The NHS; a great socialist achievement
Like many people round the country I felt emotional and proud as I watched the celebration of our NHS at the 2012 Olympic opening ceremony; one of the great social, and socialist, achievements of the last 100 years. Labour created a system where good quality healthcare is available to all, on an equal basis; a publicly provided service free for all at the point of delivery. That’s what socialist Labour governments do; they have ambition for the many not just the few who can afford it.
And, our NHS stood the test of time, adapting to big changes in the make-up of the population, medical science and available technology to produce some of the best medical outcomes for one of the lowest costs. After years of a Tory funding squeeze, the last Labour government pledged to match the average spend of 14 EU countries for our NHS and by 2010 had almost achieved this, alongside enviable patient care performance, guaranteed under a new NHS constitution.
Yet as we watched that celebration, most of us were unaware that the Tories had a different prescription for our NHS; wholesale privatisation, the harshest funding squeeze in NHS history and one big, botched top-down re-organisation. None of this was in the 2010 Tory election manifesto, which had declared “the NHS is safe in our hands”.
Taken together, these changes have shaken the NHS to its foundations and one of our local MPs, Rob Wilson, was instrumental in these changes as a Ministerial aide to the then Health Secretary.
Here in Reading, by the end of 2016 the % of people attending A&E at Royal Berks hospital waiting longer than the four-hour target had tripled.
Waiting lists for planned treatment and operations soar to new highs, hospitals actually employ ‘corridor nurses’ to treat people on trolleys for whom beds are not available, children and young people find it near impossible to get the mental health treatment they need, people have even died unnecessarily waiting for ambulances to arrive.
Here in Reading, by the end of 2016 the % of people attending A&E at Royal Berks hospital waiting longer than the four-hour target had tripled. In February this year one in six people referred by their GP with suspected cancer waited more than the target 62 days compared to just one in 32 just before the Tories took power in 2010.
So, what’s gone wrong?
Funding – the Tories like to tell us that £8bn extra is being spent on the NHS but the proportion we spend of our national wealth is just not keeping up with that Labour promise and we’re now going backwards, not catching up with the average EU spend. The government was told £30bn was needed to keep service levels at a standstill; the reality is that under the Tories the NHS has to find £22bn ‘efficiencies’ (cuts to you and me) in order to receive £8bn in actual new money.
A disastrous re-organisation – although there was nothing in the ‘safe in our hands’ manifesto the Tories soon unveiled their plans for a massive re-organisation of the way our NHS works; claiming the 2012 Health and Social Care Act would put planning of health services in the hand of doctors who would know best. Rob Wilson told me “it will strengthen the voice of patients and doctors in the NHS” and “save £4.5bn over this Parliament”. The reality has been somewhat different.
The independent King’s Fund says the changes, costing billions of pounds, led to a top-down reorganisation that has been damaging and distracting, structural change that is complex and confusing, and a new, fragmented system of leadership that is seen as a barrier to much-needed change in services – such as integration across care and organisational boundaries.
Privatisation – just as we were celebrating the achievements of our publicly provided NHS at the London Olympics, the Tories kicked off their privatisation plans with under the guise of ‘Patient Choice’. By the end of 2012 Reading billboards were plastered with adverts from private health company Circle telling us how we could tell our GPs we wanted to choose their fancy facility over the Royal Berks (but only for select profitable procedures).
Next, as the changes under the Health & Social Care Act kicked in, the Tory-led government told Reading’s new ‘doctor-led’ commissioning they had to open up local adult Audiology and Podiatry and other services to private companies under their ‘Any Qualified Provider’ rules regardless of what local people and doctors wanted. Suddenly the NHS logo appeared over Specsavers’ new hearing centre door in Broad Street.
But these private sector pickings were minor compared to the plans for gradual but wholesale, privatisation of the provision of NHS clinical services. Regulations issued under the Tory Health & Care Act now require that all future national or local NHS contracts be awarded through competitive markets. This means that every time a new or renewed ‘contract’ comes up it must be opened up to bids from private companies, British or foreign, regardless of what local people, or the ‘doctors who know best’, might want.
