02.02.2023

Dispatches from the warzone

The Tories are deliberately running down the NHS and the human cost is horrendous. But James Linney does not reckon Labour’s plans amount to anything much better

Not a day goes by when the media is not full of tragic stories highlighting how dire a situation the NHS is in - its desperate staff striking for a wage that does not leave them impoverished; stories of people with life-threatening injuries or illness having to try to get to hospital themselves because ambulances are stuck in a queue; people who are trying to get severely unwell people the care they urgently need; emergency departments like warzones. These horrors are now just another normal day in Tory Britain.

Each week we get NHS performance statistics and they are now always record-breaking - but never in a good way! This week a report highlighted that a record 350,000 patients in England had to wait more than 12 hours to be admitted to hospital from the accident and emergency (A&E) department in 2022¹ - compare this to 2015, when only 1,306 patients waited 12 hours. Earlier this month we heard how the Royal College of Emergency Medicine estimated that these delays are resulting in 500 deaths a week² and NHS data for last month revealed how delays in handing patients over from ambulance to hospital have led to an estimated 57,000 people in England experiencing “potential harm”, with 6,000 of these being exposed to “severe harm”.³

At this point the depths and seriousness of the crisis facing the NHS is blindingly obvious - it takes some effort not to see it as moribund without some drastic intervention. Yet in Rishi Sunak’s world things are not so bad: he still refuses to admit to an NHS crisis and thinks a pathetic £500 million winter funding will solve everything. This is a man whose net worth is pushing a billion pounds and who has access to the best medical care money can buy.

Many believe the collapse of the NHS was the plan all along, allowing the Tories to finally, once and for all kill off what most of them see as a kind of ‘socialist’ affront; allowing the door to be thrown wide open to privatisation - a door they have so far been sneaking open little by little. Of course, we know that socialism in one industry is a ridiculous idea and that the NHS has always been answerable to global medical and pharmaceutical companies. However, in many ways the NHS is special and considered such by the working class in Britain - its very existence represents both a historical moment of working class political influence and it has at its core a socialist idea: that people deserve to be cared for based on their need, not their ability to pay.

Whether the current crisis has been meticulously masterminded by the Tories or is a result of their negligence and monumental incompetence (or both), they are very aware that to be seen as the party that destroyed the NHS would risk political annihilation. Hence in recent months the Tory mantra has been to deflect blame, their story being that Covid-19 is to blame for the waiting times, that influenza has made things worse this winter or that A&E is overrun with time-wasters, etc. Of course, we are clearly in ‘tell a lie often enough and it becomes the truth’ territory here, because, for anyone who cares to check the trends of ever increasing waiting times,⁴ private healthcare involvement and staffing deficits, they have been clearly evident since the Tories took over government and inversely related to their lack of funding for the service.

If stage one of the Tory plan was, run the NHS into the ground; stage two: avoid the blame for it, then we are at the start of stage 3 - the nudging of the narrative towards a health service that is so far beyond saving and such a gargantuan funding drain that the only possible solution is to introduce a system of payments. Hence we saw Rishi Sunak propose £10 fines for patients who miss local GP or hospital appointments, during his campaign for Tory leadership and this week we had former health secretary Sajid Javid suggesting that “too often the appreciation for the NHS has become a religious fervour and a barrier to reform”, and proposing that, as in Ireland and Norway, patients are charged for attending A&Es and GP appointments. Of course, what is being sold as a small, nominal fee for service users - perhaps reasonable if we had a health service fit for purpose - would actually mark a fundamental change in the nature of the NHS. It would quickly lead to increased and widening charges (remember how quickly the ‘small capped fee’ for university courses escalated to drowning people with a life time of debt). The burden would fall most severely on the those who frequently use the NHS - in other words the most vulnerable in our society. From here the road towards a two-tier health service and private insurance for those who can afford it would be inevitable and very difficult to back away from.

Alternative?

