Why are all the worst horror stories from England?
The NHS in England has been run separately from those in Scotland, Wales and Northern Ireland since devolution.
And since 2000 successive Westminster governments have used it as a test-bed for experiments with untried “reforms” aimed to transform it from a public health care system into a “market” – little more than a fund of taxpayers’ money to buy services from a range of public and private providers.
One extra problem is that these so-called reforms and the involvement of private-sector providers almost invariably cost more money rather than saving it – and the transaction costs of the health market have doubled the overhead costs of the NHS in England, diverting vital money from patient care.
So it isn’t just the Tory-led coalition causing the problem?
No, the rot began under Labour, but the costs and negative effects were masked by Labour’s large-scale year-on-year increases in NHS funding from 2001-2010 which allowed NHS hospitals to employ more staff, keep more beds open and therefore cut waiting times to a maximum 18 weeks and improve services.
The banking crash in 2008 and the huge cuts that have been made in public spending to bail out the bankers brought the spending to a shuddering halt from 2010.
It has opened up the meanest five years ever in NHS funding, with an effective freeze on health budgets, while demand for health care, especially from a growing elderly population, and the costs of providing new treatments and drugs are rising year by year.
Is the problem just cuts?
No, the NHS faces a three-fold crisis, in which one main feature is the financial squeeze, requiring savings of 4 per cent per year from its £100 billion budget to add up to £20bn by 2015.
This would be by far the biggest year-on-year cuts inflicted on any health care system anywhere in the world.
Even former Tory health secretary Stephen Dorrell has questioned whether they can be achieved.
An added dimension of the spending squeeze is the inflated cost of new hospitals built through the private finance initiative (PFI), which saddles hospital budgets with bills that rise every year regardless of the income of the trust.
These costs have already bankrupted one trust in south-east London, triggering cutbacks and the plans to close most of the neighbouring Lewisham Hospital.
Alongside the cuts comes the Health & Social Care Act, forced through by David Cameron’s government with no mandate and no significant support from health professionals.
This has restructured the NHS, getting rid of many of the managers with most experience of planning services, and fragmented the NHS into a patchwork of over 200 Clinical Commissioning Groups – supposedly led by GPs, but in practice run by a network of soon-to-be privatised Commissioning Support Units.
Many of the CCGs are already looking to make cuts and three-quarters of GPs in a survey said they thought CCGs were set up to get them to take the blame for cuts and rationing of care.
Less than a third of GPs are actively involved in CCGs.
The Act and subsequent regulations aim to force CCGs to put more and more services out to tender to “any qualified provider,” opening up many of the more profitable services to private-sector profiteers while leaving the rest to an underfunded public sector.
It subjects NHS hospital trusts to competition law and encourages big foundation trusts to expand their income from private patients while NHS budgets are squeezed downwards.
And linked in with both of these is the growing privatisation of NHS service provision, whether this be elective operations, some GP services, and community health services – with giant multinationals like Serco and Virgin carving out a growing slice of the action.
Is that why my local NHS is discussing cutbacks?
Yes. Ministers have been pressing the line that NHS funding has been “ringfenced,” even while the Treasury snatches back any cash savings that have been made.
It’s this financial squeeze that is driving plans for “reconfiguration” and reorganisation of services locally, although local managers always like to pretend these schemes are “clinically led.”
Whenever you read of plans to replace hospital care with services “in the community” these are cash-driven cutbacks.
And don’t be fooled – almost none of them have any real plans for community based care!
Already services and staff are under strain.
Waiting times and cancelled operations are increasing, ambulance services are struggling, mental health services and social care are facing falling even further behind in an endless series of cutbacks.
But there is no light at the end of the tunnel. More cuts are certain after 2015, unless the Tories are thrown out and Labour changes its policy.
So what can be done?
Campaigns like Keep Our NHS Public are working with local campaigns to defend hospitals and halt the cutbacks, fight for an end to privatisation, reverse the Health & Social Care Act and scrap PFI – and also abandon the £20bn banker-driven cuts.
Hundreds will be in the discussion at the People’s Assembly today. Thousands have already joined local protests. Join us in the fight to keep our NHS, and keep grasping private hands off it!
John Lister is director of Health Emergency