A powerful new alliance of campaigners and trade unions has launched the SOSNHS campaign, demanding an immediate injection of another £20 billion in capital and revenue to help put England’s crisis-ridden NHS back on its feet.
The need for it is obvious from all the stories of patients dying in ambulances queuing outside A&E, the waiting list, set to soar above 6 million, the inadequate provision of beds and staff in the NHS compared with other countries, and desperate shortages and delays accessing mental health services – not to mention the dire state of social care.
£20 billion sounds like – and is – a lot of money: but after more than a decade of real terms freeze or cuts in NHS funding it would only be a down payment to address some of the most pressing problems. Much more investment will be needed – not least to fulfil government promises of building 48 new hospitals, expanding the workforce, and fixing social care.
To put £20bn in context we also need to remember the huge sums of money Rishi Sunak threw at the private sector with little or no accountability during the Covid pandemic.
£48bn was shelled out on ‘bounce back loans’: the National Audit Office has found that that at least 37% of loans (£17.3bn) will not be repaid, and that 11%, worth £4.9bn, were fraudulent.
Billions were squandered on dodgy deals for overpriced or useless PPE and equipment. Billions more were wasted on the disastrous privatised test and trace system.
And let’s not forget more than £2bn forked out for use of private hospital beds in 2020 – few of which were used – and another £10bn over 4 years to treat NHS waiting list patients, which will also line the pockets of private hospital bosses and shareholders, while thousands of NHS beds remain closed or empty.
Now Sajid Javid has instructed NHS England to sign yet another rip-off 3 month, £200m-plus ‘standby’ deal with private hospitals that guarantees them profits even if no private beds are used – and commits to pay at least 10% above NHS tariff prices for some operations.
The money wasted on these three things alone would have been more than enough to put the NHS back on track. If money can be raised to waste, it can be raised to invest.
But there is a common factor to these different ways of wasting money: the beneficiaries are always the private sector, and the loser is always the public purse and public services.
In recent years the main driver of privatisation and so-called “partnership” deals between NHS and the private sector has been the lack of adequate NHS capital, capacity and resources.
That’s why private sector partnerships have been proposed or implemented in building new community diagnostic hubs, and for major contracts for laboratory and pathology services and imaging, why private hospitals are contracted to fill gaps, and provide the majority of some mental health services, and why a majority of hip and knee replacements are now being done in private hospitals rather than the NHS.
So to reverse the trend of increased NHS spending on private providers – while NHS trusts lack the capital and revenue funding they need to expand services – we need to inject new investment into the NHS. This demands a change of policy.
Since 2010 even the BBC has noted that spending on the NHS has increased by only a fraction of the previous average rate of 4% per year. By 2019 NHS Providers calculated that the gap between actual spending and what it would have been was £35bn per year.
The consequence was huge deficits in NHS trusts, lack of capital for new projects, a sharply rising bill for backlog maintenance – and NHS staff pay falling ever further behind equivalent 2010 levels.
Theresa May as Prime Minister claimed to be spending “record amounts” on the NHS: but increasing cash allocations each year does not necessarily match the increased costs and demands on the NHS. At the end of 2018 Chancellor Phillip Hammond announced a “£33.9bn” increase in NHS funding – which the Treasury admitted was only £20bn in real terms.
Boris Johnson was still cynically claiming to be spending the same “£34bn extra” on the NHS in the 2019 election, coupled with even more far-fetched promises to build 40 – and later 48 – new hospitals, although the PR spin on what constitutes a ‘new hospital’ has since been revealed.
While extra funding was found to tackle Covid, the lion’s share of this was channelled in to private contractors and suppliers: and last autumn’s spending review Chancellor Rishi Sunak made clear there would be little added to the deceptive £36 billion “health and care levy” to run over 3 years from April 2022, and raised through the least progressive taxation, hitting the lowest-paid hardest.
Of this £36bn just £15.6bn was allocated to NHS England, over three years, falling well short of the £10bn extra for 2022-3 called for by NHS bosses, and just £1.8bn a year for social care: by contrast the Health Foundation estimated an extra £17bn was needed by 2024 just to shrink waiting times to 18-week target levels.
The Spending Review locks in this limited spending to 2024-5, failing to fund even the miserly 3% 2021 pay award: Rishi Sunak has set the NHS on course for a second decade of decline, and warned Sajid Javid that the NHS budget will not cover the extra costs of booster jabs to tackle the Omicron variant of Coronavirus.
To ensure high quality and safe services – and restore the performance levels that have been declining since George Osborne’s austerity regime kicked in in 2010, a change of course is vital.
We need to repair and rebuild crumbling infrastructure & reopen beds left empty since Covid-19 struck, invest in the NHS as a public service, squeezing out parasitic private contractors, and invest in staff, with new targets for recruitment, training, and levels of pay that would prevent the service losing staff. We also need to build a properly resourced, publicly run national care and support service, and invest in public health and policies to tackle huge and growing inequalities in health.
