John Lister, Secretary of Keep Our NHS Public, reports on the government's relentless attempts to fragment and undermine the NHS
“THE FLOGGINGS WILL CONTINUE UNTIL MORALE IMPROVES” appears to be the strategy of Jeremy Hunt and Cameron’s right-wing Tory government in their approach to all sectors of the NHS.
Not content with goading the junior doctors into unprecedented – and inspiring – strike action, and cheesing off the majority of NHS staff with five years of pay cuts in real terms and the threat of more to come, Hunt has antagonised tens of thousands of GPs with demands that they implement 7-day a week services that cost a fortune and put GPs under stress.
Ministers are pursuing their 7/7 NHS policy with absolutely no regard to evidence of the failure of most of the pilot schemes. Scarce cash and human resources are being squandered on gimmick ideas that don’t work. NHS England has admitted that the level of take-up of the “midlife MOT” healthcheck for people aged 40-74 had been minimal.
The drive for 7/7 access to primary care runs alongside a similar campaign on hospital care, which is now a key factor in the junior doctors’ dispute. Again it’s based on efforts to con the electorate rather than evidence, with Hunt cynically distorting the available statistics on weekend deaths in hospital to grab Daily Mail headlines.
Now Hunt’s latest diktat to the boards of NHS and foundation trusts shows he is keen to stick the boot into senior managers as well. The tightest squeeze on NHS funding since 2010 has brought the biggest ever combined deficits, with almost every acute hospital trust and foundation trust deep in the red. Trusts face five even more savage years to come.
Already NHS performance is visibly falling back, bringing delays of treatment in A&E, delays in accessing cancer treatment, and record levels of delays in discharging patients for lack of community services or social care. But instead of recognizing these warning signs, Hunt has now demanded that trust bosses do the impossible – and “balance the books without compromising patient care” – or face whole boards being suspended.
It’s a bluff in many ways: almost every hospital is failing on finances – and they can’t suspend them all. But it cranks up the heat on already stressed hospital bosses, while giving them no way out.
Hunt has of course previously imposed arbitrary limits on the use of agency staff to fill growing numbers of vacancies for nursing and medical staff – while simultaneously proclaiming his commitment to enhanced levels of staffing.
Hunt now tells trusts they are supposed to be “equally focused” on treating patients and on “how they can leave hospital”. He knows much of this is out of the control of NHS trusts, and hinges on a largely dismembered social care service that has been hopelessly underfunded, fragmented and privatized to death by local councils in most areas. Some 80% of “Better Care Fund” projects to link health and social care were failing at the last count.
Hunt’s statement itself shows the monumental task he is setting NHS managers: it estimates that to save £400 million across the NHS it’s necessary to make a 1% improvement in staff productivity. Not only is this a hopelessly vague assertion, but it means that simply to clear the £2-3 billion or more of deficits that trusts will carry into the new financial year, “productivity” needs to be increased by at least 5% – and much more in heavily indebted trusts.
Even NHS England boss Simon Stevens, in his hugely optimistic Five Year Forward View, did not expect to achieve “efficiencies” of more than 2-3% per year. The managers who are expected to deliver these results are even less confident than Stevens. A survey of the Healthcare Finance Management Association in November found 88% were unconvinced that their organisations could deliver 2-3% efficiency savings, and 84% believed the Five Year Forward View is unachievable because trusts lack the resources required.
More than half said that quality of care could only be maintained or improved if the promised extra £8 billion funding by 2020 was available soon. Instead George Osborn’s Spending Review statement soon afterwards offered a very different prospect, with extremely lean years from 2017 onwards.
Nonetheless Hunt, whose previous involvement with the NHS was limited to signing up with other right wing Tories in support of plans to break it up, is now repeating that none of the £1.8 billion “extra” funding ostensibly allocated to the NHS in 2016-17 will be available to trusts which do not balance the books.
He has told hospital bosses there is “no choice” to be made between delivering high quality care and having a good grip of finances. Hospitals which perform poorly on either measure will face closer scrutiny and intervention from regulators.
This latest ratcheting up of pressure on NHS management is likely to drive forward plans for cutbacks and closures by hospital and mental health trusts, rationing of care by local commissioners reducing the range of services available, and attempts to force staff to work under even greater pressure with unfilled vacancies. And every “failing hospital” will of course be pilloried in an obedient mass media and Tory press as reasons why the NHS itself is “no longer sustainable”.
This is no accident. Hunt and the Tories are not just blindly creating chaos. Since Andrew Lansley’s first day as a Tory health secretary in 2010 they have been seeking ways to fragment the NHS, undermine confidence and public support for it, and give more contracts to private providers, more opportunities for private insurers to attract new customers, and more scope to promote the idea of imposing charges for NHS treatment.
That’s why it’s so important for Labour to develop a clear alternative approach - based on a commitment to dismantle the costly and wasteful market mechanisms begun under Tony Blair and now driven forward by Cameron. They must promise to end contracts with private providers, stop any further haemorrhage of cash through PFI, and reinstate the NHS as a public service, publicly funded through taxation, and publicly provided.
A Bill setting out a clear way to achieve this has been drafted by Professor Allyson Pollock and Peter Roderick. It was supported by Jeremy Corbyn and John McDonnell. It has now been tabled in this Parliament by Green MP Caroline Lucas. Labour Parties need to press for Labour MPs and Shadow Health Secretary Heidi Alexander to back the Bill. Two Labour Parties in Bristol have already declared their full support.
CLPs need to be part of new moves to build a united resistance to the Tory onslaught on the NHS, bringing together health campaigns, trade unions, pensioners, and doctors’ groups at national and local level to fight cuts and privatisation.
Health Campaigns Together (www. healthcampaignstogether.com) will be seeking support in every area as it gets going this year. Make sure you and your CLP are part of it.
The NHS is under the most ferocious ever attack. If we don’t fight for it, we can lose it. When it’s gone, it’s gone.
is editor of Health Campaigns Together