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TODAY is the National Health Service’s 75th birthday. It remains a precious lifeline for the population as a whole, largely thanks to the increasingly valiant efforts of its 1.3 million staff, who have defied the odds to keep services going despite government policies.
But a record 7.4m on the waiting list and thousands of emergency patients left waiting hours on trolleys for lack of hospital beds are stark reminders of how far its performance has fallen.
When David Cameron’s Tory-led coalition took office in 2010 the NHS was reaching a peak of performance, with record low waiting times for elective and emergency care, and record high levels of performance and public satisfaction. These are now a distant memory.
The target for 95 per cent of people in accident and emergency to wait no more than four hours has not been met since 2015: the 92 per cent target for patients to wait no more than 18 weeks was last achieved in 2016. Cancer services have been missing targets since 2015.
Staff shortages, worsened by over a decade of real-terms pay cuts, have risen five-fold since 2010, with four times more vacant posts for doctors and five times more nursing vacancies.
Austerity had forced the NHS into decline well before the Covid pandemic: by December 2019, when Boris Johnson won a landslide majority (with empty promises of increased NHS spending and “40 new hospitals”) the waiting list was already double the 2010 level, at 4.5m.
Thirteen hard years of austerity and cuts in public health and prevention have undermined the health of communities and widened inequalities, while real-terms spending cuts, bed closures, staff shortages — and the continuing crisis in privatised social care — have limited NHS capacity.
So-called “reforms” imposed on England’s NHS by the Tory-Lib Dem coalition in 2012 were focused on forcing more services to be contracted to profit-seeking private providers.
That massive and costly reorganisation fragmented services, undermined the finances of NHS trusts, and boosted spending on private contractors, not least by privatising more and more mental health services, despite the often poor quality of private-sector provision.
Subsequent “reforms” last year unpicked some of those changes, but carved up England’s NHS once again — into just 42 integrated care systems, led by boards that are answerable only upwards to ministers, not to local communities they are supposed to serve, which range in size up to 3.5m people.
ICBs were established last July, and since then have remained locked in a financial crisis, seeking an impossible £12 billion of “savings” to balance their books by 2025, with some now blatantly refusing to reveal where cutbacks totalling tens of millions will fall.
The Rishi Sunak government has ignored stark warnings from emergency specialists, cancer specialists, mental health specialists and many more that services are in a dire state and in need of investment.
But ministers have instead responded to lobbying by anxious private hospital bosses who have not seen business boom as they expected despite the soaring NHS waiting list.
They are now focused on finding ways to compel more NHS bodies to send patients to private hospitals — the policy that was an expensive failure when Tony Blair’s government first tried it in the mid-2000s.
Prices for private treatment have risen so high only a small minority can pay to jump queues — leaving the so-called “independent sector” actually dependent on NHS-funded patients for its profits.
Now ministers have risked further worsening staff shortages by revealing their pathetic “workforce plan,” offering too little, far too late. It talks (as does the Labour Party) of more training and recruitment — but has nothing concrete to say on the retention of staff already in the NHS.
Published in the midst of the most substantial and sustained strike action in the history of the NHS, the plan makes no mention of increasing — let alone restoring — the value of NHS pay: nor does it offer any commitment to tackle the workplace issues that make life for too many NHS staff frustrating and miserable.
The plan includes no commitment to improve working conditions with (for example) free parking for staff, creche facilities and flexible working for parents, hot meals available for night staff, a crackdown on all forms of management bullying and discrimination, and support — including mental health — for staff working under constant stress.
The plan is unlikely to result in new expanded courses until 2025, and so far has no clear source of funding.
It may eventually deliver extra recruits, but without other changes, this will be only after thousands more existing NHS staff have left, demoralised and frustrated with declining pay, lousy conditions and by being unable to deliver the quality of care they were trained to give their patients.
Once again a ruthless Tory government has vandalised the NHS, leaving it in an even worse state than they did in 1997. They are stuck on policies that have been proven to fail. To change things for the better we need not only a change of government but a complete change of policy.
Sadly, the same Tory policies are being limply echoed by Labour. The party that brought in the historic Agenda for Change pay scales based on job evaluation almost 20 years ago, now won’t even promise to restore the real-terms value of NHS pay to that level.
Labour also refuses to make any commitment to extra spending, even after Blair’s government in 2000 eventually committed to a decade of historically large increases that cut waiting times and delivered enhanced performance up to 2010. And of course, Labour supports Sunak’s plan to rely on private hospital capacity rather than invest in the NHS.
This is no way to win the confidence of 1.3m health workers or the wider electorate.
The greatest-ever danger to the NHS demands the boldest answers to rescue it. Health Campaigns Together, Keep Our NHS Public and SOS NHS have called for an emergency injection of £20bn as a down payment to kick-start a recovery and begin to rebuild NHS capacity, backed by a commitment to at least a decade of real-terms spending increases to repair the damage that has been done.
And the NHS needs to stop squandering cash on outsourcing clinical and support services, bring privatised contracts back in-house and build back the workforce and capacity for the NHS to once again match and exceed the performance it delivered in 2010.
John Lister is a founder member of Keep Our NHS Public (keepournhspublic.com).
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