity, worsened by 132,000 unfilled clinical vacancies that has brought the crisis. Cancer targets missed. Queues of ambulances outside hospitals mean long delays reaching patients in need; soaring numbers of patients stuck of hours, days at a time in A&E, on trolleys, in the queue for beds. NHS England pushing hospitals to use corridors as makeshift wards. Mental health patients stuck for hours on end in soulless A&E waiting rooms for lack of accessible services.

None of this began with Covid.

The financial crisis did not begin with the Ukraine war or inflation, but in Osborne’s 2010 austerity budget. The staffing crisis goes back to 2010 decisions to cut back on training and axe bursaries.

The deficits in trusts have been building since 2013, partly covered up by Department of Health loans and by using capital funds to prop up spending – which has now led to a huge £10 billion backlog bill for maintenance. And the promise of 40 or 48 new hospitals is no more than a sick joke: three years on, not one new project has yet started.

In July 2022 42 Integrated Care Boards launched in financial crisis, having submitted phoney claims they could balance their books – and are almost all now staring at large-scale deficits, with no chance of generating the necessary ‘efficiencies’ this year. NHS argued the need for an extra £7billion this year and next to get the post-covid recovery under way – only to be given less that half of this – just £3.3bn this year and next — by former Health Secretary Jeremy Hunt, who knows beyond doubt how inadequate the funding level really is.

As food price inflation hits 12.4%, and energy costs are set to rip even bigger holes in household finances from April, NHS England now says not only can they not increase the pay award this year, but next year’s increase will again be a real terms pay cut, limited to 3%.

Let’s be clear: these policies which threaten to demoralise and drive out existing NHS staff and which are a barrier to recruitment of new staff are threatening the very future of the NHS. And they are POLICIES, decisions reflecting ideology and political priorities, not international imperatives.

Hunt says he wants an NHS ‘delivering Scandinavian quality alongside Singaporean efficiency’. But Scandinavians pay much more in tax and endure much less inequality than Britain where the shots are called by the tax-shy and tax-dodging billionaires who own the mass media – and own the government. And Singapore, with around half the population of London, and authoritarian government, has a far from universal health care system in which patients pay hefty charges for treatment, or go without.

Hardly anyone in Britain would want a Singapore system if they knew what it really meant. We ALL have an interest in defending the NHS. It’s a system that covers everyone.

If it is driven further into collapse there is no private alternative.

Of course private hospitals are eager to pick up lucrative contracts to treat NHS patients needing elective surgery. There are even some companies offering “minor injuries” services, suggesting some form of emergency care, but in practice lacking any capacity to deliver the full range of services and inpatient care for those with most serious health needs.

But there is no profit to be made from taking over the whole of the NHS, and even services that are privatised are not being “sold off”, but contracted out, allowing private companies to walk away from failing contracts that don’t yield the profits they expected.

So while private hospitals have changed hands, there are NO American (or other) hospital chains desperate to buy up bankrupt, crumbling, under-funded overwhelmed NHS hospitals; and no insurance companies willing to take on the whole British population, least of all the elderly who are most dependent upon the NHS (and who make up the core Tory vote!).

Levels of spending per head in the UK are so low, no profits could be coined from  wholesale provision of health care. The average size of NHS hospitals is around 400 beds, compared with average size of private hospitals 40 beds: this is because NHS hospitals deal with a much wider population with much more complex and diverse needs.

A broken NHS hits everyone

Therefore if the NHS is no longer able to offer a comprehensive range of services to all of us, we will increasingly face a two-tier system, in which the small minority who need only simple elective services may be able to access these by paying privately for their operations or obtain insurance cover, while the vast majority, with more complex needs – and all of those requiring any form of emergency care – are left dependent on the limited remnants of the NHS as a ‘skid row’ service.

So a broken NHS hits everyone, rich and poor, because only the NHS provides care for all-comers: emergency care, complex care, maternity care and all of the community and mental health services that the private sector avoids because they are not profitable.

Only the NHS trains clinical staff. So every new contract to send patients to private hospitals draws more trained staff away from the NHS and weakens NHS provision.

Only NHS hospitals run multi-disciplinary teams to deal with complex cases. Without NHS hospitals as a back-up, and as the main employer of staff, private hospitals, which mostly lack any form of ITU, and mostly employ doctors and nursing staff on a sessional basis would be even more limited on what they can do.

Without NHS-funded patients and NHS contracts private hospitals would struggle to break even, with many beds left empty. NHS money bailed out private hospitals during Covid, and is still the source of much of their profit.

So let’s stop misleading talk of the rich being protected against the collapse of the NHS, and start stressing the central need for us ALL to stand up and fight for it.

We literally can’t afford to lose the NHS, in England or in any of the devolved governments.

We need to unite around ONE campaign

We would be stronger if we could unite around ONE campaign, to maximise pressure on MPs of all parties, but especially the Tories, to make the NHS a key factor on Rishi Sunak’s political agenda. It’s the only way to force a change this side of the next general election.

To maximise its popular impact, a mass movement for the NHS needs to focus on a simplified argument that unites the broadest support, and stress defence of the NHS rather than adopt party political slogans.

I suggest the simple platform of SOSNHS, which has already won support from over 50 organisations including over a dozen trade unions, on the basis of three key demands:

• £20bn Emergency funding to save a struggling NHS
• Invest in a fully publicly owned NHS & guarantee free healthcare for future generations
• Pay staff properly: without fair pay, staffing shortages will cost lives

A fourth demand could be added, calling for the reversal of privatisation by bringing outsourced services back in-house as contracts end – effectively renationalising services – and committing to a comprehensive, universal and publicly accountable NHS free at point of use.

Of course this is not all we want, and other issues need to be addressed, not least the need for a workforce plan and action on mental health and radical reform to the dysfunctional, largely private social care system that is failing its clients and failing to support the NHS.

But without extra funding none of these are possible. It’s also the issue on which the government knows it is most vulnerable.

If more demands are added to the list, there is a danger this will create disputes and disagreements that will limit rather than increase support.

We need a campaign, a movement, qualitatively bigger and broader than we have ever been able to build before – big enough to force changes in government policy, but also big enough to convince NHS staff they have real support, and show younger people thinking of training as health professionals that the NHS as we have known it still has a future and is being actively fought for.

It’s the only way to prevent a further, dangerous decline and offer hope for the future.

John Lister