A powerful new link-up between Health Campaigns Together, NHS Support Federation, Keep Our NHS Public and the health unions is set to launch a major new SOS NHS campaign to challenge the 12-years of under-funding and growing staff shortages that have plunged the NHS into its deepest-ever crisis this winter.
The campaign will run into the new year, and combine online resources and social media with mobilisation at local and regional level, delivering solidarity and some hope to beleaguered front-line staff battling to keep services afloat.
And, while some excellent and insightful reporting by a handful of journalists in serious newspapers and trade press has been vital to chart the developing crisis, the campaign also aims to combat the complacency and superficiality of too much mainstream media reporting of the NHS, that has left much of the wider public unaware of the scale of the problem, and allowed ministers to repeat deceptive and misleading claims.
The objective is to trigger a much wider movement that can pile pressure on Tory MPs, especially in newly-won seats, to demand another government U-turn – to reopen and revise the inadequate recent Spending Review, which locks in effectively frozen funding until 2025, and gives no extra capital to repair and remodel hospitals to reopen lost capacity.
It’s vital for campaigners, opposition parties and health unions to argue now for a plan to build a sustainable, publicly owned, run and driven NHS.
It’s plain for all to see that the current workforce plan, NHS Long Term Plan and the Health and Care Bill all not only fail to address the harsh reality, but as the NHS weakens, push towards a larger, stronger private sector cashing in where it sees profit to be made.
Ministers keep arguing that spending is at “record levels”: but it’s clear to all that the NHS faces unprecedented levels of demand. Warnings on all sides stress that it lacks staff, beds and resources – as a result of ten years of frozen funding while the population has grown by 5 million.
Much larger sums of capital and revenue than the government has
allocated are needed to catch back up with what has been lost since 2010 and put the NHS back on its feet
By 2019 NHS Providers calculated that if spending had continu
ed from 2010 at the average level ithad grown from 1948 to 2010 instead of being frozen in real terms, the annual budget would have been £35 billion higher: and since then the gap has grown further.
So even if we now do have ‘record spending,’ it is at a level that is still nowhere enough to restore 2010 performance or meet demand – let alone tackle the cumulative problems of our increasingly dilapidated hospitals, inadequate provision and obsolescence of vital equipment for diagnostics and treatment, or build the promised 40 or 48 ‘new hospitals’.
And while Sajid Javid boasted on Twitter on October 28 that he was “Delighted to see record staff numbers working in the NHS – 5,500 more doctors & 10,000 more nurses,” and claimed “The NHS is recruiting even more people to join their ranks to help us recover from COVID-19 & tackle the backlog,” this came only three days after he had admitted that “a lot more” staff were needed.
Growing dependence on the private sector
The funding crisis underlies all aspects of the current NHS crisis, and is the major factor in the latest rounds of privatisation.
If the spending review stands unchanged, by 2025 we would be half way through a second deadly decade of declining NHS – but soaring profits for the private hospital sector. Private hospitals stand to gain, both as contractors treating NHS funded patients, and as private providers of elective care to desperate self-pay patients raiding savings or borrowing to pay for operations to avoid facing agonising waiting times for NHS care. (See article below)
Indeed the scale of increased NHS dependence on private providers and contractors has been massively increased by the Covid pandemic – coupled with the lack of NHS capital to invest in its own facilities and equipment. New “community diagnostic hubs” seem certain to be achievable only in a lop-sided ‘partnership’ with private companies that can put up the necessary cash—and then reap a profitable slice of the action, as has already occurred in Somerset.
As we warned in The Lowdown, NHS England guidance on new imaging networks also looks to an option in which an entire network would be contracted out to a private company. During the Covid pandemic ministers have turned instinctively and without competitive tender to the private sector to establish new “Lighthouse” laboratories, and run a new mega-lab in Leamington Spa.
The common factor in each case is that the NHS lacks the capital it needs.
