This month student nurses and junior doctors are taking up the fight to save the National Health Service. At the end of the month, on 30 January, a “Health Campaigns Together” conference, backed by the Unite and Unison trade unions, meets in London.
The campaign for the NHS Reinstatement Bill drafted by Allyson Pollock has been boosted by the Corbyn surge in the Labour Party, with a regular page on the campaign’s website now reporting on support from local Labour Parties.
One issue is funds. The Tories say they aren’t cutting the NHS, but they are. They cover up by claiming that the missing billions are “efficiency savings”.
An ageing population and more new treatments, expensive at first, mean that a standstill in NHS cash translates into cuts in real terms.
Another issue is the knock-on from the Tories’ huge cuts in local government funding. Councils have cut social care. Elderly patients well enough to leave hospital but not well enough to manage on their own get stuck in hospital, and that leaves fewer hospital resources for other patients.
A third issue is creeping NHS privatisation. When the Tories and Lib-Dems passed the Health and Social Care Act in 2012, health expert Allyson Pollock declared: “The Act effectively reduces the NHS to a funding stream and a logo. Behind the logo, corporations bid for health contracts in a regulated market”.
The Tories protest that still only 6% of the NHS budget goes to private firms. The Kings Fund reckons that about 9% of the total NHS budget is spent on non-NHS providers excluding dentistry, medicines, and general practice (not all “non-NHS” is private).
The private sector still leaves basic and difficult health care to the NHS, and for now mostly picks up easier stuff on the edges. It’s a lot of smaller contracts.
Private firms have been winning 40% of contracts that GPSs’ “clinical commissioning groups” put out to tender, worth a total of £2.3bn, only slightly fewer than the 41% awarded to NHS bodies.
According to the Kings Fund, in acute care commissioners spent about £14 million less in real terms on non-NHS providers in 2012/13 compared to 2011/12.
But in community health services the private-sector proportion increased from 12 per cent in 2010/11 to 18 per cent in 2012/13.
Private-sector mental health providers raked in 12 per cent more between 2010/11 and 2012/13, while spending on NHS mental health fell 2.5 per cent in real terms over the same period.
The contracting-out process does harm even when a public-sector provider wins. In December “UnitingCare Partnership”, a consortium of local NHS trusts, pulled out of the contract it had won only eight months before to provide NHS care for elderly patients in Cambridgeshire and Peterborough. It said, in effect, that it had cost-cut so much to win the contract that it couldn’t deliver it.
Allyson Pollock writes: “There is mounting evidence that the English NHS is paying for work regardless of whether it is done or not: with one contract, Netcare did not perform nearly 40% of the work it had been contracted to do, receiving £35.1 million for patients it never treated.
“The English NHS is on a track towards the US system, where commercialisation results in around $750 billion wasted each year due to overtreatment, undertreatment, and billing, invoicing, and marketing costs”.
The NHS can still be reinstated. But contracting-out is siphoning off its life bit by bit.
With its new leadership, the Labour Party can and must be turned round and turned outwards, to campaigning on the streets for the NHS and pledging unequivocally to reinstate a Health Service based on social provision for need, not market mechanisms.