Despite Covid and claps, the Tories have shown they remain deeply hostile to a public National Health Service
However much the Tories are now clapping for our NHS, we must remember that they are fundamentally opposed to public services, and will soon forget their panic and revert to form. There is a revealing article making this point by a former insider now disillusioned with the world view that anything funded by the state (except of course infrastructure that furthers the interests of the rich) is wrong. Additionally, there have been a number of structural changes as well as commitments to increased funding that superficially make it appear as if the strengths of a public national health service are now being acknowledged, together with an implied criticism of much of the reforms of the last near decade.
Taking over CCG powers
On the 23rd March it was announced that NHS England was taking on extensive special powers normally held by clinical commissioning groups to support efforts in the face of coronavirus. Dr. Tony O’Sullivan (co-chair of KONP) commented on the NHSE website:
“At this time of national tragedy, we should remember the function of a national health service and how politicians and the seismic restructuring policies in the Long Term Plan have weakened the NHS. I hope that this ends the fragmentation into 42 separate commissioning units and integrated care systems. How wrong that strategy has been. As we welcome some steps towards the re-integration of the NHS in our hour of need, let us not forget the follies that weakened it and that have put NHS staff and the public at risk. We need the NHS to go forward as a single coordinated public service, there for everyone in time of ‘war’ and nurtured once again in post-Covid-19 peacetime.”
We should also remember, however, that it has been the aim of NHSE to greatly reduce the number of CCG through mergers in order to implement difficult decisions regarding cuts in services as well as weakening local accountability.
Taking over the private sector?
These special powers will be in place until at least the end of 2020, and one of the principal reasons for them was to gain access to independent sector beds. Now, taking over the independent sector in times of national need is to be applauded, indeed has not Spain just requisitioned its large private sector? In stark contrast, however, we find the UK government is paying private hospitals £300 per bed per day. Business analysts have observed that this is a real boost to independent hospitals since a private hospital working on an NHS tariff at 100% capacity is much better than doing private medical insurance work at 50% capacity. Vivek Kotecha writing for the Centre for Health and the Public Interest concluded that:
Whilst the NHS will receive some immediate benefits from this arrangement, the private hospitals, their shareholders, landlords, and lenders stand to gain substantially from this deal, which effectively bails them out in the midst of a global recession.
The government announced that from April 1st it would “write-off” £13bn of historic debt across the NHS. In recent years financially struggling trusts have been routinely forced to seek emergency bailout loans from the Department of Health and Social Care. Last year, trusts’ total debts reached £14bn of which £10bn was related to emergency loans. While Matt Hancock declared this a “landmark step” made by himself to help the NHS Covid-19 response, the plans had in fact already been discussed at a January meeting called by NHS England and NHS Improvement, and had been under consideration for at least 20 months.
As tax expert Richard Murphy explained, the government has not written off hospital debt:
“All it did was make a book-keeping adjustment. What it actually did was allow NHS Trusts to record the sums they had spent for the populations they served as having been funded by central government when previously the government were claiming they had overspent.”
John Lister writing for The Lowdown and the Keep Our NHS Public website also pointed out:
“It’s like a gang of burglars seeking gratitude after handing back some of the jewels they have stolen: £13.4 billion averages to a refund of just £1.3billion per year for the last ten years – far less than the real terms cuts that have been imposed by the virtual freeze on funding while the population and its health needs have grown.”
It would be much more valuable to the NHS if the government were to abolish the huge outstanding payments for new buildings paid for through the Private Finance Initiative (PFI) by nationalising the ‘special purpose vehicles’ that own PFI debt. Strangely, the chancellor Rishi Sunak does not seem to be stepping forward with such a proposal.
Xenophobia alive and well
Before the Covid pandemic, the UK had only 4100 critical care beds, 6.6/100,000 population compared with Germany’s 29.2. An urgent need to find more ventilators was identified at the start of the outbreak, yet Downing Street chose not to participate in an EU scheme to source such vital equipment, leading to the charge of putting “Brexit over breathing”. Government attempts to justify this through claims to have accidentally missed a deadline due to communication errors were quickly exposed as groundless by EU officials.
Despite the need for the public to trust the NHS and for a unified response to the crisis by all members of the public, it is notable that the hostile environment in the NHS has not been lifted. Migrant and undocumented people liable to charges for NHS care will avoid seeking prompt advice out of fear. As one member of KONP writing in the British Medical Journal observed:
“It is simply not good enough for the UK to add the novel coronavirus to its list of exemptions from charges, which few people will know. To tackle this epidemic and protect everyone’s health, all barriers to accessing NHS treatment – including charges and reporting of debt to the Home Office - should be suspended immediately."
Trump’s references to COVID-19 as ‘the Chinese virus’ and Michael Gove promising a reckoning with the government of China after the pandemic is over are no more than attempts to divert attention from government failings in the US and UK . Zoonoses (infectious diseases that spread from non-human animals to humans) are linked to climate change and intensive farming methods among other things, and destined to be a recurrent event. Michael Gove would do well to reflect that not long ago Bovine Spongioform Encephalopathy resulted in the slaughter of 4.4 million cows in the UK and was responsible for variant Creutzfeldt-Jakob disease in humans. The World Health Organisation has warned against use of the term ‘Chinese virus’ saying that it could lead to racial profiling against Asians when “there is no blame in this”. In the UK we have already seen reports of Asian people being physically attacked in the street.
What will happen next?
We have known for the past 13 years that a pandemic at least as lethal as coronavirus represented an ever-present major threat. Historically, the rich have been forced to institute public health measures for all simply to protect themselves from the ravages of infectious disease. Having said that, the competence of the ruling elite in terms of preventing and controlling epidemics is always in doubt, since their desire for profit is in diametrical opposition to any inclination to spend money on public services until it is too late. Thus an opportunity to avert a crisis is lost and a pandemic that could have been limited if planning advice had been implemented and intervention had been timely must instead run it’s deadly course.
At the same time, we can be sure that the media hacks and think tanks will be busy rewriting the narrative in order to exculpate ministers, put the blame on civil servants and health officials and make sure any temporary step backs towards ‘re-nationalisation’ of services are quickly reversed. They may even advocate continuing the restrictions on civil liberty for much longer than medical scientific evidence dictates. Charles Moore (former editor of the Daily Telegraph - where he was Boris Johnson’s exasperated boss) is jockeying for position in the vanguard, explaining to DT readers that it is in fact deficiencies in the public sector NHS that has brought the country to lockdown. We can also expect to hear how our small and parasitic private sector came to the rescue of the NHS in its time of need.
Our job as health campaigners is now to make sure the right lessons are learned during the coming weeks and months, to keep the Tories on the hook, and to harness the public anger which will no doubt grow over time in order to rally the vast majority of society around our vision of a health and care service that is an exemplar of a more just, caring and equal society.
John Puntis is the co-chair of Keep Our NHS Public.