On Saturday 3rd February people concerned about the current state and future of the NHS will be marching from University College Hospital to Downing Street*. Each group and each individual will have different views about what they want for the health service, but there are two things that all of them, and I hope all of you, would like from the prime minister and chancellor:
- urgent steps to resolve the current crisis; and
- the opening up to public and parliamentary scrutiny of evolving plans for another fundamental NHS reorganisation.
I'll be among the marchers, along with other members of Defend Enfield NHS, and I hope that many readers will be too. As is always the case with such demonstrations, the usual "Tories Out" brigade and Socialist Worker sellers will be in attendance, but don't let that put you off. The cries that something must be done urgently have now been taken up among Conservative voters and even among the top echelons of the Conservative Party. Not just by Boris Johnson, either, but by someone with some expertise in health matters, the Chair of the Commons Health Committee, Sarah Wollaston.
Urgent action being blocked
Unfortunately, the urgent action that is needed to ease the current crisis is being blocked by the prime minister and chancellor, both seemingly convinced that it is caused by a combination of a flu epidemic and NHS "inefficiency". Well, even if that were the case (which it isn't), the duty of PM and chancellor in the immediate short term is to protect the lives of the country's citizens. They need to provide the money that the NHS and social services need NOW before any more people die unnecessarily - the number of deaths caused by lack of capacity in the NHS and social services is already estimated to be 40. And we need to return to a normal situation where patients can have non-urgent operations throughout the year and don't have to put up with pain and suffering for several months, during which time they may lose their fitness, mobility and livelihoods.
That's the immediate crisis that needs fixing - it needs more money urgently and steps to tackle the serious staff shortages (100,000 in all, including 40,000 nurses). And the government needs to provide councils with money urgently, to spend on social services and public health, which will free up hospital beds.
Moving in the wrong direction?
My second concern is about the future organisation of the NHS and is more difficult to explain, but it can be summed up as follows: that work to transform the health service is going on out of the gaze of the public and of Parliament and appears to be moving the NHS in the wrong direction - away from the comprehensive service that those of us born after 1948 have regarded as our birthright.
In 2012, during the tenure of Andrew Lansley as health secretary, the way that the NHS runs was subjected to a massive and very controversial transformation. One of the results has been a further increase in use of the "market", both "internal" (existing NHS hospitals and other NHS bodies) and external (private). This was supposed to increase efficiency, but, as many predicted, it requires more bureaucracy and expensive legal services to set up and run the huge number of contracts involved, and so in practice distracts the NHS from its primary purpose and is hugely expensive and inefficient. Furthermore, the NHS has had to take on board these new costs during a period in which the government has not been providing the annual four per cent real-terms increase in funding that is always necessary just to stand still (needed to cover population growth and the increasing costs of medical technology). Unsurprisingly, local clinical commissioners and hospitals have run up huge "deficits" - in other words, the amount of money going into the health service has not been sufficient to cover its increasing costs.
NHS reforms that would be just as radical as the 2012 changes
The Department of Health and NHS England have been trying to find a solution to this problem by introducing NHS reforms that would be just as radical as the 2012 changes. A clearer picture has been emerging recently about their emerging thinking. It includes some sensible changes aimed at reintegrating the NHS systems that have been progressively broken up over the last 20 or so years, at preventing ill health and at bringing treatment closer to home. But there are some fundamental problems with their approach.
The first concerns funding. They want to run this improved way of looking after people's health, which will require increased spending on many aspects, on the same inadequate level of funding as the government is providing now. This inadequate funding would be distributed on a per capita basis to each of 44 areas into which England has been divided. And when, as seems inevitable, it turns out that the NHS body covering one of those areas finds it hasn't got enough funding for all the treatment that its population needs, it will stop providing some treatments. It may well turn out that these "less essential" treatments are exactly the kind that private hospitals offer at the moment, eg cheaper and less risky procedures like cataract operations, hip and knee replacements etc. So better off people will, grudgingly at first no doubt, have these operations done privately, while poorer people will have to do without and suffer the consequences for their mobility, employability and general health and wellbeing. (Some NHS campaigners take the view that the NHS is being deliberately run down so that the public eventually decide that a US-style insurance-based private system would be better - but I'm not convinced, yet.)
The second fundamental problem concerns the way in which these reforms are being developed: hurriedly and out of the view of both the public and Parliament. Now, you might support the ideas that I outlined in the last paragraph, or I might have misinterpreted the messages that have been coming out of NHS bodies and come to completely wrong conclusions. But I'm sure you'll agree that something as important as a radical restructuring of health and social services deserves to be discussed thoroughly by the public and by parliament. However, the Department of Health clearly does not want this. The health secretary was in fact intending to let the first contract for one of these new bodies (an Accountable Care Organisation) in April this year, without any parliamentary discussion, and also to use "secondary legislation" to enable this without the need for a parliamentary bill.
Softening of resolve?
Literally in the last couple of days there have been signs of a softening of the government's resolve not to fund the NHS adequately and to keep NHS reforms away from proper scrutiny. It now seems that the chancellor will be providing some more money for health (and for defence, in response to campaigning by the military's top brass). And the health secretary is "pausing" the first Accountable Care Organisation contract start and will be "consulting". I don't believe that either of these will go far enough, but this does indicate a susceptibility to public pressure.
So if you want an adequately funded and comprehensive NHS, of the type that we're all accustomed to, come along on 3rd February and help increase the pressure...
*The march is due to set off from Gower Street (near Euston Square station) at 12 noon. Members of Defend Enfield NHS will be meeting at Warren Street station (just round the corner in Warren Street) at 11.30am.
