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STP me if you think you’ve heard this one before

07/05/2017

images-15There’s a fair chance that, whatever you’re up to, if you’re incurring the people hating wrath of the likes of Jeremy Clarkson or the Daily Mail then, quite frankly, you must be doing something right. So after going on strike to protect our “gold plated” NHS pensions in the autumn of 2011 to return home after a day on the picket line to hear Clarkson spitting feathers on The One Show claiming that he would have the strikers taken out and “shot in front of their families” was music to my ears.

Back at work the following day our hospital’s finance director expressed some admiration for the strikers for standing up for what we believed in but her bleak assessment was that there was “no alternative” for the NHS and the rest of the public sector other than to face up to the reality of years of cost cutting (dressed up in management speak as “efficiency savings”) following the financial crisis of 2008. It was a view that was widespread at the time, and still is, amongst NHS bigwigs. A view that we must pay the price for bailing out the banks by shrinking our public services; it’s considered the “the right thing to do” in the circumstances.

The 2011 strike was the first national walk out by NHS staff since the ambulance dispute of the late eighties (when then Health Secretary Ken Clarke infamously labelled ambulance workers as little more than “professional drivers”) and for many NHS workers it was about much more than simply protecting our pensions; it was a protest too against the wider destruction of the NHS about to be unleashed by the Health and Social Care legislation that was, at that point, trundling through parliament. We’d had enough of the relentless “private sector good, public sector bad” market-based twaddle that had infused health policy for more than two decades – it was time to stand up and be counted. And, as we stood with our placards on the picket line in front of the hospital on that November day the tooting of horns of passing cars, lorries and buses and supportive comments from patients and members of the public told us that we weren’t alone in our view that enough was enough.

NHS workers strike in London over pay increase disputeThe slimming down of the NHS over the half dozen years since that day has inevitably meant that the quality of care that patients receive has suffered. You can see it in the longer waiting times for routine operations and in the struggles of Accident and Emergency departments to cope. It’s apparent too in the increase in the numbers of patients who 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 (the government’s pretence that the funding of healthcare has somehow been “ring-fenced” whilst simultaneously plundering local authority social care budgets is surely one of the biggest political con tricks of our time). And it’s visible too in the lack of time patients are able to spend with their GPs; in the rationing of healthcare such that certain procedures are only available to those who are in the most pain; and in mental health services across the country that are stretched to breaking point. The Red Cross, not given to hyperbole, has spoken of a “humanitarian crisis”.

The roots of the current obsession with cost cutting and running hospitals as businesses can be traced back to the early nineties when the Tories began the process of carving up the NHS into purchasers and providers of healthcare; a system referred to as an “internal market” and a precursor to encouraging greater private sector involvement in the NHS. The NHS, as an example of socialism in action with everyone arriving through the doors of a hospital treated equally regardless of their economic status, has long been anathema to the Tories particularly those in thrall to the market.

That there is a “market” at the heart of the NHS is a point completely lost on the vast majority of patients and members of the public. And that this system is estimated to cost around £10 billion a year to run (to pay for an assortment of accountants, data analysts, contract negotiators, management consultants, legal advisors, computer software etc) is barely mentioned by any senior NHS figures, politicians or think tanks when discussing how the health service could save money. Remarkable given the near obsession with cutting costs. Having worked in various NHS finance departments for over twenty five years I’m at a loss to point to a single benefit that this market system has brought to patient care.

And now along come the so-called Sustainability and Transformation Plans which break the NHS down into 44 regional “footprints” and provide the means by which NHS England hopes to extract a further £22 billion worth of savings by the year 2020. This is on top of the £20 billion already squeezed out of the system in the first half of the decade; a programme of cost cutting that sold us the lie that the dire economic situation following the global financial crisis of 2008 somehow presented the NHS with an “opportunity” to simultaneously strip £20 billion out of its budget and improve the quality of patient care. That this “challenge” was inflicted on the NHS at the same time as a major reorganisation of services following the Health and Social Care Act of 2012 simply rubbed our noses in the dirt.

