It’s conference season! And with #GE2015 fast approaching our esteemed party politicians are all keen to outline why they’re best-suited for the ivory towers of Whitehall. As if by magic, each is now able to confidently proclaim themselves to be ‘the party of the NHS’. But what will really happen to the nation’s favourite institution after 2015? Here’s Peter Pannier with seven good guesses:
1. It will remain a political football.
7 May will be a “day of reckoning on the NHS” according to Andy Burnham. Danny Alexander is claiming a “comprehensive health service paid for by the taxpayer and delivered free at the point of need was a Liberal idea,” while Jeremy Hunt shamelessly suggested that “it will be the Conservative Party that completes Nye Bevan’s vision.” Meanwhile, Ukip MEP Louise Bours’s conference speech was described by The Telegraph as “an audacious bid to supplant Labour as the party of the NHS” (Greens, you get a mention below, don’t fret).
At the 2006 Conservative Party Conference Cameron boasted: “Tony Blair explained his priorities in three words: education, education, education. I can do it in three letters: NHS,” yet only 5% of health professionals in the UK think reforms since 2010 have had a positive impact. A&E closures and a shortfall of 4800 midwives have made the Coalition’s commitment to “stop the centrally dictated closure of A&E and maternity wards” farcical, while NHS staff have been treated to 3 years of dramatic real terms pay cuts.
“Don’t turn the National Health Service into a National Political Football,” Hunt demanded in his conference speech before swiftly insisting that “a Labour government with reckless economic policies is the biggest single danger to funding our NHS.”
It would appear Fergie Time is alive and well in politics – it’s crucial that we invade the pitch before the game ends.
2. It will begin to collapse.
Miliband made headlines over a promise of £2.5bn for the NHS, but like his derisory £8 National Minimum Wage policy and the Lib Dems’ offer of “an extra £1bn of real terms funding for the NHS in the years 2016/17 and 2017/18,” this is not actually much money compared to a ~£115bn annual budget (and it’s not even coming till 2017-18, which is too late given hospital Chief Executives are saying “next year [is] likely to be the toughest yet”). Neither the Conservatives, Lib Dems, nor Labour, has signed up to the “mandatory minimum ratio of nurses” demanded by NHS workers, of 4 patients to 1 nurse. In fact, a shortfall of more than 25,000 nurses is predicted by 2023.
While Tories brag cash spending on the NHS is increasing, funding is falling as a percentage of GDP and per person. With demand rising there’s not enough money to go around. Adult care services budgets were slashed by 20% between 2010-2013, making a sick joke of the ‘NHS ring fence’. Nearly a third of NHS trusts in England expect to end the financial year overspent, while only 2% of health staff say their organisation has sufficient finances.
Of course, money is increasingly being diverted from care to private providers; to the consultants, lawyers and labour time involved in writing and contesting contracts, costing upwards of £1.78million in one recent example; and to Private Finance Initiative (PFI) debt-repayments: Peterborough Hospital is spending more than 20% of its budget on PFI repayments.
When funding gets tight, things fall apart: treatment waiting lists recently topped 3 million people for the first time since 2008, 543 GP practices in England may close within the next year because a shortage of GPs, and 22 surgeries in Hackney, Newham and Tower Hamlets alone are likely to close. The use of a safe and effective NHS vaccine against Hepatitis B virus has been banned by Luton’s Clinical Commissioning Group, while Essex Council told patients to ‘Treat your own Dementia’, and Nottingham’s ‘mutual’ physiotherapy services offer patients factsheets instead of ‘hands-on’ physiotherapy. As the chairs of various Royal Colleges recently wrote: “The NHS and our social care services are at breaking point.”
3. Charges are going up.
In July 2013, NHS England stated that the NHS faced a ‘£60bn funding gap by 2025’. Regular attempts are made to use financial doom and apocalyptic demography to justify the unjustifiable. The Reform think-tank report “Solving the NHS care and cash crisis” proposed a compulsory annual fee to access the NHS, the removal of exemptions to prescription charges, means-testing, and ‘hotel charges’ for nights spent in hospital. When I wrote on this recently I felt the need to mention that Cameron recruited his chief health policy advisor from Reform, and the report was co-authored by Labour’s Lord Warner, and that Lib Dem Baroness Shirley Williams also thinks there’s a case for “a nominal charge for GP appointments.” But really all you need to know is that the Chief Executive of the NHS Confederation said on 30 September that hospital bosses will need to “think the unthinkable” if finances don’t change, and charge £75 a night to stay in a hospital.
From April 2015, 15 million patients will be offered Personal Health Budgets (PHBs). Research funded by the Department of Health says PHBs “do not improve health, do not improve mortality, and do not save money,” but they do make it easier to cut budgets with fewer opportunities for collective action, and lay foundations for charges.
