The National Health Service is currently being subjected to a government induced and government managed decline in order to legitimate arguments and policies promoting its privatisation. Historically the NHS has been able to rely on real-terms funding increases on a year-by-year basis. But, since 2010, from the Coalition government onwards, the NHS has been subjected to the longest spending squeeze in its 70-year history. The historic average funding increase that the NHS could expect to receive has historically fluctuated around just under 4%; reaching its peak in the New Labour years when it was in excess of 7%. But, under the Coalition government, the short-lived Cameron government, and the omnishambles that has been Theresa May’s premiership, the NHS has averaged a dire increase of 1%. And the results, both for the health service and for the millions of people who rely upon it, have been nothing short of catastrophic. The latest figures from NHS England are a testament to this.
They reveal that A&E performance is now at an all-time low. Only 77.1% of patients admitted to A&E last month were treated within four hours of admission. The worst performance on record since the four-hour target was introduced by New Labour in 2004 and part of a trend where the target has not been met since July 2015. As a result, the government and NHS England – against the advice of the medical profession – are now seeking to abolish the target. Things also don’t get any better when we look at cancer performance. At a national level, 5 out of the 8 key targets for cancer treatment have been missed since 2013/14, with the NHS’ performance in meeting key cancer targets now also at an historic all-time low. The waiting list for elective surgery is also at its longest since records began.
In light of this it is hardly surprising that satisfaction with the health service has plummeted. For those of us who want an NHS which is funded by the tax-payer, which is free at the point of use and premised upon the values of social solidarity, it is now more important than ever to continue making the case that the NHS is not failing of its own accord, but is instead being deliberately failed. And our first port of call should be in challenging the government over its recently unveiled Long Term Plan for the NHS.
A Long-Term Plan for the NHS?
In January the government unveiled its much-awaited Long Term Plan for the NHS. It caused quite a stir. In the runup to the NHS’ 70th birthday, the Prime Minister committed to a real term annual 3.4% increase in funding for frontline care between 2019/20 to 2023. The “plan” reaffirmed this commitment. However, the problem with this commitment is that it simply doesn’t meet the needs of the NHS.
For a start, all independent experts including the Institute for Fiscal Studies, Health Foundation, Kings Fund and the Nuffield Trust have stated that this amount will only allow the NHS to continue providing the same level of care it is currently providing. In short services, won’t and can’t improve with this level funding. In fact, it is more likely that performance will deteriorate once we take into account the context of an ageing population with long-term, complex and chronic conditions. All of the aforementioned commentators agree that a 4% increase is the bare minimum required to even begin improving services.
What’s more, none of this funding will be going towards public health initiatives. Historically, local authorities have funded services providing sexual health services, alcohol services, drug services and other public health services through the Public Health Grant. A grant from central government to local government. But this grant has been butchered by the Conservatives. Between 2014/15 and 2019/20 it has suffered a real term cut of £700m. That amounts to nearly a fall of 25% per person across the entire country. As a result, improvements in life expectancy are now stalling – according to the Health Foundation think tank – for the first time in 100 years.
Similarly, the funding won’t be going towards capital expenditure. This is what allows NHS Trusts to spend on core infrastructure, both physical and digital. As well as medical equipment and medical devices such as scanners for cancer and ambulances. Between 2010/11 and 2014/15 capital spending was subjected to a 17% cut. In more recent years, its budget has been consistently raided in order to prop up social care and the day-to-day running of front-line NHS services. In 2018 Jeremy Hunt raided £1bn from the budget to go towards funding social care. Not only is such an action perverse in light of the fact that the Conservatives have subjected social care to an overall cut of £7bn since 2010, it was also a brazen example of the short term thinking which has led to the breaking down of ambulances during last years “winter crisis”, the breaking down of CT scanners, blocked drains and sewage leaking into clinical facilities, leaks from ceilings going onto active operating tables and even the collapse of an entire floor of an NHS hospital.
As if all of this wasn’t bad enough, it is then compounded by the fact the money also won’t be going towards training and recruitment. The NHS is in the midst of a recruitment and retention crisis. In 2015 Jeremy Hunt pledged that the government would recruit 5000 full-time extra GPs by 2020. Yet the total number of full-time GPs has consistently dropped since 2015. The most recent data shows there has been a further 2% drop in full-time GPs whilst GP partners have also dropped by 4.4%. It’s almost as if the current Health Secretary’s penchant for breaking the ministerial code, by appearing in advertorials paid for by a private company, to promote the roll-out of a privately owned app financially undermining general practice, is having a detrimental effect on the uptake of general practice as a career, but I digress.
On the face of it, all of this could appear to be the result of incompetence more than anything else. And of course, there is a grain of truth to this. But overall, something far more sinister – and calculated – is going on.
