Karen Constantine says the Tories fatally undermined the NHS before the pandemic. Now, it is facing destruction

Back in 2015, I (along with many others) was knocking doors, gearing up for the general election in my hometown of Ramsgate in the South East. Nigel Farage, then leader of UKIP, was sailing high and expected to win the South Thanet constituency. UKIP had a vacuous, ill-informed, cavalier attitude towards the NHS. Farage said “we’re going to have to think about healthcare very, very differently. I think we are going to have to move to an insurance-based system”. Some local residents in the poorest wards of Ramsgate, amongst the most deprived in the country, parroted these sentiments back: when we asked residents on the doorstep if they were worried about the future of the NHS under the Conservatives, they stated, alarmingly, that they favoured privatisation. The die was cast, and the far-right played their part in assisting the Conservatives in reshaping public perception. The Tories have long eyed the NHS as a cash cow for the private sector, wishing to sell it off, as with so many previously publicly owned organisations. 

This was only the start of the stealthy, crafty PR battle to convince the public that crumbling hospital infrastructure, asset stripping, the removal and down-banding of qualified clinical staff, the rationing of GPs, the ever-lengthening queues for treatment, centralisation of vital treatment, and a demoralising culture of constant (and often pointless) costly reorganisation was, in fact, for our own good. Fast forward to 2022 and the destruction of the NHS. 

From 2010 onwards, knowing full well that there was an age demographic retirement cliff edge on the horizon, the Government already had a clear indication that many key clinical staff would need to be replaced. Their response? The removal of the nursing bursary – with the predictable result that many clinical functions in both acute and community settings are now decimated and operating with unsafe staff levels, unable to offer continuity of care, particularly in maternity and mental health services. There is still no plan in place to address this. This was all pre-Covid. 

Due to the cover offered by the pandemic, Tory rhetoric has morphed. They can now claim that it’s Covid that has impacted the NHS. It has. But only because the Conservatives fatally allowed the rot to set in, leading to the damage to the NHS which we are all now experiencing: the long waits for GP appointments, the appalling 6,358,050 people (as of March 2022) on waiting lists for elective surgery, the scandalous delays of people waiting in the back of ambulances when trying to obtain emergency treatment, the crisis in maternity care, and otherwise healthy patients ready for discharge essentially trapped in hospitals, ‘bed blocking’ as there is inadequate social care provision to discharge them into. But still, the Tories, instead of accepting they got it wrong and the need for urgent intervention, investment, training and recruitment, are content to try to pin this astounding fall in services on Covid. The truth is this is entirely due to the austerity measures the Conservatives imposed. We’ve experienced the lowest rate of growth in the NHS since 2010. The NHS had already been hollowed out, leaving Covid to take a huge toll. 

In the 2019 Conservative manifesto, Boris Johnson famously boasted about building 40 new hospitals over the next ten years. That’s great – because new facilities are needed and would drive up both quality of care and aid staff recruitment and retention. But are all of them genuinely new? Not at all is the answer. This promise amounts to little more than refurbishment and new wards tacked onto existing infrastructure. In any case, £3.7bn will not build 40 hospitals, according to experts.

Post-Covid, Johnson also promised that he would look after our NHS staff but has called for pay restraint across the public sector as inflation tops 10% and the cost-of-living crisis spirals out of control. Not forgetting that hospitals are now opening food banks – for staff struggling to manage. Little surprise that Unison leader Christina McAnea has challenged him to keep his promise and to do the right thing for this group of key public sector workers: “The Government in Westminster has completely forgotten who got the country through the pandemic and the impact on public sector workers of that. Care workers who were having to hold the hands of dying patients because the families couldn’t get to them… for [the Government] to say ‘you need to show pay restraint’ is completely inappropriate.” 

McAnea also challenges the Government to get back around the table to discuss and negotiate workforce issues. Johnson’s Government are resolutely tin-eared to the workforce insight and knowledge that the trade unions bring to the table. 

In fact, Johnson’s Government seem locked in permanent dispute with all the health unions. The BMA chair Dr Chaand Nagpaul frequently reminds the Government that the NHS is “still under crippling pressure”. Recent BMA polling shows 25% of GPs are so tired at work that they believe the care of patients is being undermined.  

Unsurprisingly Pat Cullen, general secretary and chief executive of the RCN, says that nursing staffing levels are not safe for either staff or patients and are driving nurses out of the NHS: “Our new report lays bare the state of health and care services across the UK. It shows the shortages that force you to go even more than the extra mile and that, when the shortages are greatest, you are forced to leave patient care undone.”

The warning signs of workforce decay, overwork and demoralisation were already evidenced. The King’s Fund has concluded that the impact of Covid has reduced life expectancy globally, but notes that the “UK compares poorly with other advanced nations”. Veena Raleigh, senior fellow at the think tank, adds: “The NHS is further on the back foot than most advanced health systems in coping with the pandemic’s legacy, which includes an exhausted workforce, a large and growing backlog of care, and widening health inequalities.”

And it’s getting worse. Within my role on Kent County Council’s health overview and scrutiny committee, I have repeatedly asked for up-to-date information on ambulance waits and stroke outcomes amongst other things. Many, many months later, I’m still waiting for that information, which causes me to wonder, ‘what are they hiding?’.

No one within Government takes responsibility for workforce issues in the NHS. It’s the single most important factor that the troubled NHS is facing. It’s also the one thing that Labour must do: legislate to reinstate that responsibility directly to the Secretary of State for Health. If Labour does that, I’ll be back out door-knocking at the next general election telling Ramsgate residents to vote Labour because their lives actually depend on it. This time, I think they might just believe me. 

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