NHS ‘Overhaul’: Front Line in the Firing Line

If any public institution enjoys near universal public support it is the NHS. Beloved as much by Daily Mail reading ‘middle England’ as it is by workers, any government that tries to mess with the NHS is playing with political dynamite. Although the Tories were elected on the basis that they would make major public spending cuts, they pledged to preserve the NHS and maintain spending in line with inflation. Spending, they say, will increase by £11 billion by 2015 and “no front line services will be hit”. So at least the NHS is safe in ConDem hands; well no, not exactly, in fact probably not at all.

The first point is that even the pledged increase in spending is very likely going to amount to a real terms cut of around £1bn when inflation is taken into account. But given the annual spend is over £1000 bn, and in a period of savage cuts where some government departments are seeing their budgets slashed by 25%, perhaps it may be a little churlish to get too worked up about this. More disturbing is that the increased budget is in fact a substantial and absolute spending cut. Sounds bizarre and it is, but at the same time as the budget will increase by £11 billion, the NHS will also have to find £20 billion in ‘efficiency savings’ by 2015. So what is meant by ‘efficiency savings’, cuts to back office functions, plush offices, large pay cheques for senior managers, stuff that won’t affect the front line services provided to patients or the jobs of medical staff? Well no, 560 front line jobs with the London Ambulance Service are to be axed. A&E waiting times are increasing, and across the country non-acute services are being cut back. According to Dr Mark Porter, chair of the BMA’s Hospital Consultants Committee:

The examples [of cuts] are becoming more and more widespread. The national picture is that every primary care trust is taking steps to reduce access to whole swaths of healthcare.

The Royal College of Nursing (RCN) has produced its own report which confirms this. From a survey of 21 NHS trusts it found 10,000 jobs are set to go, including doctors, nurses, midwives, therapists - in other words, 54% of them frontline medical staff. Assuming these cuts represent what’s in store for the NHS as a whole the prospect is for an overall loss of 40,000 jobs with “a catastrophic impact on patient safety and care” [Dr Peter Carter, RCN chief executive]. The idea that the NHS has been spared from spending cuts is just another multi-billion pound ConDem con trick.

But these chilling cuts are just the beginning. Alongside budget cuts, the government is also planning major structural reforms of the NHS. The big idea is that the NHS trusts will be broken up and the greater part of the budget will be dissolved to GP consortia who will be able to commission services from a range of providers including the private sector and charities as well as what may be left of the public sector, which will be expected to compete for contracts with private health providers. The plan is controversial even among the Tories and its architect Health Secretary Andrew Lansley has had to accept a ‘pause’ in its implementation. No doubt this pause will be used to re-package the proposal in a less threatening guise whilst maintaining its basic premise, the effective privatisation of the health service. The point of this competition for contracts is to drive down costs and there are only two ways this can be done. The first is to make workers redundant and make the remaining staff work harder for less money. The second is to reduce the quality of patient care. This is the future for public health provision in the UK, a bleak future both for health workers and patients.

For the first time in its history the far from militant RCN passed a vote of no confidence in the Health Secretary. But it is going to take a lot more than this to prevent the dismantling of public health provision.

And for those taken in by New Labour’s claim that the NHS is safer with them don’t forget who started the idea of decentralisation, internal competition and privatisation of parts of the health provision. Medical professionals all know the answer to that question and those that have no other financial interest than their NHS salary are well aware that the so-called abolition of the “top down” approach began with New Labour. It was they that replaced committed health professionals in the NHS with layer upon layer of managers setting more and more arbitrary targets. You do not need to rely on our word. As early as 2003 a leading academic gave the following incisive analysis