Firstly, the money that has been given to the NHS is being used to justify the closure of services. As John Lister at Health Campaigns Together has pointed out, the “plan” asks all NHS Trusts and Clinical Commissioning Groups to be out of deficit by 2023. An impossible task considering that 65% of acute hospitals currently face deficits of £1.8bn, and that the total amount borrowed by NHS Trusts as emergency loans from the Department of Health and Social Care raises this to a total of £12bn.
In short, the government is using the inadequate cash injection in the “plan” as a pretext to demand the impossible. The aggressive deficit reduction proposed by the “plan” can only mean that services close. This is made clear, for example, in the proposal to create a new GP contract which would lead to the merger of GP practices that would cater to massively increased numbers of patients. NHS England has previously made clear that this would entail an overall reduction of the 7500 currently operative GP surgeries in England, to a mere 1500.
But not only is the government deliberately setting an impossible series of targets which it knows will undermine performance, it has simultaneously used this as an opportunity to encourage patients to turn to private providers when those services inevitably decline. This is made clear on pages 24 and 74 of the plan, where it states that all patients upon being referred for an elective procedure will have the opportunity to go with an “alternative provider”, paid for courtesy of the NHS. It also goes on to state that should someone wait longer than six months for treatment, the NHS will directly contact them and give them the “option of faster treatment at an alternative provider, with money following the patient to fund their care”. In the context of the NHS having the longest waiting list for elective surgery since records began, it doesn’t take a genius to see what’s going on here.
Of course, it should be pointed out that the NHS – unfortunately – now has a rather long history of having to pay for procedures provided by private providers. Usually at a higher cost than if it had provided them itself, and in a number of cases, having to rectify the physical damage to patients caused by those hospitals and their usually lower standards of safety. So, it’s not the biggest surprise that some would attempt to argue that the inclusion of the option has been done in good faith, rather than as a calculated attempt to normalise the routine use of private health care.
However, such arguments do not stack up when the commitment of the plan to promoting the “right” to take up private care is situated in light of the fact that the plan is also seeking to rebrand Accountable Care Organisations (ACOs) as Integrated Care Systems (ICS). And what is more, has committed to their being rolled out across England in their entirety by April 2021
ACO, ICP and now ICS
I’ve previously written about ACOs and how they literally represent an existential threat to the NHS. Successive campaigns waged by the likes of JR4NHS, Health Campaigns Together, the National Health Action Party, Keep Our NHS Public, Call 999 for the NHS and many more, have heaped pressure on the government and NHS England to drop the rollout of these pernicious contracts. Yet each time the government and NHS England have responded by attempting to rebrand them.
But for those of you who don’t know, ACOs and the ACO contract are a based on the Sustainability and Transformation Plans drawn up in secret by NHS England and the big four accounting firms. These plans divided England into 44 regions with a CCG per region. Each CCG would then be required to award an ACO contract to an Accountable Care Organisation. This organisation could be made up entirely of private healthcare companies or it could be a mixture of private and public health companies. Even where the provider was entirely made up of NHS bodies it could also have the power to subcontract to private providers.
However, the main point to understand is that these organisations providing services will not be public bodies. In turn that means your ability to hold them to power will be drastically undermined. They won’t be required to consult Local Authorities or residents when they wish to shut down services, nor will they be required to comply with Freedom of Information requests. Their funding structure is designed to exclude those with irregular migration statuses from being able to access care – incidentally the commitment to the racist exclusion of those with irregular migration statuses is also reaffirmed in the current “plan” as the “overseas visitors costs recovery” – as well as hard to reach patients such as the homeless. On top of this they are designed to encourage co-payments. In short, the 400 NHS contracts that Richard Branson’s Virgin Care has managed to amass since the introduction of Health and Social Care Act 2012 will look like small beer.
Accountable Care Organisations haven’t been voted on in parliament. There is literally no law which justifies their being brought into existence. Public consultation on the ACO contract only came about as a result of a judicial review originally spearheaded by the late Professor Stephen Hawking. If this “plan” shows anything, it is that the government is still very much determined to bring these to fruition.
The government wants to delegate the management, decision-making powers and delivery of healthcare worth billions of pounds to unaccountable private providers. Consequently, this is why we shouldn’t get distracted by the lip service the “plan” pays to removing the clauses of the Health and Social Care Act which have required the NHS to put services out to competitive tender on the private market. It is nothing more than a distraction from a far bigger threat.
Don’t be fooled; this “plan” is nothing more than another covert, and ever more cynical attempt, to undermine one of the remaining institutions in our society which is still founded on the principle of people before profit. We must fight to save it.
Kane Shaw is the Press Officer to the National Health Action Party
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