It would be remiss of GIMMS not to mention in this week’s blog the visit of Donald Trump to the UK. The good news is that he retracted his statement made during a speech that the NHS would be on the table in any trade deal. The bad news is that someone, and we can only guess who, must have whispered in his ear that the US healthcare companies are already here and it’s only a matter of time. I mean we wouldn’t want people to get a whiff of what has been happening behind their backs over the last few decades, would we?
As our sister organisation, Public Matters noted here in 2017:
“It’s not a dystopian vision, the Americans are here, reshaping the NHS into Accountable Care Organisations. The Americanisation of the NHS is happening right here, right now”.
Behind the blue logo and largely invisible to the general public, the US healthcare companies have been quietly embedded into the NHS and successive governments have been party to it. The marketisation/commercialisation that began with Margaret Thatcher and was pursued with enthusiasm by New Labour and Tony Blair allowed the Conservatives to pursue their long-held aim of privatising the NHS when they came to power in 2010. This all happened under the cover of cuts to public spending which, it was explained, were needed to restore the public finances after Labour’s overspending which had, they claimed, left the cupboards bare. Then there was the idea implanted into the public consciousness since Thatcher that publicly run services are inefficient and expensive and private companies more efficient and cheaper. As we are seeing the chickens are coming home to roost on that one!
As global corporations like the US company United Health have moved in to ‘help’ redesign the NHS not as a philanthropic exercise to make things better but to serve their interests and worse benefit from public funds to do so, profit has become the underlying motive in service provision. It has supplanted the idea of the benefits of publicly run and funded services serving the interests of citizens which has been at the heart of British life since 1948.
If anyone doubts what is going on, they only have to tune in to the radio or TV adverts which promote private healthcare on a daily basis and talk openly about avoiding NHS waiting lists. Increasingly, we hear about the raw experiences of patients and staff who are suffering the consequences of cuts and the drive to cut costs, which have led to longer waiting lists at hospitals, delays in getting appointments with GPs or for specialist referrals, ambulances stacked outside hospitals and A&Es filled to overflowing as committed staff struggle to provide the service, clinical treatments being denied to those who need them and hospital and bed closures. Isn’t it any wonder that those that can afford it are considering jumping queues through either insurance (ignoring the risk element of insurance plans) or paying out of their savings for vital treatment. At the same time, those with few financial resources wait their turn on an NHS waiting list – that is if the service they require is still available as rationing kicks in to cut costs. As the services offered shrink in an environment where budgets, not people, drive what is available, there can be only one outcome. A US medicare style healthcare system, dividing people into haves and have nots – the latter being left without proper medical care and waiting perhaps for the travelling charitable surgeries for treatment. A dystopian vision. A study from Harvard University estimated in 2009 that 45,000 people die every year due to lack of health insurance and lack of access to ongoing medical care for a wide variety of treatable conditions. A shocking prospect. Is that the sort of world UK citizens want?
How have we allowed this situation to arise unnoticed and what can be done? Can we reverse this situation? There are two key issues to address; funding and removing the private companies from public health care.
From a modern monetary perspective, funding the NHS or indeed any other public services is perfectly possible where a sovereign government issues the currency. That has been a common thread through GIMMS blogs since we began. Our aim has been to unpick the myths and lies told about how governments spend and show that such a government neither needs tax revenue nor to borrow in order to provision itself and provide public services. However, this is only half the story and whilst we have always indicated that the size of deficits does matter and that governments, whilst not constrained by money, are constrained by resources, we have perhaps not been as explicit as we could have been about what this means for prospective governments in waiting.
When progressive parties promise to fund the NHS they fail to ask the key question; do we have the resources to provide a first-class healthcare system? What this means in effect is do we have enough nurses, doctors and other health professionals to provide the service and do we have enough hospitals and beds to meet the needs of sick patients? Promising money to fill the funding gaps is laudable but if we haven’t thought about how we are going to provide the people to run it in the short and long term we haven’t really addressed the issue. Money will be the least of the worries and the consequences inflationary!
To give a few illustrations.
At the end of last month, the Mirror reported that the NHS will be 70,000 nurses short within five years as a result of cuts to public spending. Not only have staff been leaving in droves due to the pay cap imposed by George Osborne and worsening employment conditions, scrapping bursaries has led to significant falls in applications for nursing and midwifery courses and learning disability nursing.
A report from the Royal College of Nursing also warned last month that District Nursing Services are significantly stretched and are under resourced, under-staffed and facing serious difficulties in staff recruitment and retention. The report showed that the number of District Nurses employed by the NHS had dropped by almost 43% in the last 10 years. To put that percentage into real terms compared to 2009 when there were 7,643 there are now only 4,031 ‘full-time equivalent’ district nurses working in the NHS.
In mental health, the situation is equally dire. Again, according to the Royal College of Nursing, the total workforce in mental health has decreased by 10.6% since 2009. In acute and inpatient care over 6000 mental health nurses have left the profession. Equally bed shortages have led to very vulnerable people being sent many hundreds of miles away for treatment often in privately run facilities paid for by the NHS.
GPs are also coming under growing pressure due to funding and resourcing issues including recruitment. According to a survey by the medical website Pulse, surgery closures affected around half a million patients in 2018. In another investigation by the same organisation, it was revealed that doctors are seeing up to 60 patients a day – double what is considered safe – and working an average of 11-hour days.
In short, whilst it is not difficult to see that this situation has arisen out of political choice which has nothing to do with whether the government has the money to fix it, there is a common thread which runs through the reports – resources. Even if the present government were to backtrack, promising more money, if we don’t have enough doctors and nurses in the first place it will not solve the problems or treat the underlying causes; at least not in the short term. Our current shortage of skilled employees can be traced to 9 years of cuts to public spending which have not only led to redundancies, but also driven people to leave their jobs through stress, dissatisfaction and poor pay. It can also be traced to governments which have abdicated their responsibility to plan for the future in the belief that the invisible hand of the market will provide. Clearly, we are now reaping the damaging consequences of that opinion.
Pledges to splash the cash without considering how improvements can be delivered or indeed if they can be delivered in the short term would be most unwise. The health service currently relies heavily on staff from overseas to run its hospitals. Instead of attracting home-grown staff with good wages and terms and conditions successive governments have raided the resources of other countries, thus robbing them of their own investments in skilled workers and depriving their people of good healthcare. Shades of our colonial exploitative past most certainly.
Balancing the books and fixing the public accounts has become an enduring mantra at the expense of the NHS and our public services. Yes, we have to change that narrative through understanding how money really works but the reality is that finding solutions will also require from a progressive government commitment, forward planning and time, as well as money. Electorates are impatient and want solutions immediately; but the truth is that there are no quick fixes. If a future government wishes to implement a progressive agenda it will also need to provision itself to provide those essential services and will have to make decisions about where the necessary resources will come from. It will need commitment to the idea of social distribution of society’s resources for the benefit of citizens and a healthy, functioning economy. This may mean tough decisions and depriving the private sector of some of those resources to deliver the government’s public purpose aims.
In conclusion and briefly, it will also be up to a future progressive government to reverse the on-going damaging restructuring of our now fragmented health service which is currently being transformed into an American style accountable care system. The aim should be to restore it into a publicly funded, provided and accountable service. However, we should be under no illusions. The reversal of 30 years of reorganisations which have embedded the private sector and US healthcare companies into the NHS cannot be achieved overnight. But with political will and determination, the narratives which have done so much damage to society by preferencing capital and corporate power over national economic and social well-being can be challenged and we can make a difference.
As the economist Bill Mitchell puts it ‘The government is us’.