New Labour has had to come to terms with the party’s previous history. Nationalised and centralised institutions such as the National Health Service (NHS), once praised as crowning glories of previous Labour administrations are now seen as problematic for the party. Many of New Labour’s policies are as much about distancing themselves from ‘old’ Labour as about distancing themselves from the Tories. Here I want to argue, with respect to the introduction of NHS ‘foundation trusts’, that Labour is selectively reinterpreting history to justify policy measures which are driven by pragmatic and ideological considerations, and which have the potential to fragment the NHS. This entails the construction of a mythical past which has two central elements. Firstly, it denigrates centralism and state planning, allowing the government to insist that only competition and choice can drive forward improvements in the NHS. Secondly, there are proposals to return hospitals to the autonomous status which they enjoyed prior to 1948. These arguments rely on invocation of a mutualist and localist past, in which hospitals were somehow more responsive to the wishes of the local community. These policies might have short-term electoral advantage but they have the potential to impact adversely on access to health care. This is because the establishment of autonomous foundation trusts will remove or weaken some important mechanisms for planning and cross-subsidy within the NHS.

John Mohan in History and Policy to be found at historyandpolicy.org

Anyone who has frequented hospitals over the years since that was written know only too well the consequences and the way in which some hospitals have declined faster than others. These have been closed so that the sick and elderly have had to travel further for treatment. Treatment which is becoming ever more cursory, incompetent and down right shoddy.

The real truth is the NHS is not safe in the hands of any capitalist crew. In a continuing economic crisis of a system that is in visible social decay the idea of socialised medicine is at total loggerheads to the demands of the market. The entire political ruling class are consciously lying when they tell us otherwise.

The Cuts Drive Home

According to a Financial Times estimate based on twenty councils, cuts voted in by local authorities for the 2011 financial year amount to £6bn and hit the elderly and children hardest. Apart from £6,669m of general cuts in corporate services (a 27.4% reduction) some of the others include,

Adult social care 23% (£6,669m)
Universal children’s and education services 15.8% (£961m)
Children’s social care 5.5% (£337m)
Public transport 4.7% (£284m)
Road maintenance 2.7% (£163m)
Housing and homelessness 2.6% (£159m)
Library service 1.1% (£68m)

Behind these figures lie a tale of pay cuts quite separate from the two year civil servants pay freeze. From Cumbria County Council’s 3,500 teaching assistants whose pay is being cut by a quarter to workers providing for disabled adults in Sefton, Merseyside who face a take it or leave it 26 per cent pay cut. Thousands of jobs are being cut including 2,450 in Birmingham, England’s largest local authority. In Blackpool Conservative council leader Peter Callow praised the trade unions for persuading staff to accept pay cuts.. etc etc..

Last year (2010) 111,00 general government jobs were lost, including 66,000 in local government. By February 2011 local authorities had earmarked 150,000 jobs to be axed, with more to be decided. Nobody yet knows the full total to be cut this year.

At the same time Iain Duncan Smith’s rolling programme of cuts in welfare benefits has started to bite. Like pensions, all welfare benefits are now ‘uprated’ according to the lower CPI (consumer price index) instead of RPI (retail price index). Child benefit is frozen for 3 years. Local Housing Allowance is reduced. Working tax credit reduced by 10%. Draconian changes to Incapacity Benefit and Disability Allowances which, if implemented as in the trial runs in Aberdeen and Burnley, will deem thousands of ill and disabled fit for work and thus unentitled to financial support beyond job seekers allowance. More measures ‘to make work pay’ are due in next year, and the next…

In the NHS, a report by the Royal College of Nursing (April 2011) into 21 trusts, estimates that 12% of nursing jobs are due to be cut out of an estimated 10,000 total job losses, including doctors, nurses, midwives, therapists. If this scenario is repeated through the NHS 26,841 posts are at risk in the UK.


Revolutionary Perspectives

Journal of the Communist Workers’ Organisation -- Why not subscribe to get the articles whilst they are still current and help the struggle for a society free from exploitation, war and misery? Joint subscriptions to Revolutionary Perspectives (3 issues) and Aurora (our agitational bulletin - 4 issues) are £15 in the UK, €24 in Europe and $30 in the rest of the World.