The NHS is at breaking point. The planned destruction of the service, through cuts, closures, privatisation and poor treatment of staff is coming to a head.
The UK has one of the lowest provisions of beds per head in Europe, and it is falling. BMA figures have shown that from 2010 to 2016 we lost 13,681 beds, a fall of 9.5%, comparable to 24 hospitals being closed. Mental health bed provision has fallen 44% since 2001. This has meant doctors struggle to admit patients, and that more and more patients are stuck in A&E for long periods — more than 700 people stay in A&E more than 12 hours every day.
It also means staff are under pressure to discharge patients before they are ready, which results in increased emergency readmissions. High bed occupancy rates have led to several months of planned operations being cancelled, with no outrage comparable to that during the junior doctors’ strikes.
The numbers hide a huge burden of human misery. They hide the woman with a brain haemorrhage turned away from three hospitals with no available ITU beds, dying without surgery that could have saved her. They hide the elderly confused man being moved between cubicles as we make space to assess newly arrived patients. They hide the woman house-bound and in pain awaiting a hip replacement. They hide the football player waiting in the cold for an ambulance that is queueing to handover at the local hospital.
Sustainability and Transformation Plans (STPs) will see further bed, ward and hospital closures. Emergency departments will close, healthcare staff will be made redundant. This will be forced by cuts which mean that in 2021 the NHS will be underfunded to the tune of £30 billion. But the STPs are not just about cuts. They are also about reconfiguration, privatisation, and aligning NHS structures with the health insurance formats preferred by large corporations like UnitedHealth and Virgin.
These changes require capital investment of £9.5 billion, which will probably have to come out of already stretched NHS budget, as only £339 million has been allocated so far. Many of the STP “footprint” areas hope to make savings through increased prevention of ill-health, but Public Health budgets are also being slashed.
We know that privatisation costs more to administer and delivers a worse service. GMB recently released evidence showing MRSA infection is 50% higher in hospitals with outsourced cleaning services. Half a million medically sensitive documents were lost by a private contractor running internal NHS mail from 2001-2016. Circle pulled out of Hinchingbrooke Hospital just before a damning CQC report was released.
Social care is in a shocking state, with 41% of community-based adult social care services, hospice services and residential social care services rated as inadequate or requiring improvement by the CQC. Staff sweated for the profit margin provide lower standards of care. The catalogue of failures is longer than the phone book. What’s worse is that private companies and their owners walk away scot-free, pockets full of taxpayer money, with no responsibility for the suffering they cause.
Under the STPs, Accountable Care Organisations will be created. This is a concept from US Health Insurance: a group of healthcare firms take responsibility for providing care for a given population for a defined period under a contract with a commissioner, such as Medicare or the NHS. ACOs use market-based mechanisms to lower costs whilst achieving pre-agreed quality outcomes.
One form of ACO, mentioned in many leaked drafts, uses “capitated” or “global” payments which are fixed payments to providers for all or most of the care that their patients may require over a contract period. Once the payment is in place, it is open to providers to offer only as much care as required by the contract.
This is a direct transfer of resources from those who need them — the sick and others accessing healthcare — to the already rich. It is socialism for the wealthy, and austerity for the poor. It is no solution to NHS crisis. What is needed is the immediate renationalisation of the health and social care system, without compensation.
The NHS and social care should be publicly provided, publicly and properly funded, publicly accountable and well-staffed. Staff should be well paid and work under good terms and conditions — unpaid breaks and travel time must end, proper rest facilities must be provided and so on if we are to have safe, decent care. PFI, a never-ending debt owed largely to tax-payer owned banks, should be abolished.
Our care systems are sustainable and effective in public hands. The Labour Party should back the NHS Bill, and develop policy alongside health and social care workers and service users to restore the whole care system to the standard we deserve.