And of course, most dramatically of all, when money was apparently no object, ministers turned first, and without any due process to the private sector — Deloitte, Serco and Sitel, and a ‘fast-tracked’ list of as their initial response to the Covid-19 virus, bypassing existing public health networks to set up a new, privately-run, eye-wateringly expensive and spectacularly ineffective ‘test and trace’ system, and commission testing kits and PPE. Only when it came to rolling out the vaccine was the NHS brought fully in to the leading role it should have been playing all along.
Rebuild crumbling Infrastructure
While money has been pumped into contracts to treat NHS patients in private hospitals, there is no capital to invest in re-modelling hospital buildings, refurbishing and where necessary rebuilding to enable the hospitals to reopen the thousands of beds that have been closed or left unoccupied since March 2020 because of social distancing and infection control. Rishi Sunak has to be told to make a fund of up to £3bn immediately available for this work to be done – and end the need to ship NHS patients off to costly and inefficient private hospitals.
But the lack of capital reaches wider: across England the bill for backlog maintenance to repaircrumbling buildings and fix or 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.
Rishi Sunak has to be told to make at least £5bn extra available, ringfenced as a fund for trusts to cover their most significant and urgent maintenance problems as soon as possible, with additional capital each year to wipe out this shameful backlog.
A dozen or so hospitals built in the 1970s using reinforced autoclaved aerated concrete planks are in serious danger of collapse. Among the hospitals affected by the crumbling concrete are Airedale in West Yorkshire, Crewe’s Leighton Hospital (Mid Cheshire); Hinchingbrooke (North West Anglia FT); Wexham Park (Frimley Health FT); James Paget Hospital, Lowestoft; Queen Elizabeth Hospital, Kings Lynn, and West Suffolk Hospital (Bury St Edmunds).
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 any 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: just three of the schemes (Leighton, West Suffolk and King Lynn) have been costed at almost £1.7bn between them. Rishi Sunak has to be forced to make the necessary funding available as soon as plans are in place to partially or completely rebuild these hospitals that put patients and staff at risk – this could easily add up to £6bn.
And while we look at inadequate capital allocations, the £2.7bn allocated to build six, and then eight prioritised ‘new hospitals’ was completely unrealistic to begin with. But it’s even less plausible now that the New Hospitals Programme insists the same pathetic pot of cash has to stretch to cover costs of eight previously existing schemes – including two long-delayed PFI hospitals held up by the 2018 collapse of Carillion, the Royal Liverpool, now due to open next year, and the Midland Metropolitan in Smethwick, not now due till 2023.
The New Hospitals Programme itself, which during the summer instructed all of the priority schemes to submit new plans costing no more than £400m – implying drastic cutbacks from the schemes already drawn up – has now been dropped to a “red rating” by the government’s infrastructure watchdog the Infrastructure and Projects Authority, which defines this as meaning: “Successful delivery of the project appears to be unachievable. There are major issues with project definition, schedule, budget, quality and/or benefits delivery, which at this stage do not appear to be manageable or resolvable.”
It’s all but certain that a central issue in this unfavourable rating is the lack of capital to complete the new hospitals which were central to Boris Johnson’s 2019 election manifesto and campaign: estimates at the time suggested the full cost could be as high as £24 billion, and not less than £18bn.
Rishi Sunak needs to be told to make this much money available as soon as clinically viable plans have received planning approval and the go-ahead from the NHS.
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 to make the effort worthwhile. A clutch of schemes have been published, adding up to a total cost between £3.4bn and £5.1bn.
There is also need for NHS capital to build its own community diagnostic hubs and its own elective surgical hubs to streamline efforts to reduce the waiting list. And capital and revenue funding are also needed for investment in mental health services, which have been promised more staff and parity of esteem for years on end with no extra resources to match.
Adding all these capital schemes together suggests a need for an extra £10-12bn immediately, and at least another £28bn in the next few years as plans to replace collapsing hospitals and for the 48 ‘new hospitals’ get the go-ahead.