These STPs are based on work that has been going on across the country for several years now looking at “reconfiguring” health services and labouring under such nonsense-names as “fit for the future”, “healthier together”, “shaping a healthier future” and “better services, better value”; words stripped of their true meaning to concoct meaningless slogans that are, in turn, fed to a public too busy fiddling with our phones to be unduly concerned about the potential closure of our local Accident & Emergency department. Or so they think.

This ideological assault on the NHS has brought us to a situation where more than eighty per cent of hospitals are in debt and during the last financial year the NHS as a whole was £2.5 billion in deficit. To put that into some sort of perspective, when the Tories came to power in 2010 the health service was breaking even. Ironic that the party that prides itself on “balancing the books” should make such a mess of the finances of the NHS.

But the dire financial situation that the NHS currently finds itself in is far from accidental or somehow inevitable as the government would prefer us to believe – it is the result of a stark political choice, pure and simple. The government has chosen to starve the NHS of much needed funds with the result that since they came to power in 2010 they have overseen the biggest sustained cut to the amount of money that we spend on health care since the birth of the NHS in 1948. This means that we now spend 8.5% of our gross domestic product on healthcare, considerably less than the Netherlands and Germany who spend around 11% and also less than the likes of Greece, Portugal and Austria.

imagesThis fact alone makes a mockery of the argument that is continually trotted out that the NHS is overspending, that it is inefficient and that if only those doctors and nurses, instead of protesting and walking out on strike, worked a little bit harder then we would not be in this mess. Far from being the result of inefficiency on the part of its hardworking clinical staff the financial crisis that the NHS currently faces is ultimately the product of a world view that huge multinational banks are too big and too important to fail but the health of the nation is not. That we can justify spending billions on weapons with the capability to wipe out hundreds of thousands of people but refuse to adequately fund our health service is difficult to stomach.

By rights we should be on the streets protesting at this government’s dismantling of our heath service. Far from being unaffordable a fully functioning NHS is absolutely essential to a successful economy. How can we hope to have a booming economy if we are too ill or too frail to go to work? A point that is often overlooked in the debate on affordability is the fact that for each one pound that we invest in the NHS we receive three pounds worth of benefits to the wider economy.

Yes, the NHS has its faults, but let’s face it what other organisation of similar size doesn’t? It’s a vast organisation that sees and treats around one million people every thirty six hours. However, despite the many pressures it faces it is a wonderful system that bears comparison with any other healthcare system in the world. In fact, it does more than that, it’s the top of the pile according to a 2014 study by the Commonwealth Fund that compared different health systems around the world.

So it comes as no surprise that when we finally get a political leader who challenges this deeply entrenched view that there is no alternative to austerity that, of course, it scares the living daylights out of the press barons and broadcasters who fail to hold the government to account, protect this mainstream view and in the process label anyone who makes the case for an alternative, be they a politician or a striking NHS worker, as some sort of extremist.

As well as committing to properly fund the NHS Labour’s recent “radical” election manifesto also promised to reverse the privatisation of the NHS and return it into public control; thus signifying the rejection of more than two decades of the NHS snuggling up to big business. At last, in Jeremy Corbyn, we have a political leader prepared to take on the might of the huge multinational companies who are itching to grab a slice of the billions spent annually on the NHS. It’s wonderful to see and provides a glimmer of hope that the NHS can survive the ideological onslaught that has been waged on it for more than two decades.

The NHS is something that we, as a nation, should be immensely proud of and provides proof that putting people before profit can work. Established in the aftermath of war and when the country was on its knees financially, it remains one of our greatest achievements and “an example of real socialism” as its founder Nye Bevan declared. 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 checking our wallets is something very special indeed. That we should celebrate the 5th July, each and every year, as national NHS Day feels like, to coin a phrase, “the right thing to do”.

#MakeJuly5NHSDay

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