Finally, in a bigoted response to Ukip and to set up infrastructure for wider charges, the Immigration Act 2014 allows a new charge for migrants of at least £200, to be paid at visa-application. Emboldened, Ukip have gone further, proposing that visitors and migrant workers not only “meet a minimum health insurance requirement,” but a “minimum health standard” in order to be allowed entry.
Charges will always be profoundly inequitable and less efficient than taxing income, but they’re attractive to private companies and those who believe they can suppress demand for health services.
4. More outsourcing, more privatisation.
Hunt demands we “stop scaremongering about privatisation that isn’t happening,” the Liberal Democrats claim they “stopped Conservative privatisation plans” (utter nonsense).
Privatisation and outsourcing mean cuts in staff numbers and conditions. Following cuts, just 27% of workers feel there are enough staff “to do their job properly” at Hinchingbrooke hospital, now run by Circle Healthcare, and Care UK cut the holidays and wages of staff in Doncaster, for example. Non-emergency ambulances have been privatised around the country, resulting in corner-cutting that led to the death of a double amputee who “died when his unsecured wheelchair tipped over as he was being transported [by G4S].” Serco will leave the UK clinical services market after “losses of £17.6 million on three of its NHS contracts,” having been fined for failing to meet performance standards, but Virgin now runs over 100 health services and 358 GP surgeries (including the surgery in Cameron’s Witney constituency).
Burnham stated in his conference speech that “the market is not the answer to 21st century health and care.” Given the market drains billions away from NHS services, this sounds good, but Labour’s policy is “the NHS as our preferred provider.” Like the Conservatives, Labour will probably include private organisations such as ‘mutuals’ as ‘preferred providers’ (as for the railways) – if the preferred provider policy isn’t ruled illegal.
Other providers will continue to bid for contracts, and will sometimes win (Burnham was heckled about this), and there’s still room for private purchasers (or commissioners). NHS England offered up £5bn worth of contracts to advise CCGs this year, meaning private companies “will advise on patient care reforms, finances, drug purchasing, negotiating hospital contracts, handling NHS patient care data, supporting organisational change and outsourcing services.”
The Labour Party is not offering renationalisation or ‘reinstatement’ of the NHS, despite the impression it is attempting to give.
5. ‘Integration’ of private and public provision.
“Just as Nye Bevan wrote to every household to introduce his new NHS, so I will write again in 2015 to explain what people can expect from our national health and care service,” Burnham promised in his conference speech. Labour’s activists will love this alignment with Bevan and to most people it probably sounds good. It’s been dissected well elsewhere – watch out for:
- Means-testing being brought into the NHS from social care.
- The merger of two near-bankrupt services producing one bankrupt service.
- Guff about people being treated ‘at home’ or ‘in the community’ as code for ‘closing hospitals’.
- The introduction of conditionality from the DWP (or a DWP with a ‘minimum health standard’).
- Access via benefit cards, as in Australia.
- Integration of purchasers and providers into private companies.
Before leaving NHS England, former Chief Exec David Nicholson advised looking “closely at US organisations Geisinger and Kaiser Permanente.” This model suggests “companies would decide if the NHS will fund a treatment for their customers, and then perform it too.” There’s also nothing in what the Lib Dems are saying about ending the purchaser-provider split to suggest this isn’t what they intend.
6. It won’t make much difference which party wins the most seats.
Neither Labour nor the Conservatives plan to raise sufficient funding for the NHS. Neither of them have plans to abolish PFI or to default on or renegotiate current PFI debts. Neither plans to remove the market. Both have plans for integration that will likely involve further privatisation. The Green Party support the “Campaign for an NHS Reinstatement Bill 2015,” as do some Lib Dem figures, but the text of Labour’s proposed version is not yet public.
7. Resistance is on the cards.
There are tentative glimpses of a movement capable of reclaiming the NHS. A campaign I was involved in saw health workers and the local community stop privatisation of Gloucestershire’s community health services (planned under Labour legislation). Union and public campaigning also stopped the sell-off of George Elliott hospital in Nuneaton (despite the investment of at least £1.78 million by NHS organisations in the process). Last week nearly 4000 people filled a rugby stadium in Whitehaven to protest at threats to West Cumberland Hospital, while Cambridge mental health drop-in centre ‘Lifeworks’ was saved from closure after a sit-in by patients that, despite being planned for two hours, lasted nearly four months.
From 13 October, members of GMB, Unite, UNISON and the Royal College of Midwives will take industrial action including strike action from 7am-11am on the Monday in pursuit of wage increases. Please show your solidarity by joining, and refusing to cross, picket lines. Here’s some advice on how to show your support.
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Many of the references in this article are to pieces hosted by Open Democracy’s OurNHS project – worthwhile journalism desperately in need of cash. Support it here.