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Health Service At 70, the NHS is at a defining crossroads

GAIL CARTMAIL lays out Unite's demands for saving the NHS and creating a health service worthy of Aneurin Bevan’s grand vision

THE NHS, reeling from a cash crisis caused by the Tory austerity agenda, is at a defining crossroads as it prepares to celebrate its 70th birthday in July.

The NHS needs a massive and immediate cash injection to tide it over the winter crisis, a long-term funding plan to meet soaring demand in the decades ahead and a coherent, well-funded strategy that ensures that health and social care are neatly woven together.

However, under the malign stewardship of Health and Social Care Secretary Jeremy Hunt since 2012, we have seen the NHS drained of cash increases in real terms, a dedicated workforce demoralised by a dramatic erosion in their pay because of below-inflation increases, a recruitment and retention crisis across many health disciplines and increasing waiting times at A&E departments and for routine operations for patients.

That’s why there will be excellent turnouts for today’s demonstrations, organised by the People’s Assembly across the country, by people deeply concerned about the state of the NHS and what harm this hard-hearted Tory government has inflicted on one of Britain’s greatest achievements.   

While there is so much to condemn about Tory health policy, rhetoric is not enough. It is incumbent on those on the left to offer practical solutions to ensure that the NHS enjoys many more birthdays so that everyone in need benefits from a health service free at the point of delivery. 

Our health service is not being funded enough. Since 2010 the NHS budget has increased by about 1 per cent on average each year.

This is the worst funding settlement since the creation of the NHS in 1948. The average increase in funding has been almost 4 per cent per year, according to research from the Kings Fund.

This yawning gap needs to be bridged and a commitment to stick with the principle of progressive taxation to ensure health and social care are both free at the point of delivery. This may mean a rethink on taxation, possibly even an increase, if social care is to be stripped of the wrong-minded commercialisation and delivered as a public service. 

This would only work if the public was genuinely convinced that the money was going directly to the NHS and social care and not disappearing into general expenditure. 

While it has become practically universally accepted that the NHS needs more money and it needs it now — even a growing list of Tory MPs are demanding more funding — Unite believes that substantial funding must be coupled with a plan for its future, one that puts patients and the workforce at its centre.

There’s a lack of confidence across the whole NHS workforce that anybody really has a plan. Soundbites don’t make policy.

Staff have had a pay cut of almost 20 per cent in real terms since 2010 and this has contributed to a recruitment crisis. This needs to be addressed in a generous fashion by the independent Pay Review Body and its recommendations then need to be honoured and not undermined by ministers 

NHS Digital’s latest vacancy rates update showed that the number of unfilled advertised nursing and midwifery posts in England reached 34,260 in the three months to September — the highest level since records began.

Crucially, we need consultation with the staff and clinicians — the people who keep our hospitals and community services running — and constructive dialogue with local communities.

If politicians took consultation with staff seriously, they would listen to people on the front line like paramedics and nurses who would point out that, beyond a proper funding settlement, social care services must be in place for the NHS to survive. 

A strong social care set-up would stop people, often the elderly, ending up in A&E departments when they don’t have to be there, but the pathways need to be in place for this to happen.

We need to bring the social care system up to the high standards of the NHS, not move health services into our failing social care system. Councils across the country have suffered 40 per cent cuts at the same time as public health has been put into their domain, meaning that much-needed health visitors are being cut and district nurses are also being axed.

The Local Government Association predicts that local government will have an overall funding gap of £7.1 billion by the end of the decade when money to stabilise the adult social care provider market is included.

It estimates that underfunding of social care means that there will be a £2.3bn funding gap by 2020. 

Privatisation is also undermining the health service, with 43 per cent of clinical contracts advertised going to the private sector last year and cash-hungry octopus Virgin Care sucking up more than £1bn worth of NHS contracts with its tentacles. 

Commercial confidentiality cuts out staff consultation, whether that’s the right thing for patients or not.

Unite believes that privatisation of the NHS makes it more open to a Carillion-style collapse and is calling for a rethink on the billions in private sector contracts in the health service.

The collapse of Carillion,— which had many NHS contracts, including managing 11,800 beds, has brought the outsourcing of public services to profit-hungry private companies into disrepute.

Unite called on Lancashire County Council this week to reconsider its decision to transfer NHS community services to Virgin Care in a £104 million contract. We think there needs to be greater transparency surrounding Virgin Care’s finances.

Private Eye recently revealed that, much like Carillion, Virgin Care’s finances are questionable at best. On a turnover of £252m, the private outsourcing firm posted losses of nearly £16m last year. 

Its liabilities are larger than its assets by about £30m and the only reason, according to Private Eye, that the firm is “spared insolvency” is because its owner Richard Branson keeps pouring cash into it to keep it afloat.

We need to end the privatisation of services that’s extracting profits at patients’, staff and taxpayers’ expense.

We need short-term building blocks to stabilise the NHS, ie more money, evidence-driven reform that undoes the wasteful and ideological reorganisation carried out by Tory governments since 2010 and to reverse the haemorrhaging of staff numbers in nursing and other health professions by giving them a proper pay rise.

And then we must raise our eyes to the far horizons so we don’t rely on quick fixes, the sticking plaster approach, but create  a joined-up strategy for the future that would be worthy of Aneurin Bevan’s grand vision.   

Gail Cartmail is Unite assistant general secretary.

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