In Reading for example, when the existing GP partnerships at Priory Avenue in Caversham and Circuit Lane in Southcote surgeries could no longer provide a service, our local Berkshire Healthcare NHS Trust was only allowed to step in for an emergency temporary period whilst the contracts were then tendered and awarded to private companies. At Priory Avenue surgery standards deteriorated rapidly and in 2015 inspectors from the Care Quality Commission rated the service “Inadequate for being safe, effective and well-led”; it was placed in Special Measures.
Hundreds of patients had signed a petition against this privatisation that Labour candidate in Reading East, Matt Rodda, had organised. I asked Rob Wilson why patients had no input into whether this contract was put out to tender when he had promised to ‘put patients in the driving seat’; he refused to answer. Somehow, in his election leaflet Rob Wilson claims this sorry episode is “campaigning for improvements at Priory Avenue Surgery”.
The Tories were never going to be happy that the private sector was ‘restricted’ to just profiting from buildings, equipment or cleaning and car parks; slowly but surely our NHS clinical services are now being taken over for profit. In 2014/15 private firms won nearly 40% of the £9.628bn worth of national NHS contracts and 40% of local contracts worth £2.3bn.
Of course Tories always deny they want NHS privatisation, but that’s because they don’t count outsourcing clinical services to private companies as privatisation! As Rob Wilson explained to me in February 2013 – “using private sector providers to deliver free treatment for patients through the NHS is not privatisation”. When the NHS is forced to put every contract out to tender, I think it is.
So, what next?
Under Tory plans privatisation will gradually pick off the most lucrative NHS clinical services, eventually leaving a public sector rump with just the ‘difficult’ bits, fragmenting services, reducing efficiency and making it ‘look expensive’ and sending NHS Trusts into ‘bankruptcy’ – a good excuse for more privatisation.
We can take Tory promises about another £8bn for the NHS which is uncosted with a pinch of salt. The Tory funding squeeze will go on and the amount we spend through the NHS will continue to decline relative to our GDP and our neighbours in Europe; there’s still that £22bn ‘saving’ to find.
What about he failed re-organisation? Well, we know a bit about plans there too, but not too much because it’s all being kept behind closed doors – especially during an election. Almost unbelievably, the Tories have put in train another top-down re-organisation of how NHS services are planned, which they hope this time will deliver the cuts they need to hit government budget targets.
We now know that in late 2015 Jeremy Hunt issued a diktat through NHS England to produce a so-called Sustainability and Transformation Plan for every area of the country. But the local doctors’ commissioning groups were not much involved in developing these plans, neither were the current regional offices of NHS England, nor the Local Authority ‘partners’ and certainly not patients in any meaningful way. These plans were developed in secret using private sector consultancy firms at a cost of hundreds of millions of pounds.
Here in Reading, we know that our future NHS service planning and provision is to be lumped in with half of Berkshire together with the whole of Bucks and Oxfordshire. Together, these areas will have to ‘save’ around £500 million pounds per year. But these are not just plans, they plan a whole new (top-down) structure where the local doctor-led commissioning groups will be swept away and Reading council will have to try to deal with a mono-lithic regional structure that has no democratic accountability in trying ensure our local health needs are met and services are linked up with social care. It may well be that NHS clinical services need reconfiguration to meet changing future needs, but this is no way to do it.
The question I keep coming back to is why do the Tories want ever-increasing private sector involvement in NHS clinical services? The largely private healthcare system in the USA costs about 60% more than in the UK with often poorer health outcomes for the population. We know that profit-driven health services cost more and don’t work; is it just that their ideology drives them to oppose any successful public service – even our NHS?
What will Labour do?
Just like when the NHS was founded, a socialist Labour government will have ambition for the many not just the few who can afford it:
Funding – Labour will invest in our NHS, committing to over £30 billion in extra (fully costed) funding over the next Parliament. Once again giving patients the modern, well-resourced services they need for the 21st century and upholding the standards patients are entitled to under the NHS constitution.
Re-organisation – Labour will halt and review the Tories’ ‘Sustainability and Transformation Plans’, which are looking at closing health services across England, and ask local people to participate in the redrawing of plans with a focus on patient need rather than available finances.
Privatisation – Labour will reverse privatisation of our NHS and return our health service into expert public control. Labour will repeal the Health and Social Care Act that puts profits before patients, and make the NHS the preferred provider.