As NHS staff battle to keep patients safe and services afloat, right wing politicians and pundits see the worsening crisis that has been created by a decade of underfunding as a possible opportunity to rehearse more of their ideas for NHS “reform” that have been rejected by every Tory leader since the war. The spring and summer have seen a barrage of slanted and hostile articles urging the end of the NHS as we know it.

Every increase in the waiting lists, every tragic problem faced by patients, every negative account of the NHS failing to match the outcomes of other health care systems, every delay in A&E as NHS hospitals struggle to discharge people to hopelessly inadequate social care and community health services, every indication of falling satisfaction in the NHS and public frustration at delays and problems getting appointments with a dwindling number of GPs is amplified in distorted news coverage and seized upon in delight by vicious columnists in the Daily Mail, The Sun, Daily Express, the Telegraph and the Spectator, as well as a growing gang of loud-mouthed broadcasters misinforming their audiences, most notably on LBC and newer right wing networks.

Most of the key media outlets spouting hostility to the NHS are of course owned by billionaires who avoid paying any taxes in to the pot to sustain public services: Rupert Murdoch owns The Sun, Barclay Brothers own The Telegraph, and Lord Rothermere owns Daily Mail.

The venom flows so thick and fast from these publications that no longer even pretend to value the NHS that it can be hard to keep track. At the end of June Polly Toynbee in the Guardian surveyed a few of the recent examples:

“The Mail says the NHS has made us “the sick man of the world”. “It’s time to realise the NHS is not a ‘religion’ – our hospitals are not the envy of the world,” blasts Trevor Kavanagh of the Sun. “The NHS is failing us all,” says the Spectator.

“… The Telegraph’s Charles Moore relishes every bad news NHS story: “Patients are failed by the NHS’s blind belief in its own altruism – and no politician can admit it,” and “Tinkering with NHS governance is hardly the radical reform patients crave.” More intemperate Telegraph assaults come from Allison Pearson: “Surprise surprise, the NHS has spent its windfall on yet more waste and wokery.” She takes a swing at “so many doctors on the golf course, feeling fatigued or attending to pressing matters in the Dordogne”. Her columnist colleague Judith Woods rails: “It’s time to ditch the mawkish NHS love-in”, bewailing “hand-wringing sentimentality about the need to preserve our creaky NHS from the ‘threat’ of a social health insurance system that would raise standards”.

And after the Telegraph and Mail have spent months waging repeated attacks on GPs, accusing them of failing patients, a Telegraph editorial in early April attacking the ‘health and care levy’ on National Insurance (headlined ‘The Tories have made a costly error on NHS spending’) had the nerve to argue “Britain is among the worst in the world at detecting cancer early, thanks in part to a broken system of primary care.” The article again insisted “we should look elsewhere in the world for ideas on how to improve the health service for patients.”

It went on to attack Rishi Sunak for “squeezing largely Tory voters”, claiming  – without any evidence of public support – that the extra cash was to prop up “an unreformed, and increasingly unpopular, socialised behemoth that too often shows more interest in its staff than its patients.”

The Telegraph also gives regular coverage to the anti-NHS bile of Kate Andrews, the annoying American who first gained prominence as a spokesperson for the obscurely-funded right wing “think tank” the Institute of Economic Affairs, and is now economic editor at Boris Johnson’s old magazine the Spectator. Her April 28 offering ‘Our feckless NHS is squandering Rishi Sunak’s tax raid’ rattles through a rap sheet of NHS performance failures, and spurious comparisons with better-funded health systems elsewhere, while insisting that more money is not the solution.

It concludes with what is supposed to be a killer point:

“… already the government has suggested the £12bn extra for Covid catch-up will be used to fund things like nurses’ pay. One does not need to oppose a pay bump for healthcare workers on the lower end of the pay scale to also lament that, already, the catch-up fund is being prioritised on anything other than frontline services.”

For her already hare-brained neoliberal co-thinkers that argument is no doubt sufficient. But Andrews (who at no point discusses the 100,000-plus vacant posts that are leaving services dangerously understaffed) makes no attempt to show how front line services are supposed to be improved and waiting lists reduced without the NHS recruiting and retaining staff.

Or how that is to be done without ensuring NHS pay is high enough at a time of soaring inflation – and spending more money.

More recently still the Telegraph has unleashed a fresh onslaught, with a barrage of statistics on July 23  headed ‘The NHS is broken – is it time for a radical rethink?’

It once again delightedly notes the decline of the NHS and its failure to meet performance targets, but follows this with a quote from former Tory minister and recent NHS England chair Sir David Prior, who again echoes the vague refrain that ‘fundamental and sweeping changes’ are required:

“We have to completely change the system from a late-stage sickness system to one that is about [preventative] health,” says Sir David. “… We have to completely relook at the way we spend resources, which means a progressive shift from secondary care to primary prevention and investment in public health.”

Exactly how this could shift could be achieved without worsening all of the hospital performance figures cited at the beginning of the article is of course not explained.

The same article then goes on to quote the blatantly misleading statistics on comparative spending in a recent report from right wing “think tank” Civitas, choosing the year of 2020 (in which spending was temporarily increased to cope with the pandemic) as the point to claim NHS spending has risen to 12% of GDP.

The report’s author Tim Knox shamelessly uses this figure to dismiss the argument that Britain’s poor health outcomes are caused by lack of investment as “now at the point of death”.  “It is time we look elsewhere,” he tells the Telegraph, singling out the high-spending Netherlands (which spends 28% more per head on health than the UK) as an example.

The Civitas report rejoices in every instance of relatively poor performance from the NHS, but does not once look at the huge and rising levels of social inequality, growing poverty and failure to develop adequate public health initiatives, all of which contribute so much to the high and rising levels of demand for emergency and elective treatment.

