Worse than it appears
Why go for open privatisation when you can quietly administer concealed poison? James Linney describes the reality of underfunding
I don’t know if you’ve heard, but the national health service is in crisis. Well, given how much the crisis has been in the media this winter, the only way you could not have heard is by walking around with headphones over your ears and a bag over your head - not something to be recommended and likely to lead you to witnessing the crisis first hand.
Headlines such as The Sun’s ‘Third world A&E’1, The Daily Mail’s ‘Thousands dying of thirst on NHS’2 or The Guardian’s ‘NHS faces humanitarian crisis’3 have left little doubt that the NHS is sinking. The media have long been telling us that each crisis represents the final nail in the coffin for the NHS - a coffin that by now must be so well secured that you can’t see the wood for all the nails. For those of us that work in the NHS, that feeling of trepidation in late autumn, when airborne viruses start their seasonal peak, will be all too familiar. It led to us walking around like characters from Game of thrones, whispering to each other in a hushed voice: ‘Winter is coming …’
But there is far more to the current situation than the usual sensationalised headlines and this year has certainly been one of, if not the most, challenging for the NHS. Accident and emergency department waiting times are the worst they have ever been,4 there is a critical shortage of beds, leading to patients spending hours on trolleys in A&E, and even when they are admitted they may have to be put on a ward that has inadequate staff and training to deal with them. After the deaths of two people were attributed to waiting for hours on A&E trolleys in Worcestershire Royal Hospital in January, Mike Adamson, the chief executive of Red Cross, described the situation in the NHS as a “humanitarian crisis”.
The reason for this abysmal situation is undisputedly chronic underfunding. The consequences of which were recently highlighted in research by the University of Oxford London School of Hygiene and Tropical Medicine, which concluded that in 2015 30,000 unnecessary or premature deaths were the result of cuts in health and social care.5 For evidence that this horrible situation is only going to get worse we need only look to the Tory spring budget published on the March 8. In it Philip Hammond announced a total of £425 million in extra funding for the NHS over the next three years, with another £2 billion for adult social care over the same period. You do not have to be the chief executive of NHS England (in fact, as we shall see, it helps if you are not) to realise that £425 million is a drop in a very large ocean. And if we look in detail as to how this money is going to be spent, we see the situation is even worse than it first appears.
Of the total £425 million, £100 million will be allocated to A&E departments - “to help them manage demand ahead of next winter [and] provide more on-site GP facilities”.6 This amount of funding is clearly not going to have any impact - perhaps if you allocated £100 million to each large A&E in the country you might get somewhere. And, even if A&E departments were able to build state-of-the-art on-site GP facilities, they would remain largely empty, because, as BMA council chair Mark Porter pointed out, “the government also needs to explain how it will fund and recruit GPs to work on site at hospitals … Many are already working in practices with permanent vacancies which they are unable to fill.”
The remainder of the NHS budget allocation (£325million) will be ring-fenced for investment in the controversial ‘sustainability and transformation plans’ (STPs). If the budget was the first you heard of STPs, then you are not alone - according to a recent BMA survey, 59% of doctors had never heard of them either and 85% of consultants had not received any information from their NHS trusts about them.7 The STPs were rush-published last year and are championed by NHS England’s chief executive, Steven Simons. This is the same Steven Simons that health secretary Jeremy Hunt hired in 2014 - the ex-president of global operations for United Health of America - to help Hunt enforce his crippling NHS cuts … sorry, I mean ‘efficiency savings’: all £22 billion of them.
The STPs split the NHS up into 44 areas of the country called ‘footprints’, and each area has published an STP that sets out its aims for the next four years. These very lengthy documents are essentially an echo chamber for Jeremy Hunt’s “five-year forward view” plan for the NHS. Like this document these STPs are a mixture of aspirational corporate-speak without any basis in reality and loosely veiled plans for further savings. Each plan has to outline the area’s current estimated ‘overspending’ and set out how it aims to reduce it - 44% of them include hospital closures. The BMA sent a freedom of information request to the 44 STPs, enquiring as to how much up-front capital would be needed to implement them and received 37 responses. The total came to £9.53 billion - that £325 million really isn’t going to go very far.
For campaign groups such as 38 Degrees these STPs represent the end of the NHS as we know it and they see them as a secret plan for devolution that will lead directly to full privatisation, based around the American-style insurance networks called health maintenance organisations (HMOs). In fact Jeremy Hunt made a telling slip in 2016, whilst being questioned about STPs by the health select committee: he stated that we may have to find a way “forward to budgetary arrangements you would have in Valencia or Kaiser Permanente”.8 Kaiser Permanente being one the largest HMOs in America.
All of this can only lead us to one obvious conclusion: the Tories’ claim that their budget represents a much needed boost for the NHS - an NHS that they allegedly remain committed to - in fact represents something very different. To everyone but the most naive the NHS budget allowance confirms that the Conservatives have no desire to tackle the serious crisis. Behind all the talk of finance, the need to reform and ‘modernise’, the efficiency saving and the STPs, lies a political ideology that is in opposition to the very idea of free healthcare and welfare. This ideology is not limited to the Tories: it is embedded within capitalism. Yet, as we know, capitalism’s genius is its adaptability and ability to compromise when forced to.
The NHS represents one of those compromises. Created after a devastating world war, when the working class, having paid the price in the form of mass devastation and the deaths of millions, was ready to fight for a more equal society, the NHS was born. Yet almost from the beginning capitalism has been slowly eroding the NHS’s status as being protected from the market. The STPs are simply a continuation of this long, subtle, erosive process.
But the working class still holds the NHS dear and is still ready to put up a fight whenever its existence is openly threatened. According to the much-used quote from then minister of health Aneurin Bevan in 1948, “The NHS will last as long as there are folk left with the faith to fight for it.” This was visible on March 4 when the demonstration to defend it saw around 200,000 people take to the streets of London. This is the reason why the Tory government, whilst being opposed the NHS, will not come out openly for its privatisation. Why call out a risky open duel, when you can quietly administer concealed poison? This privatisation by stealth needs the NHS to be in continual crisis to demoralise its workforce and convince the public that more ‘efficient’ ways of doing things are needed.
Yet, despite the erosions and its many imperfections, the NHS still represents a very special organisation - its very existence is a hint towards the possibility of a different kind of society, where people are valued and provided for according to their own needs, as opposed to those of capital. But the will to fight alone is not enough: the working class also needs to have the means to fight effectively. This means more than just demonstrations: we need organisation and a party.
That is why the best hope for the NHS lies in the struggle to transform the Labour Party and building a real fighting party of the working class.
4. See www.qualitywatch.org.uk/indicator/ae-waiting-times.