Martin Shelley –

In an increasingly polarised country like modern-day Britain, prey as it is to the twin challenges of Brexit and covid-19, few institutions offer the reassuring sense of social cohesion that the National Health Service (NHS) represents today.

Under threat from ideology-driven re-organisations and cost-cutting initiatives almost from day one (even back as far as 1951, when Winston Churchill and his fellow Tories were said to be furious, because the report they’d commissioned was unable to come up with a more efficient alternative), the NHS is still with us after 72 years and still very much part of the fabric of everyday life in this country.

And the post-war Labour government health secretary Aneurin Bevan’s statement of intent – “No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means” – remains as powerful and relevant today as it did during the early post-war years.

Certainly, since its inception the NHS has undoubtedly gone on to play a pivotal role in improving the nation’s health, right up to the present day.

Life expectancy between 1948 and 2020, for both males and females, has improved by more than ten years, while infant mortality – deaths per 1,000 live births – has plummeted over the same period.

Mass immunisation programmes have largely banished diseases like diphtheria, and smallpox. Health campaigns have led to a huge drop in cigarette smoking.

Contraceptive pills and abortions became available during the 1960s, and rapid advances over the following decades saw the introduction of heart and other organ transplants, together with IVF treatment, keyhole surgery and CT and MRI scanning, as well as free mammograms.

And although access to long term care, dental work and spectacles is far more limited; GPs, health clinics and hospital services all remain free, while the NHS has become one of the world’s largest employers.

Its cultural and social importance was famously celebrated in the Danny Boyle-designed opening ceremony of the London 2012 Olympics, despite the reported displeasure of the then culture secretary Jeremy Hunt.

And who can ignore the almost constant presence in the TV schedules of nurse- and doctor-related dramas and documentaries? Call the Midwife, Casualty and Holby City are all prime-time viewing and reflect the universal affection people have for the work of the NHS.

Public interest and support for the NHS was clearly demonstrated when local health service fundraising group NHS Charities Together raised more than £90m for its covid-19 appeal.

But no matter how much money is raised through public appeals, state funding of the NHS is central to its existence,

Government-imposed funding constraints over the past decade have steadily undermined the capacity and efficiency of the NHS and prior to the Covid crisis the NHS had just published its worst performance figures, with record waits for cancer treatment and delays in A&E.

Last November, research by the Labour Party showed that almost 80,000 urgent or elective operations had been cancelled over the previous 12 months due to staff shortages and equipment failures.

‘Trolley waits’ and ‘corridor nursing’ are phrases that have become part of every newspaper sub-editor’s lexicon, resurrected each winter to describe the scenes in A&E departments across the country.

Now, after all the efforts in fighting the first wave, hospital bosses have warned it will take up to four years for the NHS to get back to providing its full range of services because of the huge disruption caused by covid-19. The number of patients waiting for a planned operation could rise from 4.2m to as high as 10m by the end of 2020.

Meanwhile the government’s strategy during the pandemic of relying on private contractors – is increasingly transparent, and follows ten years of NHS and local government reorganisation and funding constraints.

One academic, also a former regional director of public health in the NHS, told the Guardian, “There has been a destruction of the infrastructure that stops England coping with major emergencies. It absolutely explains why you’re now seeing private companies being brought into these functions.”

Moves to centralise purchasing functions within the NHS confirmed the suspicion of many campaigners and medical professionals that the government is using the pandemic to transfer key public health duties from the health service and other state bodies to the private sector.

The Guardian reported that centralising purchasing of crucial items such as PPE and ventilators during the pandemic was likely to lead to more functions being handled by management consultancy Deloitte rather than directly by NHS trusts, with stock information then being gathered by US data mining group Palantir.

Deloitte was also revealed to be co-ordinating three new ‘Lighthouse’ test centres, assuming responsibility for testing previously handled by NHS-accredited laboratories. This, despite a recent study that showed NHS trusts which hire management consultants to cut costs can end up spending more.

Some commentators consider the government’s current policy of ‘private good, public bad’ when it comes to health service provision stems from the passing of the 2012 Health & Social Care Act, which gave private companies the green light to extract profits from the health and social care sector (and which many working in the NHS now think should be reviewed).

But since the Act hit the statute books the number of NHS beds has actually fallen by 5 per cent, private care home providers have been awarded £1.5bn, and PFI contracts have paid out almost £1bn that should have been retained within the health service. The Act also saw the transfer of public health duties – central to the current response to the pandemic – from the NHS to local government, a sector which has suffered cuts of £850m in central government grants over the past six years.

This loss of income has obviously had an impact. In 2018, on the occasion of the NHS’ 70th birthday, the BBC commissioned a ‘How good is the NHS?’ report that found unusually good financial protection to the public from the consequences of ill health, it was relatively efficient and performed well in managing patients with long-term conditions, despite an “unusually low level of staffing and… equipment”.

However, it performed worse than average, relative to other wealthy countries, in the treatment of eight out of the 12 most common causes of death. It was also the third-worst performer on the rate at which people die when successful medical care could have saved their lives, and it had consistently higher rates of death for babies at birth or just after birth.

But in the post-Brexit era – when many in the UK fear the NHS could soon be “up for sale” to US interests, despite repeated government denials – it’s timely to put that BBC report into perspective by glancing across the Atlantic to see how the patient experience there differs from our own, under a system that isn’t funded centrally through taxation.

In 2018, the same year as the BBC report appeared, almost 28m people in the US had no medical insurance at all in a country where the healthcare system is largely dependent on the financial services sector for its very existence.

A US survey in 2018 showed that more Americans were afraid of paying for healthcare if they became seriously ill than they were afraid of getting seriously ill. Another survey a year later revealed that, over the previous decade, 30 per cent of US citizens had delayed seeking any sort of medical treatment at all because of the prohibitive cost.

Hardly surprising, given that one 70-year-old Seattle resident, recently recovered from covid-19, was presented with a hospital bill of $1.1m earlier this year.

Meanwhile, for the past three years Donald Trump has been trying to overturn the Affordable Care Act (commonly known as Obamacare, and hardly the dangerous experiment in socialism it’s often made out to be in the right-wing US media) and is now, under cover of the rapidly deteriorating covid-19 situation in the US, pressing the Supreme Court to terminate the Act. If he’s successful, that means millions of Americans who have survived Covid-19 or face future infections could lose their insurance, or even be barred from getting coverage.

Clearly, the US experience is something to avoid, and presents a strong case for retaining and bolstering the NHS in its present form, especially at a time of increasing social polarisation and encroachment by commercial interests. We must cherish and defend it at all costs.

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