Nor, unlike for example the 2017 survey by the Nuffield Trust, which highlighted the damage being done to the NHS by the austerity regime brought in by the Tory-led coalition government from 2010, does Civitas set the figures in any historical context. The Nuffield Trust came to quite the opposite conclusion from Mr Knox, blaming the deterioration of services on the cash squeeze, and correctly warning things were set to get worse:

“Performance across a majority of the quality metrics analysed began to deteriorate three or four years into the period of much slower funding growth for the NHS. This perhaps suggests that while productivity improvements by the NHS aimed at closing the funding needs gap and maintaining standards were for a time successful, the continued squeeze in funding beyond 2014/15 started to overwhelm the ability of the NHS to meet its headline quality standards.

“[…] the opportunity cost of stabilising current overspending by trusts and prioritising emergency and primary care services may well be further deterioration in elective waiting lists and waiting times.”

But if we can bear to look more closely at the Telegraph’s statistics that are supposed to back up their demand for “reform”, we find they too effectively show that the deterioration in performance has come entirely during the last 12 years of Tory governments. It admits that:

“seasoned observers note that the deterioration in NHS performance long predates the pandemic. Indeed, it is now a full seven years (to 2015) since NHS targets to start treatment within two months for referrals classed as urgent have been met.”

It even admits that: “When David Cameron’s coalition came into power in 2010, the NHS was ticking along nicely – at least by some headline measures. Public satisfaction with the service was peaking at 70 per cent, while key waiting targets, including those for cancer and A&E, were being met.  It followed a period of sustained investment, backed by a plethora of centralised targets which had been introduced some years earlier under then prime minister Tony Blair.”

Since then a decade of real terms cuts in funding have rolled back all of the gains made in the 2000s: and performance has, predictably, slumped back as a result.

The article claims, wrongly, that “in total, around 20,000 acute and general hospital beds were lost during Labour’s time in office:” The real figure was 16,290 (12%) – compared with 58,666 acute and elderly beds (29%) axed in the ten Tory years 1987-97. However the Telegraph astonishingly continues by attacking Cameron’s record:

“After the financial crash of 2008 and during the decade of austerity that would follow, bed numbers and staffing ratios were hacked back further by the coalition government – some would say cut back to the bone. By 2019, Britain was already languishing at the bottom of international cancer league tables, with the lowest survival for five of seven common cancers, in rankings by the World Health Organisation.”

Now, after the peak of the pandemic and three more years of inadequate funding, staffing and investment the Telegraph’s new NHS Data Tracker reveals the result of sustained neglect: “the NHS in England is failing to meet every single one of its key duties of care to patients, with not a single official target being met.”

Of course the Telegraph echoes the government mantra that the NHS has been receiving “record levels of funding”, but this means only that the cash value is nominally higher than the year before, and takes no account of the growing population, the rising cost of drugs, equipment and infrastructure, or the growing proportion of older people with greater levels of health need.

Similarly lop-sided and misleading arguments  were also predictably wheeled out last month on BBC Radio 4’s Moral Maze programme, although the assertions of Tim Knox and several other right wing panellists were at least partially counterbalanced by the well-informed Chief Executive of the Health Foundation Jennifer Dixon, who pointed out that if Britain had had the German investment over the years, maybe we would have what they have – 40% more doctors, 70% more nurses and 200% more beds. “We have fewer tests, scanners, everything, than Germany, because we have less capital investment.”

She added: “Instead of asking can we afford the NHS, ask why our economy can’t support the funding of a relatively cheap health care system.”

Dixon also correctly argued that health services only affect 20% of our overall health, and wider determinants of health affect life expectancy far more.

More recently the Telegraph has again undermined much of its own case for “reforming” the NHS, and their claim it has received more than enough funding, by carrying another report that blames government under-funding of the latest NHS staff pay award for an NHS England decision to scale back plans for increased cancer testing.

It goes on to quote former cancer csar Prof Sir Mike Richards warning that the plans “could damage services that were already “woefully” under-funded.” In case anyone missed the fact that the pay award was not decided by NHS England, but by the government, who then refused to fully fund it, the Telegraph says again:

“The action is being taken after the Treasury refused to fund NHS pay rises higher than three per cent, saying the money would have to come out of existing health budgets.”

Meanwhile in the real world, the Nuffield Trust’s Sally Gainsbury has published a blog warning that the already dire financial plight of the NHS could well be made even worse by whichever new PM we are stuck with in September:

As we have previously argued, NHS funding levels prior to the pandemic were already unrealistically low, with NHS England, the Department of Health and Social Care and the Treasury seemingly caught in a mutual confidence trick where successive funding rounds were premised on unachievable assumptions about efficiency savings and demand management.”

Gainsbury warns, as the Lowdown has warned, that even after Sunak’s ‘health and care levy’ the funding is now so tight every new Integrated Care Board will have to deliver cuts:

“one of the first tasks for the 42 new integrated care boards now charged with managing the bulk of the NHS’s budget is to deliver over £5.5 billion worth of spending cuts this year alone – “targeting savings” in NHS England’s lexicon.”

And she points out that the Tory party members who are being wooed with promises of tax cuts may be among the millions who will be less than delighted with the results if these pledges are implemented:

“While talk of tax and national insurance cuts may be popular – particularly amid the current cost of living crisis – the implications for NHS services, staff and patients may be less so.”

What’s clear is that neither of the potential PMs, nor the newspapers backing them, nor the Party faithful who will choose them has even the vaguest clue about the scale and causes of the NHS crisis or any practical idea of what needs to be done about it.

Hold on to your hats – it will be a rocky road from here.

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