What Now for our NHS?


A majority Tory government, a fixed term parliament and the collective failure to persuade the voters that saving the NHS means defeating the Tories is a very hard reality.  What now?

Many have said that the NHS as we know it will not survive 5 years of the Tories, we have to make sure they are wrong by defending it.  We must also recognise that this strident message about an NHS in danger made little impact on how people voted. As with much else the polls were wrong; the economy, immigration and nationalism dominated.

We know the NHS and social care are totally dysfunctional, a fragmented mess of disparate semi-autonomous bodies not linked by either a clear strategy or even good local cooperation.  It has already got all of the worst features of a market in terms of having no strategic oversight and no direct accountability, with not even the Secretary of State actually responsible.

Set against that is the worst financial crisis since 2006, and maybe worse still.  The ability to manage the system has gone as have many of those who knew how to do it. Whilst the choice was made to load the failure onto providers and 80% are predicted to run a deficit this year the reality is that underfunding and the H&SC Act have made every part of the NHS a financial disaster area.  The staff are demoralised, tired and often leaderless.  All staff; we must stop the easy stupidity of attacking back office and managerial staff as if they were the problem.

Social care is even worse. The continuing failure to provide adequate services for some of the most deprived and vulnerable in our society is a national disgrace.  It fits sadly to the attacks on welfare generally and both these lines of attack will continue.

What should we expect?  This is the optimistic version.

The rush to privatise even core clinical services will continue – the Tories are wedded to their belief in competition and regulated markets and even if they don’t bring back Lansley his ideas still dominate.  The limitation is the lack of private capacity and they may well try to address that this time.

The financial disaster will be addressed through further cuts – however they are dressed up.  The reconfigurations which are actually financially driven closures will continue.  Cutting costs through outsourcing will in fact add costs and ensure services deteriorate.

They will try to cover up deterioration either by redefinition of targets or by ensuring data is not properly collected and analysed so reporting is limited.

The consequences of financial failure locally will be blamed on local management and we will see more “failures”. There will be attempts to privatise through Hinchingbrooke or other franchise type nonsense.  We will also see private sector management consultants grow rich as they run endless investigations to tell us badly funded services are not sustainable.

We will see consultants and lawyers grow rich advising on procurement exercises to deliver privatised solutions.

The drive to privatise all areas around pathology, decontamination, and diagnostics and near clinical services will be finished off.

Any non clinical services currently still provided within the public sector (including the shared services) around HR, FM, finance, informatics and IT will be outsourced.  Properties that then become vacant can also be sold off.

The privatisation of commissioning with spurious lead contractor and other fig leaf excuses will expand.  Privatisation of the vital but little understood Commissioning Support Units will be driven through – meaning vast amounts of highly valuable skills and years of experience will be handed to the private sector and sold back at a profit.

Social care will be cut further, with outsourced provision meaning poor working conditions, an untrained workforce, 15 min visits and even tighter eligibility conditions.

And attacks on managers and bureaucrats will continue.  Actually these are the people who can and do speak out to point out the stupidity of what is being inflicted.  They have to go as they are the inhibitors to the grand project of marketisation.

How can we respond?

Our job has to be to ensure that there is still a system we can save come 2020.  We must champion the alternative of a properly funded universal and accountable public care system; its better, fairer, cheaper and more in harmony with the values the vast majority believe in.

A good start is no recriminations.  We have to keep the broad unity of those who wish to defend our NHS and to fight for decent social care; we agree on what we are against so we can fight together to oppose it.  A much easier task than trying to agree on alternative policies.

We support the staff, back their fight for fair terms and conditions and avoid the trap of seeing attacks on staff as the solution to the inevitable but actually rare failures in care.  And managers are not overpaid parasites they are essential to maintaining services, all staff have value – we know who the parasites are!

We keep the NHS as a major political issue.  We know that Europe and immigration will be dominant in Parliament as the Tories try to cope with a small majority and an army of head bangers in the back benches.  Many Tories actually accept in private that the H&SC Act was a disaster so an attempt could be made to amend it.  The Efford private members Bill or one like it could be a possibility.  Even just getting some dilution of the S75 Regulations could help.

As further attempts at integration involve local authorities the political campaign can be fought out at every local election – it’s not potholes that are the key issue it’s our care service!!! We can pit local politicians against their national leadership.

Remember this is still public money being spent and that opens up rights to attend meetings, use FoI (perseverance required!), ask questions, lobby and all the paraphernalia our democracy is supposed to offer. We must use the opportunities and challenge any restrictions.

And we have to get involved and carry the fight on through every avenue.  The system offers endless opportunities to some form of involvement (however superficial it may sometime be) from being a non-executive director, a governor of a Foundation Trust to being a member of a local Patient Reference Group; get in there. Go to “consultation” meetings and speak out.

And the H&SC Act at least gave us an almost endless list of possibilities for legal challenges.  They wanted a system that was run through the Courts and not by the Secretary of State and the down side is that the Courts can be difficult!!  We have already seen a few Judicial Reviews and threats of JR can reap rewards – let’s use this avenue against them.  Find out early what is planned then find every way to show the correct legal process has not been followed.  Can be very effective as current commissioners are basically often poorly informed and lack good advice.

And we can campaign, march and protest, raise awareness by the time honoured traditions of dissent.  It’s not a pleasant prospect but as many have said the NHS is worth fighting for.