This Government has shown it won’t change course without pressure from below: but U-turns have occurred. It’s up to us to pile on that pressure.
How much does the NHS need?
£14bn needed now to repair and rebuild crumbling infrastructure & reopen beds left empty since Covid-19 struck
The bill for backlog maintenance to repair crumbling buildings and replace clapped-out equipment has soared to £9.2 billion – double the £4.5bn capital allocation to NHS England. The lack of maintenance causes thousands of incidents each year that interfere with clinical care and put patients at risk. To tackle the most urgent of these issues will cost around £5bn: in addition up to £6bn needs to be made available sooner rather than later to rebuild a dozen or so hospitals built in the 1970s using reinforced autoclaved aerated concrete planks, which are in danger of collapse.
West Suffolk NHS Foundation Trust is so concerned over the threat that it has hired a law firm to assess the risk of being charged with corporate manslaughter should part of the hospital collapse and kill patients, staff, or visitors. Several of these hospitals are in such a dire state that it could be cheaper to knock them down and rebuild – but there is no capital to do so.
A further £3bn is needed to reorganise, rebuild and in some cases refurbish hospital buildings to enable them to reopen almost 5,000 beds that were closed in 2020 to allow for social distancing and infection control, and remain unused today. Sufficient capital is also needed to build new community diagnostic hubs and surgical centres without any private sector involvement. The latest desperate short-term moves to create “mini-Nightingale” hospitals in tents in carparks or under-used areas of NHS hospitals do nothing to address the long-term problem of inadequate NHS capacity.
£3bn capital and £5bn over 3 years in additional recovery revenue funding to equip mental health services to cope with the increased demands since the pandemic and expand services for adults and children, as called for by the Royal College of Psychiatrists.
Rebuild public health
Rebuild public health: The Health Foundation has calculated that an extra £1.4bn a year by 2024/25 is now needed to reverse years of cuts in public health, which should be leading a local-based test and trace system and preventive work to reduce ill health and stem the growth in health inequalities.
Fund a fair pay deal
Invest in fair pay: this is essential to help restore morale. Each 1% increase in England is estimated to cost £340m: so even to fully fund even the miserly 3% 2021 pay award needs an extra £1bn in core NHS budgets. Covering recent inflation needs another £1.3bn. The promised extra 50,000 nurses will cost another £1.5bn – plus a pay award for all staff, which is key to efforts to recruit, retain and grow the workforce. All of these sums are annual costs – ensuring the NHS has the staff needed to deliver safe, efficient and effective services.
Research commissioned by the unions has shown that increased spending on NHS pay generates increased tax and economic activity that means over 80% of any increase flows back to the Treasury: Rishi Sunak must be told to pay up to enable the NHS to grow the workforce to meet health needs.
In addition to the emergency funding
A further £18bn+ capital will be needed to ensure the promised ‘new hospitals’ can be built as planned. The £2.7bn allocated to build six, and then eight prioritised ‘new hospitals’ was completely unrealistic from the outset.
But it’s even less plausible now that the New Hospitals Programme insists the same pathetic pot of cash must stretch to cover costs of eight previously existing schemes – including two long-delayed PFI hospitals.
The New Hospitals Programme itself, which during the summer instructed all the priority schemes to submit new plans costing no more than £400m – implying drastic cutbacks – has now admitted few of the prioritised projects will be completed by the next election in 2024.
Estimates in 2019 suggested the full cost of 40 new hospitals could be as high as £24 billion, and not less than £18bn. To get any projects started Rishi Sunak needs to be told to make the necessary funds available as soon as clinically viable plans have been locally agreed and received planning approval.
Meanwhile, as The Lowdown has reported, the government has invited trusts to bid to be one of eight additional hospital projects to be funded, bringing the total schemes to 48 – but so far has allocated no additional capital. A clutch of schemes have been published, adding up to a total cost between £3.4bn and £5.1bn.
We’re calling on the government to revise last autumn’s spending review and allocate an immediate extra £20bn NOW – an amount we believe is well within the power of Government to fund and addresses all the key urgent problems we have discussed above.
But it will only do so if we make it.
£20bn is an adequate down-payment to ensure these investments can go ahead as soon as suitable plans are in place and public consultation complete. Of course a lot more will be needed to fulfil government election promises, expand the workforce and restore NHS performance to the levels they reached before the austerity squeeze on funding.
That’s why The Lowdown supports the SOSNHS campaign which has been launched with the backing of campaigners, the health unions and many other unions. SOSNHS is holding an online rally on the evening of January 19, with over 1,000 already signed up to participate.
The campaign is united around the need to act now to rescue our NHS, before more patients and staff lose confidence that things can ever get better. The government’s current weakness gives us an ideal opportunity to build a movement strong enough to force another U-turn on funding.
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