Stephanie Clark and Debbie Saunders say underfunding, neglect, privatisation, staff depletion and strikes for fair pay is not what we want or need on the 75th anniversary of the NHS
Seventy Five years of a free at point of use, publicly provided, universal health service – paid for through progressive taxation – ought to be a moment to celebrate. But the NHS is in crisis.
There is a massive backlog of care that it lacks the resources to deal with; waiting lists of 7.6million; a huge loss of beds (almost 25,000 since 2010/11 according to the Royal College of Emergency Medicine); a lack of equipment; outdated buildings; a dangerous maintenance backlog -appliances and premises – (34 hospital buildings in imminent danger of collapse); and a staffing crisis across the NHS workforce with staff pushed to, or beyond, their limits. Evidence of mental distress across the workforce includes staff suicides and PTSD at the same level as found among post-military veterans. As a result, the NHS is haemorrhaging staff.
This includes GPs, with many taking early retirement and a lack of applicants – circa 2000 fewer in December 2022 than in December 2015. As a result, GPs are overstretched, now delivering ½ million more appointments a year than before Covid. Even so, patients have difficulty in getting a GP appointment.
Current strikes across the NHS workforce for fair pay and safe working conditions are unprecedented. Also unprecedented is the prevailing Government’s absolute refusal to address the causes and seek a resolution.
These all pose dangers to staff and patients and cause preventable deaths (among them around 500 in 2022 from ambulance delays alone).
This deliberate underfunding over the past 13 years of Conservative administrations has resulted in the UK being demoted from the top of the Commonwealth Fund rankings as the best and most cost-effective health care system in high income countries (even as late as 2017) to near bottom (above only the US).
The impact is also reflected in the drop in public satisfaction with the NHS from 70% to, by 2022, 29%.
Moreover, since 2010, the health of the population has suffered from government-inflicted “austerity” and neglect, exacerbated by the Covid pandemic and the cost of living crisis.
What Professor Michael Marmot and others describe as the ‘social determinants of health’ have been decimated: services for young and old gone from council budgets; and the social support system has been systematically dismantled.
Healthy life expectancy has stalled, and life expectancy at birth fallen, with the most deprived communities worst off. Our country’s 5 year-olds are shorter than European children – stark evidence of the harm caused by “austerity”. Office for National Statistics (ONS) figures also show that people in deprived areas are living more of their lives in ill-health. There is a mental health crisis all around us – most of it caused by poverty, lack of essential support and a collapse in public services.
Although Covid can be expected to have contributed to this multi-faceted crisis, it pre-existed Covid and indeed the lack of pandemic preparedness was another aspect of it. But there is another, ideological, factor behind this: Government antipathy to public services and determination to create capacity for the private sector to profit directly from the NHS through contracting out NHS funded services, and also to reduce funding for the NHS to increase the market for private healthcare and healthcare insurance.
NHS Privatisation to Date
Significant elements of privatisation were established before 2010, with the establishment of the internal market: the outsourcing of hospital cleaning, catering and laundry services with the commissioner/provider split, and the disastrous private finance initiative, which saddled hospitals with enormous debt for their construction projects. However, it has only been with the massive re-organisations delivered by the 2012 and 2022 Health and Social Care Acts that the infrastructure for an NHS fully opened up to the market, based on the US model of health care and health insurance, has been put in place.
Under the 2022 Act, England’s national health service has been replaced with 42 Integrated Care Systems, with legally autonomous Integrated Care Boards. Each Board has the freedoms to choose which services to provide (or not); to set their own pay, terms and conditions; and to deskill and to deregulate health professions within their area. The new systems undermine NHS institutions and invite commissioning and delivery of services by private corporations on a mass scale. The Act even includes new contract forms which reward providers who cut costs by denying care to patients (‘risk-reward contracts”).
Though responsibility for commissioning health services in their areas is devolved to the Boards, their funding is set top down, by the Treasury via NHS England.
The new Integrated Care Systems in England are currently being required to find draconian “savings” of £12bn and also threatened with strict financial controls. That this will result in denial of care and cuts to services is undeniable. Current indications are that Boards are struggling or finding it impossible to achieve the amount of savings required of them.
According to CHPI research (Centre for Health and the Public Interest, an independent non-party think tank) 18% of the NHS budget now goes to private companies, and over 50% of NHS funded hip and knee operations and nearly 50% of NHS funded cataract operations are included in this.
People are increasingly forced to “go private”’, where they can afford to, because of waiting lists. One in eight did this in 2022. The poor, though, have no option but to wait.
Private treatments will also be sought where no longer available on the NHS – ear waxing, for example.
Contracted out provision has extended from hospital cleaning to:
- a whole hospital (Hitchingbrooke Hospital – to Circle Health – which failed);
- Operose Health, a subsidiary of the US Centene Corporation, now the largest provider of GP surgeries;
- tech companies writing online mental health apps (instead of face-to-face sessions with therapists);
- 9 out of 10 beds in private mental hospitals filled with NHS patients.
The NHS at 75: what now?
The risks for our personal health from the Conservative governments bent on succeeding in their long game to undermine the NHS before privatising it are clear.
A Guardian report on 4 July testified to the despair of medics on the frontline, their belief that the Government wants to “destroy the NHS”. Patrick Bamfield, the BMA Chair of Council, was quoted as saying ”it was a conscious political decision to underfund and undervalue the NHS as a national asset and its staff”, and added “I would be very surprised if the NHS in its current form survives the next five or 10 years”.
We can’t stand by and let this happen.
As Aneurin Bevan said at the time of his founding of the NHS, “The NHS will last as long as there are folk left with faith to fight for it”.
The NHS must be rebuilt, with its founding principles restored as a universal, comprehensive health service, publicly provided, publicly accountable, publicly financed through general taxation, free at the point of use, with clinical decisions on treatment taken without regard to ability to pay.
To enable this rebuilding of the NHS on the basis of its founding principles, key demands of the health campaigns can be identified as:
- Reverse privatisation and strengthen democratic accountability
- fund the service properly
- increase capacity, most importantly by caring for and investing in staff
- seriously address wider determinants of health and expand public health.
Whatever we can do, let’s do, whether as patients, NHS staff, trade unionists, in our movements and communities, in the Labour Party.
Stephanie Clark and Debbie Saunders are members of Save Our Heath Service.