“Our NHS needs not just a cash injection but a major cash transfusion – not just to survive Covid & repair the damage it has done by lengthening waiting lists, but to reverse a brutal decade of disinvestment since 2010.”John Lister
By John Lister, editor Health Campaigns Together & co-editor The Lowdown. This is an edited version of his speech at the rally for a People’s Budget (full video here.)
Our NHS needs not just a cash injection but a major cash transfusion – not just to survive Covid and repair the damage it has done by lengthening waiting lists, but to reverse a brutal decade of disinvestment since 2010.
Staff at the front line delivering patient care were already running on empty before Covid struck. Since then, the pandemic has stretched, stressed and tested them as never before, in a full year fighting a virus that was given extra chances to spread by repeated government delays, ineptitude and tragically ill-judged policies like Rishi Sunak’s “Eat out to spread out the virus,” and the pathetic, privatised test and trace system.
What do I mean by running on empty? A series of what in the rail industry they call SPADS – signals passed at danger. The NHS was not only ill-equipped to deal with a pandemic, but it was also in no fit state to cope with a British winter without crisis measures.
Throughout 2019 and especially in the run-up to the December election there were warnings from many organisations that the NHS needed more investment.
But Boris Johnson won commited only to implement Theresa May’s 2018 promise to increase NHS spending by £33.9 billion in cash terms by 2024 – just £20.5 billion extra in real terms over five years according to Treasury figures, well below the level of increase needed to keep pace with cost pressures. That grossly inadequate increase has now been enshrined in law.
Immediately after the election the BMA pointed to a £6.2 billion “black hole” in future NHS finances. NHS Providers belatedly pointed out that if NHS and social care spending had risen each year in line with the average prior to David Cameron taking office, the Department of Health budget would already have been £35 billion higher.
The cash shortages have brought capacity shortages, and therefore performance on almost every measure has lagged ever further from the high-water mark of 2010. Even before the pandemic:
- The 95% target to see and treat or discharge A&E patients within 4 hours had not been met in England for over 5 years.
- 65,000 patients needing admission spent at least 4 hours waiting on trolleys in September 2019 – 46% higher than the same month in 2018 and 1,400% higher than 2010.
- The 62-day target to start cancer treatment had only been met once in five years, with more than 20% waiting longer.
- The waiting list had soared to 4.5m, with 15% of them waiting over 18 weeks.
- 9,000 front line general and acute hospital beds had closed since 2010, along with 5,200 mental health beds – 22% of 2010 capacity.
- Staff shortages were rampant, while promises of 6,000 extra GPs and 50,000 extra nurses proved to be worthless. GP numbers actually FELL,
and it turned out the 50,000 included retaining 18,000 nurses already working in the NHS, and recruitment of thousands of trained nurses from overseas – as Brexit drove thousands of EU staff out, and Priti Patel smirkingly slammed the door on immigration.
- Inadequate provision of capital has not only made a nonsense of Johnson’s promises of new hospitals left hospitals crumbling for lack of maintenance. The backlog maintenance bill rose by almost 40% in 2019-20 alone, to £9 billion. In July 2019, fire chiefs threatened to close down parts of four hospitals that had become a hazard to patients and staff.
NHS Providers in August 2019 warned: “The NHS’ annual capital budget is now less than the NHS’ entire backlog maintenance bill (which is growing by 10% a year)”.
During 2020 thousands more NHS beds were closed, and thousands left unoccupied for infection control, social distancing and to switch staff and equipment to Covid wards and ICU.
So, as we have said in our Rescue Plan for Health Campaigns Together, to restart the NHS as a comprehensive service will require a substantial one-off increase of cash – plus increased annual spending. But as a ‘once in a century’ event, the pandemic requires extraordinary measures, including:
- A complete rethink on the Long-Term Plan, local plans to reconfigure services and build new hospitals, and a halt to all sales of NHS buildings and land – pending costing of fresh plans to re-jig and refurbish existing buildings with social distancing to restore capacity, reopen closed beds and avoid any need to spend billions hiring private hospitals.
- Investment in expanded mental health services and community support for those with Long Covid.
- A workforce transformation plan, coupled with a substantial pay increase for all NHS and social care staff, and investment in a programme to recruit and train thousands more health and care professionals.
- Full reimbursement for trusts for all of the additional revenue and capital costs of tackling the Covid epidemic.
So, we need an even more ambitious equivalent to the ten-year investment programme from 2000-2010 which reduced the waiting list and waiting times, and improved NHS performance on all fronts.
We know austerity worsens the health of the poorest, and Covid has further widened inequalities. So, the extra cash must come from the rich. The free ride for wealthy scroungers, the tax dodgers and billionaires must stop. It’s time to look after people, not profits.
Let’s fight to make them pay their share – for the sake of our health.