The elephant in the room during much of the interminable and vacuous “debates” between Liz Truss and Rishi Sunak competing for votes from Tory Party members has been the dire state of the NHS after more than a decade of real terms cuts in bed numbers and funding, alongside increased pressures.
Truss’s limited comments on the NHS were limited to a vague suggestion that she wants to “cut bureaucracy” – and slash £10 billion from NHS budgets to give to social care. This would amount to an impossible 7% outright cut in NHS spending on top of existing inflationary pressures and targets for £5bn “savings”.
Calls for action
The new health secretary, Therese coffey now has the job of overhauling lacklustre Tory health policy in the face a near unanimous view that the situation has gone from bad before the Covid pandemic to much, much worse.
Matthew Taylor, chief executive of the NHS Confederation, which represents trusts and commissioners, not known for hyping up an issue, has warned that the “NHS is in its worst state in living memory … There is no escaping that the NHS is in a state of crisis.”
But funding is not the only pressure on the NHS. Earlier the NHS Confederation had breached convention by writing publicly to warn chancellor, Nadhim Zahawi that without urgent action to protect the living standards of the poorest against soaring energy bills the UK could face a “humanitarian crisis” of ill health, excess deaths and rising inequality this winter. Widespread poverty, cold homes and missed meals would inevitably push up rates of sickness, which could increase the number of winter deaths. Former Tory Health secretary Jeremy Hunt agrees:
“The new PM will inherit an NHS facing the most serious crisis in its history.”
Alastair McLellan, editor of the Health Service Journal aimed at NHS management, told The Guardian: “There is not one area of NHS provision that isn’t really struggling … There is literally nowhere where it isn’t bad, and in some cases really bad.”
Analysis in the Financial Times explains that the NHS is being “squeezed in a vice” – with too few beds and inadequate social care.
Recent Nuffield Trust analysis shows that the pandemic is by no means the only cause of the sky-high waiting list, which had doubled to 4.6 million between 2010 and February 2020.
“If pre-pandemic trends had continued, we might have expected the waiting list to be around 5.3 million.”
The report concludes: “… it would be misleading to say that Covid is solely to blame for the crisis we now see in NHS services. Covid has accelerated the trajectory the NHS was already on, and makes the size of the NHS backlog less an unexpected aberration but rather a predictable consequence of the pandemic, for a system where pressures have been mounting for some time.”
Even the Telegraph has admitted that in 2010 David Cameron’s government took over an NHS that was “ticking along nicely” – but somehow glides over the fact that George Osborne’s brutal austerity regime effectively began to reverse all of the previous investment.
Daily Mail graphs similarly show the disastrous decline in A&E and waiting list performance, cancer care, etc since 2010.
The Nuffield Trust’s Sally Gainsbury has shot down the boasts by ministers that Rishi Sunak as Chancellor has given generous “record” funding to the NHS. Instead, she argues it faces a 3% real-terms budget cut (measured against whole-economy inflation figures for the budget in March).
This, she argues, is only “the first and widest step in a three-year plan to claw back the bulk of the extra funding given to the NHS to deal with the pandemic, with the following two years scheduled to see budgets grow at less than half the NHS’s historic real-terms average.
“The upshot is that 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.”
Nurses’ and doctors’ unions have focused on the long term worsening staffing crisis – which has been even more linked in to the hotly-disputed pay award as inflation has hit double figures and energy prices have soared. Staffing is vital to any expansion of services and patient safety: but the latest figures show 132,000 unfilled vacancies – a 25% increase in just 3 months – including 47,000 nurses and almost 11,000 doctors.
Dr Subramanian Narayanan, the president of HCSA, the hospital doctors’ union, says the NHS is in a worse position to face a pandemic now than it was in 2020. “Staffing shortages are more severe than at the beginning of the pandemic and there is no evidence that the drivers of this are being addressed.”
The situation is worsened further by constant sniping attacks by the right wing press apparently on a mission to vilify GPs, despite a reduced number of GPs delivering higher than pre-pandemic numbers of appointments, two thirds of them face to face. But now GP practices are also set to face losses of tens of thousands of pounds due to rising inflation and uncapped energy costs, according to Pulse, which could force some struggling practices to hand back their contracts, leaving patients without access to primary care.
And while the media focus tends to be fixed upon acute hospitals, mental health too is facing a triple whammy of inadequate capacity, especially bed numbers, inadequate staffing (with repeated broken ministerial promises of action) and rising demand – which has been worsened by the pandemic and now by the rapid collapse of living standards as the poorest are hit hardest by inflation.
Rightwing see opportunity
The problems are daunting, and as satisfaction ratings plunge, right wing politicians, columnists and pundits from a range of obscurely-funded right wing think tanks are hoping the public is feeling sufficiently disenchanted with the NHS to consider so called “reforms” and alternative models – which offer greater scope for private profit in health insurance and provision of services.
The BBC’s Nick Triggle has now echoed and reinforced the right wing’s defeatist line that it is “near impossible” to repair an NHS broken by the last decade of real terms cuts – despite the evidence of the 2000-2010 period, in which sustained investment showed that it WAS possible to rebuild and revive an NHS that had been debilitated by 16 years of under-funding.
None of the advocates of ‘alternative models’ and more private sector involvement is willing to address the fact that the health insurance industry does not want to recruit older people (who are more likely to make a claim, and more likely to have more than one pre-existing condition) and charges hefty higher age-related premiums to deter them. The growth of “self-pay” private treatment for those without insurance cover has been much slower than the growth of the waiting lists – as the hefty costs and limited range of such treatments act as a barrier to most.
Private hospitals (average size 40 beds) are not geared up in any way to handle emergencies or complex cases, and have never shown any interest in doing so. In other words, even for the wealthiest people needing emergency treatment there is no private sector option that avoids the long queues of ambulances and delays in accessing NHS A&E departments.
What is more worrying is that Liz Truss herself has embraced many of the right wing policies and “solutions”. She is one of an 8-strong Parliamentary Board of the 1828 Committee, whose ‘Neoliberal Manifesto’, published jointly with the Adam Smith Institute in 2019, condemns the NHS record as “deplorable” and calls for the UK to “emulate the social health insurance systems as exist in countries such as Switzerland, Belgium, the Netherlands, Germany and Israel, among others.” The Manifesto is silent on the fact that (with the exception of the deeply flawed Israeli system) all of its preferred models spend much more per head on health than the UK.
Open Democracy has also pointed to Truss’s long-standing links to other right wing think tanks including the notoriously anti-NHS Institute for Economic Affairs, which, with the Adam Smith Institute appears to be the source of many of her ideas on the economy and the cost of living crisis.
So as Truss takes over, appointing yet another new health and social care secretary, the crisis could rapidly degenerate from the worst-ever to even worse.
That’s why the broadest-possible fight has to be waged now, focused on the core issues of the funding deficit and the staffing shortages, and demanding a substantial emergency cash injection to cover an above inflation pay rise for staff, as well as capital investment to tackle the growing backlog of maintenance and rebuilding of crumbling hospitals and renewal of clapped out equipment.
The SOSNHS petition launched earlier this year for an emergency down-payment of an extra £20bn to rescue the NHS has attracted well over 300,000 signatures so far. This is now the bare minimum extra funding needed to stave of major and damaging cuts and the haemorrhage of staff to better-paid, less stressful jobs.
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