“It’s not clever tactics for Labour to be focused on policies so close to the Tory line that the right wing press and private sector can claim there is a “cross party consensus” – especially when the consensus is on greater use of private hospitals.”
Dr John Lister, Keep our NHS Public & Co-Editor of The Lowdown
We know the NHS has been reduced to a state of chronic crisis by 13 miserable years of Tory austerity, underfunding, privatisation and plunder. We all depend on the NHS – it’s the only provider of emergency care, and the only provider with a historic commitment to treat all who need care.
To defend it, restore it and improve it we need a change of government – but most of all a change of policy, to ensure the NHS gets the immediate cash injection needed to kick start its revival. It’s not clever tactics for Labour to be focused on policies so close to the Tory line that the right wing press and private sector can claim there is a “cross party consensus” – especially when the consensus is on greater use of private hospitals to treat NHS patients.
This policy was tried by Tony Blair’s government in the 2000s and wasted millions, creating a new, parasitic so-called ‘independent sector’ that was always entirely dependent on NHS funding. It cost more per patient, and drained money from NHS budgets, but failed to make any significant difference to waiting lists, because the lion’s share of the work reducing waiting times was done by NHS hospitals.
There’s no reason to think this would work any differently now.
The Health Foundation and the NHS Confederation have questioned whether sending the least complex cases to small private hospitals really adds any extra capacity – rather than diverting treatment to a different venue. NHS Providers have warned that because the private sector can only take the lowest risk patients, those with greatest health needs wind up waiting longer for inadequate numbers of NHS beds.
This is especially true when, as now, around one front line bed in six in England is filled with Covid patients, or medically fit patients who can’t be discharged for lack of community health and social care.
If we want more recent proof that privatisation of elective care is a costly and ineffective solution to waiting lists a new report has just analysed the results of a 3-year experiment by the right wing government in Alberta, Canada, seeking to privatise 30% of elective operations. It increased costs and led to less surgical treatments being done, fewer specialist operations in public hospitals, public sector operating theatres standing idle, and longer waits.
And if anyone thinks that is in any way a progressive policy, ask why it is most stridently embraced by right wing parties – Tories in Alberta, Ontario – and now Sunak’s Tories in England.
If we want to expand capacity in the NHS the cheapest and most efficient way to do so is to expand the NHS itself, not build another, smaller, profit-centred alternative. And this is even more true of mental health where rampant, scandalous expansion of poor quality private sector care since 2010 has flowed directly from the austerity squeeze and lack of capital to expand NHS capacity.
If we’re talking seriously about integration of services, that starting point should be integrating them within the NHS rather than fragmenting into multiple contracts.
Another cross party consensus seems to have emerged on primary care and community services. This is another puzzle. Figures show 3,500 English GPs left primary care in the last 12 months, almost half of them citing burn out as the reason. Since 2012-13 England has had a 7% increase in population, a 20% increase in GP workload and a 12% decrease in real terms funding for GP services.
And it’s not just GPs who have been walking away and not replaced: we have seen a 42% reduction in District Nurses, a 30% reduction in health Visitors, a 23% cut in Learning Disability nurses, 25% fewer school nurses. And while we are talking about resources in the community and primary care we have had a 12% reduction in nursing home beds and a 16% reduction in residential home places.
So when the Labour Party issues a 20-page Mission statement on the NHS, and talks repeatedly about moving care out of hospitals and into the community we have to wonder how the authors think this could be done without a lot more investment, not least to reverse the cuts that have been made to public health and prevention. How can they deliver the thousands of additional staff they are promising without improving the conditions and pay levels – and committing to the necessary spending.
We also have to wonder whether the people advising them have any idea that health secretaries of both main parties have been flogging this exact same dead horse for at least 30 years, hoping to cut pressure on – and funding to – acute hospitals by diverting patients elsewhere.
It hasn’t happened yet, and we can confidently say it won’t happen soon, because without a serious commitment to put the right resources in place, patients gravitate back to the one bit of the NHS they know will be open 24/7 and deal with all-comers. And when we say the right resources we have to include the F word. Funding.
Of course we have been repeatedly told about Labour’s plan to train more doctors and professional staff – funded we are told by taxing any slow witted non-doms who have not upped-sticks to tax havens in Jersey, Guernsey or the Isle of Man.
But we have yet to hear any convincing commitment to measures that could retain the staff who are now in post, to improve the working conditions, staffing levels, mental health and other support for staff working under constant pressure.
We are yet to hear Labour, the party that brought in the Agenda for Change pay system based on job evaluation, commit to restoring the real value of today’s pay to the equivalent when the scheme was established. We have yet to hear Labour speak up in support of the very reasonable demand of junior doctors for their real terms pay, reduced since 2008, to be restored.
It seems accepting long term continuing pay cuts is another cross party consensus.
So will we keep seeing the rising numbers of British-trained doctors working overseas? It makes no sense to train more staff unless you also organise to keep them and support them in the NHS for the long term.
What is the essence of what I’m saying? To keep on doing the same thing, and hoping it will turn out better is a definition of madness. But to promise to do pretty much the same as the Tories and expect to magically improve the NHS and meet “all the big NHS targets in 5 years” is political madness.
The cross party consensus is quite probably another reason Labour’s own advisors are warning that their policies for the NHS are not “cutting through” to voters.
People want a change: NHS staff know they need a change. They don’t want a cross party consensus, and they want an NHS for all, rather than the private sector cherry picking the easiest cases while they struggle to cope with the rest. SOS NHS, Keep Our NHS Public (KONP) and Health Campaigns Together (HCT) have called for a £20bn cash injection into the NHS – to finance a fair pay settlement, tackle the £10bn maintenance backlog, start rebuilding the collapsing hospitals, increase spending on mental health – and to pay for the extra staff the NHS so desperately needs.
It’s a tangible, understandable demand. It’s a down-payment, but would show intent.
We have explained how much more than this could easily be raised by taxing only the wealthiest, who have become so much wealthier as the majority have got poorer since 2010, and big business, which has been so merrily stacking up profits while the cost of living crisis weighs down on millions of families.
If the NHS is to be repaired after the Tory wrecking crew are finally forced out it will need bold commitments like this, firmly focused on staff, funding and capacity to drive that forward.
- This article is a published version of the speech given by Dr John Lister at the “NHS @ 75 – How can we repair & restore it after 13 years of austerity?” held as part of Arise Festival 2023. You can watch it here or listen to the discussion on the Arise Festival podcast.
- Dr John Lister is a founding member of Keep Our NHS Public and co-editor of The Lowdown. You can follow him on Twitter here; read The Lowdown here; and follow Keep Our NHS Public on Facebook, Instagram and Twitter.