By Bernie McAdam
As health unions call a second strike on 24 November, NHS England’s five-year plan demands more funding. But the plan is a trap for staff and patients.
NHS England Chief Executive Simon Stevens argues that the NHS needs a further £8 billion by 2020, as limited resources lag behind increasing patient demand. However, the Stevens plan envisages a huge change in service delivery, depending on greater “efficiency”, code for cuts and privatisation.
It is no wonder then that the main political parties have not contested his plan. Tory Chancellor George Osborne said that Stevens’ requested spending increases are “conceivable”. Liberal Democrat Care Minister Norman Lamb is calling for a funding increase next year and £1 billion the year after that, while Labour politicians say that it is in line with their pledge of £2.5 billion extra per year.
In fact, as thousands of healthworkers and millions of NHS users can testify, years of neglect and cutbacks mean that the NHS needs a far bigger injection that only a massive tax on the rich could fund.
Smokescreen
Stevens’ seemingly cautious demand for £8 billion is actually a smokescreen for the planned dismantling and privatisation of our health service, which the 2012 Health and Social Care Act laid down the groundwork for.
Stevens may call for an end to top-down reorganisations of the NHS, but there won’t be an NHS when Lansley’s law kicks in.
The Health Secretary’s legal duty “to secure or provide health services” has now been replaced with the weaker and less accountable duty only to “act with a view to securing” comprehensive services.
The Health Secretary’s general powers of direction over NHS bodies are also now abolished. Clinical Commissioning Groups (CCGs) have inherited the task of spending the NHS budget, supposedly with doctors at the helm.
Stevens’ plan acknowledges this by expanding the role of General Practice, allowing GPs to employ consultants and senior nurses with a view to transferring outpatient work from hospitals. Private health companies and management consultants must be licking their lips as our money heads their way.
Lansley’s law will leave commercial enterprises and not doctors or health professionals in control of health spending. This is a colossal attack on the principle of free, universal and comprehensive healthcare. In its place will be a rapid programme of privatisation, in the form of Private Finance Initiative (PFI) contracts and the outsourcing of most of the NHS budget.
More Cuts
Stevens “warns” that the rising number of admissions means that we need to take healthcare out of hospitals, with 17,000 additional hospital beds needed by 2022 on present trends. His plan puts the emphasis on care in the community, but there is no way that CCGs can accommodate this on a profitable basis.
His plan effectively also calls for deskilling, with staff taking more responsibility for patient care by treating conditions usually dealt with by doctors. Doing this properly would require thorough retraining and a phenomenal increase in staffing levels, given the dramatic increase in community care to compensate for the running down of our hospitals. Stevens of course does not propose this!
The loss of an extraordinary number of hospital beds, the closures of Accident & Emergency departments, hospitals mergers and so on are already happening daily without any corresponding increase in “care in the community”.
North West London Hospitals Trust is 100 beds short because the casualty department at Central Middlesex has been closed and Northwick Park A&E has to cover all of Brent and Harrow. In the north of Ireland, wide-ranging cuts will see fewer beds and weekend ward closures.
This is a critical crossroads for the NHS. Either we accept a service based on commercial contracting with increasing charges and no equity of access, or we build a mass movement prepared to defend the principles on which the NHS was founded.
Action
Labour must repeal the Health and Social Care Act if elected, and reverse all privatisations with no compensation for the privateers. Tear up the Public Private Partnership and PFI deals!
The private health sector should be nationalised and all hospitals brought back into a fully state-owned system, under the control of service providers and service users. The hugely profitable pharmaceutical companies should be expropriated and put to the benefit of the public.
Where local services are under threat, we should prevent their closure by occupying their premises and rallying the community to their defence. We should build strike action from the health unions and all unions locally.
The health unions’ strikes for higher pay are an excellent start. They should be escalated and linked to a mass political movement, using each and every struggle in the NHS to defend the service as a whole against all attacks.
