In my view… by Dr Jan Macfarlane, Health & Social Care Coordinator, South East Cornwall Labour
Birthdays are a time for reflection; for reviewing the past, for taking stock of the present and planning for the future. Decade birthdays even more so.
The NHS was born in on 5 July 1948 at a time of great austerity but high ideals recognising that one of the prime functions of a civilised government is to protect the health of the people.
It was founded on the beautiful principle of providing care based on need and not the ability to pay.
And so generations have grown up free from the fear of unnecessary suffering. When we were ill we had ready access to GPs. If more serious we would be sent to a well-staffed hospital. In a real emergency we could count on the swift arrival of an ambulance. I was proud to be a small part of this great service for 35 years.
But what of the NHS at 70? It’s not so easy to get a GP appointment. Funding for general practice has fallen while workloads have risen. Stressed older GPs are taking early retirement, young doctors aren’t joining practices. In Cornwall we will have 20% fewer GPs by 2020. Ambulance services are unable to meet response time targets. And when patients get to hospital, A&E waiting time targets haven’t been met since 2015; trolley waits up a hundred fold since 2012. Hospitals are running at unsafe levels of bed occupancy. Beds have been cut by a fifth in 10 years. Our health system is not at risk of failure – it has already failed, with disastrous consequences. Ten thousand more people died in the first seven weeks of 2018 compared to previous years.
What has gone wrong? The main causes are lack of funding and reorganisation. Increased life expectancy is both the triumph of the NHS and an increasing financial challenge. The population increases and treatments become more complex. Over the past 60 years NHS spending has grown on average 4.1% each year to meet demand. But since 2010 the increase has been on average 1.1% – only 0.6% more each year per person. The government required the NHS to make £ 22billion “efficiency savings” despite health service providers and professional bodies warning this would be impossible. Mrs May’s “NHS birthday present” promising 3.4% annual increases over five years is tantamount to acceptance that a quality NHS can’t be provided on the cheap. But it’s not enough to repair the damage and meet current demand.
The Conservatives say it is no use “throwing money at the NHS” – it needs organisational change. In fact the Government has already given us organisational change “so big it could be seen from space”. Its abolition of primary care trusts and strategic health cost £3 billion and made things a lot worse. It handed control to local bodies, including GPs, but coupled it with an unprecedented funding squeeze, effectively giving them responsibility to ration patient services. It applied commercial law to the NHS, giving private corporations rights to make profits from the NHS. Billions are wasted in contract tendering.
Now, the failure of the 2012 reorganisation necessitates further structural change. New funding will be conditional on setting up “integrated care” contracts, opening to bids from private companies. These will allow unelected and unaccountable bodies to determine which treatments are covered: the less they spend on patients the more profits they make.
Some continue to believe private companies will run the health service more efficiently, at the same time as generating huge profits for themselves. They turn a blind eye to the numerous examples of inefficiency, service failures and fraud by private providers. They discount the lessons learned from the collapse of Carillion and the failure of privatised railways to deliver services fit for purpose.
I love the NHS. I believe in a properly funded, publicly run, not for profit NHS, paid for by progressive taxation and free at the point of use.
So let’s celebrate the birthday of this great humanitarian institution and give the last word to the great Nye Bevan, founder of the NHS: “The NHS will exist as long as there are folk left with the faith to fight for it.”
First published in The Cornish Times, 29/06/2018