Contribution to Merseyside Keep Our NHS Public meeting - NHS Crisis: Who Profits? Casa, Liverpool, July 12, 2023

Almost everyone but the government recognises the NHS is in crisis. A bit like Russia’s ‘special miliary operation’, it talks about this being ‘an extraordinarily difficult time’ and in January, Steve Barclay, blamed flu, Covid, Strep A infection, staff sickness, and delayed discharges from hospital in turn.

Government even commissioned a report from the King’s Fund to help it understand why things were so difficult. It probably was not too pleased by the report’s conclusion that a ‘decade of neglect’ by successive Conservative administrations had weakened the NHS to the point that it cannot tackle the huge backlog of care. Years of denying funding to the health service and failing to address its growing workforce crisis have left it with too few staff, too little equipment and too many outdated buildings

In 2021 Chief Ambulance Officers estimated that up to 160,000 patients were coming to harm because they cannot be transferred into A&E departments, and around 500 deaths from ambulance delays occurred last year.

The House of Lords Public Services Committee on Emergency Healthcare reported that: ‘The state of emergency healthcare is a national emergency. The substantial delays that patients face when trying to access emergency health services create considerable emotional distress and an unprecedented clinical risk’.

One Royal College President said the NHS was now breaking its ‘basic agreement’ with the public to treat the sickest in a timely way, commenting ‘the true barrier to tackling this crisis is political unwillingness; the current situation is breaking the workforce and breaking our hearts’.

The Royal College of Emergency Medicine (in peer reviewed published research, independently verified) has estimated that the number of deaths occurring across the UK associated with crowding and long waiting times in Emergency Departments is in the region of 530/week.

The Commons Select Committee on Health report last year concluded that ‘We now face the greatest workforce crisis in the history in the NHS and in social care, with still no idea of the number of additional doctors, nurses and other professionals we actually need’, emphasising that this was putting patients at risk of serious harm.

The report also suggested that nurses be given a pay rise to match inflation, but now as Chancellor this has been conveniently forgotten by Jeremy Hunt, with the Treasury being the main block on progress in pay talks.

Commenting on recent NHS performance statistics, the Health Foundation remarked ‘these figures show a gridlocked health and care system struggling to meet the needs of patients . . . in October 2022, hospital waiting lists hit a record high of 7.2 million, with nearly 411,000 waiting over a year. More than 1 in 10 people with a serious condition such as a stroke or chest pain waited over 105 minutes for an ambulance in November (the target is within 18 minutes), while nearly 38,000 people spent more than 12 hours on trolleys in A&E’. Added to this, 39% of urgent cancer referrals waited longer than the two months target to receive their first treatment.

This year we have seen unprecedented strike action by different NHS staff groups, all emphasising the damage being done to the NHS by government policies. Staff vacancies are around 130,000 - and it’s no good government insisting there are more staff being appointed than ever before because175,000 are estimated to have left the NHS over the last year. The recent workforce plan fails to seriously address what is needed for safe staffing, and in particular the importance of retaining experienced staff.

Meanwhile, the number of working age people claiming disability support has doubled since before the pandemic. Record numbers of people are taking early retirement, most commonly because of ill health. Nine million people are now ‘economically inactive’, with 2.5 million of those giving long term sickness as the reason - all showing that the UK cannot afford for the NHS to fail and making the point that a good health service is not contingent on a strong economy, but rather it is the other way around – you can’t have a strong economy unless you have a good health service.

All this has prompted those on the right to say the NHS is broken, that radical reform is needed if it is to survive and that there should be greater involvement of the private sector, with some advocating a change in funding model.

We in KONP would argue that what would be really radical is a return to an NHS based on its founding principles:

Comprehensive

This means providing all kinds of care - physical health, mental health, public health, care of expectant mothers and new-born babies, care for the dying. Often referred to as care from the cradle to the grave.

This needs adequate funding – so that we match per capita spending of comparable countries, get rid of unrealistic ‘efficiency’ targets and move away from investment in poor value private provision

• we must build up the capacity of the NHS in primary care, community services and hospital services: the service simply not been allowed to grow as population has grown
• fix NHS dentistry
• annually reviewed workforce plan based on safe staffing levels across all specialties
• improve pay and working conditions to retain staff
• greater capital investment in necessary repairs; out of date equipment and buildings

It means

Universal

everyone must be included with provision of free health care to all who are resident in the UK, including migrants

• this is made possible through the use of general taxation as the funding mechanism
• charges for NHS care such as prescriptions and dentistry which are a barrier for many should be ended

The service should be

Equitable – fair and impartial

This means people paying for the health service through taxation according to their ability to pay and receiving health services according to their need, but also

• fair treatment for employees
• tackling racism and bringing privatised staff back in-house
• moving away from reliance on private companies

Money should be spent

Efficiently

Scarce health care resources should be allocated according to need and not wasted through making us consumers of care and incentivising unnecessary diagnostic procedures or treatments, or through wasteful competitive tendering processes

• maintaining good quality care should be a priority
• we are against use of ‘integration’ and collaboration to pursue cheaper but also poorer quality models of care
• any new workforce roles (e.g. physician associates) should not reduce the quality of care
• to decrease demand, invest in public health and social justice: reducing poverty, strengthening trade unions, reforming the tax and social security systems, improving housing, jobs, and environment

We need

Rational planning

• market competition means unpredictability and uncertainty
• with certainty and predictability of funding for NHS organisations we would not need reliance on private companies
• we should abandon the competitive market which undermines sensible planning
• regional planning for hospital and community developments, ensuring enough capacity across all parts of the system
• planning for future needs including workforce and surges in demand and public health planning for emergencies and pandemics
• decision-making by public bodies should not be shaped by private and third sector organisations
• there must be democratic scrutiny and accountability around planning; higher transparency and greater involvement of the public in scrutiny and accountability process

In summary, we want and need to:

• reverse privatisation and strengthen democratic accountability
• fund the service properly
• increase capacity, most importantly by caring for and investing in staff
• seriously address wider determinants of health and expand public health

John Puntis, co-chair KONP

with thanks to Sally Ruane: Scoping the issues