It is obvious that the NHS is facing difficult times with the financial constraints impacting on safe staffing and the quality of care. But it is still functioning well most of the time – the ambulance arrives, emergency care is still generally excellent, you can get to see a GP, you will get your hospital appointment. Of much greater concern is the collapse of community and social care; not because of the impact on the NHS which is real enough, but because it is causing unnecessary and unjustifiable suffering for hundreds of thousands of mostly vulnerable people. We must start thinking about how we might generate more campaigns in that area, instead of a focus wholly on hospitals and GPs.
In our NHS the era of markets is coming to an end. Serco and several other big providers have withdrawn from the clinical care market. There has been little increase in the relatively small proportion of clinical care provided by for profit companies. Some non-clinical services have been privatised but Commissioning Support Units have mostly collapsed rather than being sold off.
If the Government wants to privatise the NHS they are not doing a very good job of it. Of course they may return to that agenda, but at the moment most private providers seem to have concluded that there is no money to be made. Simon Stevens does not appear to think competition and tendering is important. The 50 plus major projects he has initiated, from DevoManc downwards, are all undermining the internal market and ignoring the provisions of the 2012 Health and Social Care Act.
The biggest problem at present is the funding of mainstream services. Spending on social care for all age groups in England is over 10 per cent less than it was in 2009. 40 per cent of care homes for the elderly are below standard. Social care needs a major increase in resources and the NHS appears to need significant additional revenue funding which has been vaguely promised, but also significant investment for new models of care – no sign.
Without extra funding we have an NHS crisis like we used to have, as all vestiges of financial control have been lost. It is unclear what is to happen to the very large number of NHS providers, and a smaller number of CCGs, which appear to be broke. In the good old days, before the internal market, what used to happen was that elective surgery would stop in February when the money ran out, and start again on 1st April. That still happens in Northern Ireland, where average waiting times for elective surgery are now more than a year. The NI government doesn’t have the money to pay either the NHS or private providers to bring the waiting list down, and of course the UK government doesn’t care.
Similar effects could be seen in England soon. It is clear that the money is running out, and the talk about savings and efficiency is no longer convincing. 75% of hospitals are running deficits, some extremely large. 90% expect to be in deficit by the end of the year. There will be longer waiting lists, ambulance queues, cancelled operations and more obvious rationing but that does pose a political risk to the government. Less glamorous services like mental health and learning disabilities may be quietly cut.
The money is the issue. Integrating services and public health measures, very desirable in themselves, are not going to save a lot of money in the near future. In any large organisation there is scope for reducing waste and increasing efficiency, but it’s a fantasy to think that money can be saved on the scale required.
Rather than the government selling NHS organisations or ending the NHS as we know it, the danger is that people with money will seek out private provision, and the NHS will be left as a poor service for poor people.
There is value in local campaigns against cuts and service reductions and even against outsourcing. But that has to include cuts in social and community care.
A national campaign against privatisation of the NHS (social care is already privatised) or to reinstate the NHS of three decades ago, ignoring the huge changes since then, didn’t seem to have any resonance with the public in the run up to the general election, and seems even less viable now.
A better campaign would be to support the NHS and campaign for decent funding for all care, especially to alleviate the quiet suffering due to cuts in other public provision.
Only a government can stop privatisation. We will only get a different government if the opposition can convince the voters that care services will be far better with us in charge and that we are credible as stewards of the public sector. Campaigning has to take that into account.