The treatment backlog threatening the NHS is a symptom not just of the pandemic, but of long-worsening problems that preceded it and sharpened its impact.
Last week the backlog hit a record high of 5.6 million people. It is currently growing by 150,000 a month. Health Secretary Sajid Javid has said that the figure could rise as high as 13 million. Presumably Javid is trying to drum up support for the Tories’ attack on workers’ incomes to raise more funds for the health service; but the Institute for Fiscal Studies (IFS), for instance, has sketched out what seem like plausible scenarios in which waiting lists could grow even bigger than that.
Within the headline figure of 5.6 million, the number waiting upwards of 18 weeks has tripled to around two million, and the number waiting more than 52 weeks has gone from zero to hundreds of thousands.
Before Covid hit NHS waiting lists had been mounting steadily for years, from over two million when Labour left office in 2010 to over four million at the start of 2020.
Since 2010 the NHS has been chronically underfunded. If the funding increases it got between 1997 and 2010 had been matched since, its core budget this year would be over £200 billion rather than £150 billion.
The health service has not been literally “defunded” in the way local government has. But NHS care has long been more and more rationed, with many services in effect no longer freely available. Sustained underfunding has meant a system desperately over-stretched even in quiet times, with very little flexibility or reserve capacity, even before March 2020. Thus the health service’s repeated near-overwhelming during the pandemic, and probably a lot more Covid transmission within hospitals than there would have been if they had been less crowded.
If Covid disappeared tomorrow, the NHS would still urgently need substantial extra funding just to catch up. But Covid is not disappearing. New cases are 30,000 a day or more, and hospital admissions around 1,000 a day.
Boris Johnson has claimed that his government’s National Insurance hike, a so-called “health and social care levy” raising funds by targeting workers’ incomes, will raise over £10 billion a year for the next three years. That would be inadequate. But the IFS calculates that in fact the NI increase will raise £6.6 billion extra next year, £3.6 billion extra the year after and £5.6 billion extra the year after that.
The NHS lacks facilities. About 22,000 beds have been lost and over a hundred A&Es closed since 2010. The Tories have no plan to remedy that, only spin: it has been revealed that the government’s policy to meet its promise of 48 “new hospitals” is to rebrand hospital upgrades as new facilities.
Perhaps even more urgently, what the NHS lacks is people. At the end of last year NHS organisations reported a staff shortage of 84,000, including 38,000 nurses (one in ten positions), and rising. The shortfall of GPs is 2,500, projected to grow to 7,000 in the next five years. The shortage of GPs is hitting more deprived areas in particular.
A large part of this problem stems from how NHS workers have and are still being treated, most recently with the 3% pay rise – i.e. a real terms pay freeze (and maybe worse for those who have been outsourced from NHS terms and conditions). Since the government has refused to provide additional funding for pay increases, even this measly offer will further diminish NHS budgets.
Over the years, starting under Blair and Brown, more and more NHS funding has been diverted to private companies through various forms of privatisation and outsourcing. The Tories are working hard to increase this flow: since 2010 the amount going to “private providers” has increased by 72%. Not including GPs and dentists, 18% of NHS clinical spending is now with private providers. During the pandemic, instead of requisitioning private health facilities, the Tories have given £10 billion to private health companies for fallback use of those facilities, generating £200 million in shareholder profits.
Its plans to reorganise the NHS into “integrated care systems” will give private providers an institutionalised voice in the health service.
The labour movement must:
• Rally round the NHS workers and help them get serious industrial action off the ground for a fully-funded 15% or £3,000 pay rise.
• Demand and campaign for significantly larger funding increases to stabilise the NHS, curb and clear the backlog and restore services. We should oppose “hypothecated” taxes linked to funding a particular service, and fight to tax the rich, not workers’ wages.
• Demand a comprehensive reversal of privatisation and outsourcing so we have an NHS worthy of the name and funding increases fund health services, not profits.
• Fight for a plan to fund and transform social care. Of the money raised by the “health and care levy”, it seems only about one sixth will go to social care. Social care also needs more money, but we should not advocate more public handouts for private care providers (some of them owned by hedge funds and the like). The labour movement should demand public funding to establish and expand a free, publicly-owned and provided care and independent living service.
Petition which Keep Our NHS Public is promoting, from We Own It, here