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Feigning concern, a Conservative pastime…..

03/13/2017

unknown-74“I reckon that people who work in the NHS think it deserves special treatment or something….” 

This was a comment made to me recently by a fellow NHS finance manager whilst discussing the gap that has opened up (and is now expanding) between the demand for NHS services and the level of funding it receives year on year. At first it struck me as a casual “ooh, look at fancy pants there off to that swanky cocktail bar in town while the rest of us sup in Wetherspoon’s” type remark. But this colleague was adamant that, in the context of cuts to other areas of government spending it was unreasonable for us to expect the NHS to continue to receive increases in funding year by year. Why should the health service be treated differently to any other government department when it comes to funding?

Of course, Conservative politicians lend credence to such views by falsely claiming that health service funding has somehow been ring-fenced and protected from any cuts driven by austerity. “Look at all the extra money that we’ve pumped into the NHS” they cry whilst feigning concern and professing support for the NHS, in public at least. But if we delve into the headline figures behind the rhetoric a very different picture emerges and one that shows the price that the health service is now paying, in stark terms, for bailing out the banks. Before we do though it’s perhaps worth reminding ourselves that the amount spent on propping up the capitalist system in 2008 (more than a staggering £1 trillion) could have funded the annual cost of the entire NHS ten times over. It’s a salutary reminder that when it comes to government spending it’s often a case of where there’s a will there’s a way. Whilst the banking system was “too big to fail” apparently it appears that the health of the nation is not.

Put simply the problems that the NHS currently faces are the direct result of a political choice taken by a government that does not have the will or the desire to adequately fund health and social care. We are told by the Department of Health that the main reason why demand for NHS services is now outstripping funding to such a degree is that we have an ageing population. You see, it’s us, it’s our fault, we’re all living too long. And, of course, not missing a chance to get another dig in about migrants, people who haven’t paid into the NHS pot coming over here and taking advantage of free access to NHS services (so-called “health tourists”) is also a major problem according to some. It’s true that we are, on average, living much longer than we did in 1948 when the NHS was born, by as much as twenty years in some cases, but to identify this as the major reason for the current financial problems is to miss a key point that ought to be staring us all in the face and perhaps rousing us from our settees to take to the streets in protest.

In the 2016-17 financial year the total budget for the NHS is £120 billion. This compares to a budget of £437 million in its first year of operation in 1948. To put that into context that sum now is roughly comparable to the annual budget of a medium sized district general hospital. However, it takes no account of rising prices over the last seven decades – at today’s prices, it equates to a total budget of around £11 billion. So over the course of its 68 year history the NHS’s annual budget has increased by pretty much eleven times its original figure.

images-78If we split this 68 year period into two and look at the periods before and after the current government came to power in 2010 then the differences in increases in funding year on year is stark. The total budget of the NHS in 2010 was £98 billion meaning that it had grown by about £87 billion in the health service’s first 62 years; an average increase in funding of 4.0% per year. Of course, this increase in funding wasn’t consistent across the six decades; investment in the NHS by the Labour government of 1997 to 2010, when there was a concerted effort to bring spending on health into line with other European nations, dwarfed that of decades like the fifties and eighties when the health service struggled financially.

Since 2010, however, the picture is very different. NHS England’s “Five Year Forward View” published in 2015 envisages a total budget for the NHS of £133 billion by the 2020-21 financial year; an increase of £35 billion in health service spending since 2010. But of this £35 billion around £24 billion will be swallowed up by increased prices so in real terms the increase in funding will be £11 billion over the 11 years from 2010 to 2021. This equates to an annual increase in funding of 0.9% per year. A fact that the Tories would prefer not to share with you is that we are living through the biggest squeeze on NHS spending since the 1950s. We now spend around 8.5% of our gross domestic product (GDP) on healthcare, considerably less than most European nations (the Netherlands and Germany spend about 11% for instance) and a percentage that is set to fall even further over the next few years.

But what does this mean? Well, in broad terms, it means that we’re putting the safety of patients at risk only four years after the publication of the Francis report into failings in care at Stafford Hospital recommended that we make patient safety a priority. Sir Robert Francis, the author of that report, recently warned that the current financial and demand pressures on the NHS have created an environment where another care scandal of the magnitude of that at Stafford Hospital is “inevitable”.

unknown-54The slimming down of the NHS during the last half dozen years has meant that the quality of care that patients receive has suffered. This is apparent, like a bad eighties flashback, in the number of people lying on trolleys in hospital corridors waiting to be seen. Indeed there have even been cases of hospitals having to turn away patients. And it’s apparent also in the number of patients that are forced to stay longer in hospital than they should because huge cuts to funding for social care often mean that there is nowhere for them to go. Health and social care is at breaking point. The Red Cross, not given to hyperbole, described it as a “humanitarian crisis”.

Arguably mental health services are struggling even more as can be seen with cases like the one recently reported in the Eastern Daily Press of a mental health patient being held in a police cell in King’s Lynn for three days as a result of a shortage of mental health beds across Norfolk and Suffolk where the number of mental health beds has been reduced by a quarter since 2012. It’s only one patient but imagine how you would feel if that was your son, daughter, brother or sister who was locked up in a police cell when they required urgent healthcare. Nationally the number of unexpected deaths of mentally ill patients has risen sharply as the availability of beds has decreased. The cuts in funding and beds are literally killing some people.

The chances are that everyone will use the NHS at some point in their life and naturally we all expect it to be there for us when we most need it. In a world where almost everything comes at a price to know that if we fall ill or have an accident that there will be trained people who will treat us with kindness and compassion, look after us and nurse us back to full health regardless of our social and economic status and without requesting to check our bank details is something very special indeed. And something worth fighting for. This “example of real socialism” as the founder of the NHS Nye Bevan called it hasn’t quite been swept away by the prevailing obsession with profit just yet. Earlier this month a quarter of a million people took to the streets of London to show their support for the NHS, a fantastic turnout and the largest demonstration of support for the NHS in its history. But we must all do our bit over the coming months before it’s too late. Don’t leave it to others, it’s OUR NHS remember.

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