Where then, we ask is Labour’s furious defence of the NHS? After all, its very existence was enabled by the Labour government nearly 75 years ago and remains its most significant pro-working class reform. Sir Keir Starmer signalled his intentions for the NHS in a recent article in The Daily Telegraph titled “The NHS is not an out-of-bounds shrine. It needs unsentimental reform”. This is phrasing that sounds worryingly similar to that of Sajid Javid’s - not a good start.

The article is spiked throughout with red-flag politician-speak that should have us worried; so we hear that Labour will make the “hard choices” we are told we need to “get real about reform”, and warned that the NHS should not “somehow be off-limits”. We can be confident that these coded hints speak to what Starmer is too cowardly and calculating to come out and say openly: that if he becomes prime minster - currently looking very likely - the NHS funding deficit will continue. We can also infer from his recent refusal to support the nursing and ambulance staff strikes, and the lack of any mention here of increasing pay for NHS staff, that under his premiership workers will not do much better than they are currently doing.

In the article Sir Keir commits to training more nurses (Labour has pledged 10,000 more nursing and midwifery clinical placements each year⁵) and doubling medical student places, but the Tories have been promising similar things for years. The point is how to get there. Sir Keir has already signalled he is going to renege on his previous pledge to abolish university fees,⁶ so NHS staff will still be left financially crippled by their education, face years of extra training at near minimal wages, have to work long hours (often with unpaid overtime) in an environment so stressful they risk their mental health - a career prospect that is hardly going to have people applying in their thousands.

The most ‘radical’ idea in Sir Keir’s article sets out his plans to phase out GP partnerships and bring primary care closer to other parts of the NHS - supposedly GPs would be working, like hospital consultants, on fixed salaries. This could potentially put an end to the separation of primary and secondary care that has existed since the creation of NHS - a separation that has meant that they have had to compete for funding instead of working in unity. It has also led to many illogical, bureaucratic barriers to better patient care.

IT systems

So, for example, historically IT systems have been different and incompatible between primary care and secondary care, meaning that, if a patient becomes unwell and has to be admitted to hospital, the doctors there have no way of accessing the notes written by the doctors in primary care, which would be invaluable for them in assessing and treating the patient. The other benefit of phasing out GPs as partners in running surgeries would be to free them up from having to constantly balance all the administration that comes with running a small business against having clinical time for their patients. As Marxists we also recognise that it would free them from their petty bourgeois role and allow them to fully align their interests with the working class.

There is a double-edged sword element to Sir Keir’s plans though, and in the wrong hands it could easily make things worse. GPs work incredibly long hours - often doing unpaid extra work in order to manage their surgeries - and they are best placed to know what the needs of their local patients are. So, if GP surgeries are not going to be run by GPs, then who? The last thing the NHS needs is another influx of layers of managers more concerned with arbitrary targets and efficiency savings than patient care. Even worse though is the prospect that this could provide an opportunity for private health or accountancy companies to fill the gap. In the current climate it will inevitably lead to more outsourcing - we are reminded of how a previous attempt to integrate the IT systems of primary and secondary care resulted in £6 billion of contracts being awarded to some of the largest IT companies: Accenture, Fujitsu and CSC. The result was a colossal failure that ended up costing taxpayers over £10 billion. Sir Keir and his shadow health secretary, Wes Streeting, have already made it quite clear that the influence of private health companies in the NHS will continue to grow under a Labour government, with Streeting recently saying, “No doubt the next Labour government may have to use private sector capacity to bring down NHS waiting lists, and I won’t shirk that for a minute …”⁷

Everything we know about Sir Keir suggests that getting himself into office is what matters above all else: he is a careerist snake. Initially pretending to be supportive of the Corbyn manifesto until he could shed that particular skin, he then dedicated all his efforts to expelling as much of the left as possible from the party, and his priority now is to demonstrate to the UK elite that in government Labour under his leadership would not make the slightest challenge to their interests.

Whether under Sunak or Starmer, the NHS (and the working class in general) is caught between a rock and a slightly less hard rock, and the direction of travel (in this case downwards) is the same. For now though, the NHS limps on, the one potential light on the horizon being the increasing preparedness of workers to resort to industrial action - we welcome the February 6 militancy, when nurses and ambulance crews will coordinate the biggest strike action the NHS has ever experienced.