Further investment and revenue is also needed at local level to rebuild public health services that have been foolishly cut back and are now straining to support the fight against Covid, but should be a mainstay of the fight to tackle health inequalities and reduce the pressures on the NHS.
But before Rishi Sunak bleats that such levels of funding are unaffordable we need to remember the huge sums of money thrown at the private sector during Covid, vast amounts of which were stolen, wasted, or squandered on overpriced or useless PPE and equipment. £48 billion was shelled out on ‘bounce back loans’ alone, with minimal checks on the credentials of the companies claiming the cash – with no less than £26billion of that lost to fraudsters and borrowers who cannot repay, according to the National Audit Office.
£37 billion was famously allocated over 2 years to the disastrous privatised test and trace system, blowing over £1m per day on Deloitte consultants, with no proper value for money checks or consideration of an NHS and public health-led scheme.
The money wasted on these two things alone would have been more than enough to put the NHS back on track: if it can be raised to waste, it can be raised to invest. Sunak has also ditched plans to increase capital gains tax to the levels of income tax, which could have raised another £17bn per year from the wealthiest people, and given scope to invest further in health and social care.
Responding to the staffing crisis
NHS capacity of course is much more than buildings and beds: staff shortages are a major threat to safe services and an obstacle to restoring the capacity lost during the pandemic.
As an immediate step it is vital to ensure that all constraints of spending on agency and bank staff are lifted now, to ensure trusts have the scope to bring in temporary staff wherever they are available and needed to keep services going this winter. Once more we know England’s NHS will be struggling to cope with thousands of Covid patients (6,280 at November 23) as well as record numbers of emergency patients, and a near-6 million backlog of waiting list patients – with thousands of NHS beds still out of use since the pandemic struck in early 2020.
Delivering on government promises to recruit more nurses, mental health professionals and GPs requires more revenue funding almost immediately, to ensure ring-fenced resources are put in place to expand recruitment and training of new professionals.
The ridiculous decision of Tory MPs to vote down Jeremy Hunt’s proposal for two-yearly reviews of staffing levels and workforce plans serves only to underline the yawning gap where there should be a workforce strategy, and the lack of realism in ministers’ attempts to hold down NHS pay.
A substantial across the board pay increase for all NHS staff is also needed – over and above the 3% ‘increase’ that has already been swallowed by inflation and increased national insurance payments. This is needed to show hard-pressed and demoralised staff who are beginning to leave that they are valued, help retain them – and make it more attractive for qualified staff who have left already to come back and work for the NHS.
A combination of investment to make it possible for skilled staff to do their jobs safely and well and investment in their pay and conditions maximise the chances of building and retaining the staffing levels the NHS needs to rebuild capacity.
With pay in some supermarkets and service industries now outstripping the NHS, this combined investment in staff, a zero tolerance crackdown on bullying and harassment, all forms of discrimination and an investment in staff welfare and wellbeing are also necessary to make the NHS an employer of choice.
And to tackle the dwindling recruitment of EU and other overseas qualified staff to strengthen NHS and social care teams the government has to scrap all limits on overseas recruitment and the counterproductive migrant surcharge and visa fees which spell out a message that foreigners are no longer welcome.
The cost of these measures in lost revenue would be minimal and the potential benefits very substantial.
While the extra spending required is substantial, it will, as health spending always does, generate other benefits including the creation of more jobs in construction, in health care, and the supporting industries, which in turn will generate economic growth across the country.
Above all the NHS needs a realistic workforce plan, based on the projections of future health needs.
Sajid Javid’s highly politicised attempt to make political capital out of launching a new “NHS Reserves” scheme, branded with the Tory Party logo, indicates that ministers are still refusing to take this issue seriously, and intent on propping up their own position rather than supporting the NHS.
Any genuine effort to “mobilise a broad range of fully trained staff, from retired doctors to IT experts”, as NHS Reserves claims to do, must be combined with the measures outlined above to ensure that the NHS is able to convince any returning staff that it offers significantly better terms and conditions than the ones so many have left in anger and frustration.
It’s also important to note that all of these necessary investments in the NHS will still fail to deliver the most efficient service without the long-needed root and branch reform of the dysfunctional, largely privatised social care system which suffered so heavily during the peak of Covid, and which is now struggling in many areas to deliver home care support or care home places.
The chaos that is social care needs to be replaced by a new national care and support service that is publicly owned and run for the needs of the clients, not the profits of private businesses.
The lack of such a service means thousands more acute hospital beds are filled with patients who should be discharged to support outside hospital, but who can’t be because no such support exists. The Health and Care act proposal to strip away the legal right even to have patients’ needs assessed before they are discharged risks making this even worse.
More than money is required to tackle this crisis, not least tough regulation and scrutiny to ensure any increased funding for ‘social care’ goes towards improved services, pay, conditions and staffing levels rather than straight into off-shore bank accounts of the multinational corporations running many care homes.
But the government’s new, hollow White Paper on social care reform confirms fears that they have no real plan or ambition to reform this broken system other than to impose a regressive system of capping personal spending to protect the assets of the wealthiest at the expense of the poorest.
Private hospitals income from the NHS
The staggering £2.15 billion paid out by the NHS to private hospitals since the Covid pandemic, to cover their costs and ensure capacity would be available, have been broken down by Private Eye (issue 1561).
It found £468m (boosting its revenue by more than 50%) had been paid to the largest hospital chain Circle Health Holdings, with 54 hospitals and over 2500 beds, which has now been acquired by grasping US health corporation Centene. The NHS payments effectively trebled the value of the company.
£430m was paid out to Spire, with 39 hospitals and 1,870 beds, helping to almost double the company’s share price.
And Australian-owned Ramsay Health Care UK picked up a cool £385m (equivalent to 76% of its revenue) in the first 13 months of the pandemic for providing capacity in its 29 hospitals with 892 beds.
Both Spire and Ramsay have bragged that the increased NHS waiting list offers them even more lucrative possibilities with self-pay patients. Spire’s 2020 Report notes that they were able to keep back beds from the NHS deal to ensure they could continue to treat private patients, and that some of this was exceptionally profitable:
“Q4 saw exceptionally strong growth in self-pay revenue with priority given to more clinically urgent complex cases, which carry a greater average revenue per case.”
Spire’s Strategic Report notes:
“our self-pay admissions were broadly in line with the same period in 2019. This wave of activity, following the pause between March and August, was largely due to pent up demand and a desire by people to avoid a lengthy wait for treatment in the NHS at a time of increasing NHS waiting lists and times;”
NHS England’s eagerness to strengthen its ties with Ramsay was underlined in October when NHS England’s Director of Clinical Improvement turned up to cut the ceremonial ribbon, opening a new Ramsay Hospital in Chorley – where the future of NHS acute services remains uncertain.
The private hospitals have obviously been happy to accept NHS subsidies to cover their costs during the Covid lockdown, and to fill their otherwise under-used beds with NHS patients as part of the 4-year £10bn “framework” deal announced last autumn.
But it’s clear that, despite the lavish payments, nowhere near the full 8,000 private sector acute beds have been made available to the NHS, and fewer still have been used. If they can choose, the hospitals themselves would clearly rather treat more profitable self-pay and privately insured patients than fill beds with NHS patients at the lower NHS tariff cost.
But even utilising all of the private acute beds would still leave the NHS still facing a drastic loss of capacity compared with 2019 at the end of the four years, and leave the capacity gap unresolved, with the NHS more chronically dependent on the private sector.
As private hospitals increase their caseload, they poach more staff from the same limited pool of NHS-trained staff – increasing the pressures on front-line NHS services – with NHS teams split up and vital staff redirected to work away from main sites in small private hospitals.
Any benefit in access to additional beds for elective work would be offset by the greater problems maintaining adequate staffing of emergency services. Private hospitals’ gain is inevitably at the expense of the NHS.
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