PEOPLE ON THE RIGHT OF POLITICS often say that for the UK, the NHS is like a religion – by which they mean that the NHS is something in which the population has an irrational and outdated belief.
They may not openly call for the privatisation or abolition of the NHS, but the truth is that for many Conservative politicians it represents the antithesis of their values, everything they oppose. For those with an increasingly zealous libertarian belief in a low tax, small state, free market economy which upholds the primacy of the individual, a publicly funded, not-for-profit service, free at the point of use, with patients treated on the basis of need, not wealth or status, is an anathema.
Despite professions of concern, a crisis is in fact a golden opportunity for these politicians. Even the ‘solutions’ they come up with, ostensibly to help the NHS, are populist ways of eroding its core principles.
Rishi Sunak, for instance, has proposed a £10 fine for missing a GP or hospital appointment – though the Prime Minister’s sister Rachel thought it should be £30. There may be some patients who are truly irresponsible, but the people most likely to miss appointments will often be those who can least afford to pay a fine, and least deserve to be penalised. People with dementia or memory problems, people who struggle with caring responsibilities, who have unpredictable working hours and unreasonable bosses or people with serious mental illness. No doubt supporters of such fines would say those people could be exempt – which just means more expensive administration, and more hoops for struggling people to jump through.
Another proposal was for the NHS to charge patients for overnight stays. The suggested charge of £8 a night might sound modest, but we know that for many it would be unaffordable, and once established, could always be increased. Again, supporters may argue that only the prosperous would be made to pay. But in that case, why not keep it simple, and raise the money through progressive taxation? It is more efficient and involves less red tape and paperwork. Yet, ironically, the people who most enthusiastically support such charges and fines are often the very same people who think the NHS is overrun with ‘pen pushers’ or ‘bean counters’. Who do they think will run a payment system – doctors?
Whatever Conservative politicians might say about the NHS and its problems, and whatever ‘solutions’ they might now propose, they should in fairness start by accepting that it is largely their actions which have brought it to its current state of crisis. There are too many examples to examine here, but let’s look at just a few.
First and foremost – funding. It is simply a fact that the Conservatives have starved the NHS of funding and investment.
In the ten years prior to the 2010 election, the NHS received average funding increases of 6.3 per cent a year, the highest average increase for the NHS over any ten year period. In the following decade, up to the pandemic, the NHS received an average funding increase of 1.1 per cent a year: the lowest ever period of average growth. This in large part is why the NHS, hit by a global pandemic after being deliberately weakened over a decade, is now at breaking point.
Of course some politicians like to portray the NHS as a bottomless pit swallowing public money, and would like us believe it is unaffordable and unsustainable. But in the year prior to the pandemic, at 9.8 per cent, the UK spent less on healthcare as a proportion of its GDP than France, Germany and many comparable countries. In the USA, with its privatised medicine, healthcare absorbs 16.9 per cent of GDP.
So it’s not surprising that compared to many other countries, the UK has a very low number of hospital beds relative to its population. The average number of beds per 1,000 people in OECD EU nations is 4.6, but the UK has just 2.4. Germany has 7.9. Between 2010 and 2020, the number of general and acute hospital beds fell by 6,425.
But of course, beds are no use without qualified staff to care for the patients who occupy them. Here again, Conservative policies have greatly contributed to the current crisis. Pay freezes and below inflation rises mean nurses, and other colleagues like paramedics, are now thousands of pounds worse off than they were in 2010. This inevitably creates problems for recruitment and retention. But student nurses don’t just study for a degree, they also work long shifts on busy hospital wards, for no pay. Far from being grateful that people are prepared to do this, George Osborne axed the training bursaries for student nurses. Predictably, between 2015 and 2019, the number of people applying for nursing degrees fell by 10,000 a year.
But not only has funding and pay been systematically cut, the NHS has also been reorganised in a way which makes it possible to siphon off more and more money to the private sector. Through the Health and Care Act 2012 Andrew Lansley reshaped it, “with an expectation of easier entry and exit to the market for a range of private and voluntary sector providers.”
To understand the implications of this, we need to understand the nature of private healthcare in the UK. Essentially, it feeds off the NHS. Private healthcare providers do not train their own doctors, nurses, or other clinical staff. They rarely, or never, provide the most expensive and essential features of a comprehensive healthcare system, like intensive care or A&E departments. They offer routine, predictable and profitable treatments, and if, for instance, post-operative complications arise, those patients are often transferred to the NHS. Their business model would surely not be viable without the NHS. So when the private sector is paid to treat NHS patients, the gain is almost all on one side.
This has always been the case, but it has never been so blatant, or so costly, as during the pandemic. As Colin Leys, of the Centre for Health in the Public Interest explains: “the NHS paid £400m a month for the private sector’s entire capacity, covering not only its running costs, but also all the interest payments on its debt, saving some companies from a serious risk of failure after Covid wiped out demand from private patients.”
And in the event, private hospitals delivered only 0.08 per cent of Covid care.
Whilst money was seemingly no object when it was going to private providers and dubious PPE suppliers during the pandemic, increased spending on the NHS is always framed as one of those famous ‘difficult decisions’, meaning an inevitable rise in income tax or National Insurance for workers. But why couldn’t corporation tax be raised, so employers could invest in the health of their workforce? Or wealth could be taxed the same as income, so that those who ca afford to choose private treatment also contribute to the true cost of that treatment.
Also, it is impossible to ignore the inextricable link between problems in the NHS and problems in social care. Without going into details, one telling fact is worth noting. In 2020, after a decade of austerity, annual adult social care spending in England was still £600m lower than in 2010. Imagine the consequences of that decline, in the level of care for an ageing population, and the pay and conditions for those who work to provide it.
Investment in the NHS is an investment in the wellbeing of all of us. If we must justify it economically, then as an employer and purchaser it is a very effective way of distributing money throughout the whole UK. As a collective endeavour of care and compassion, it is unmatched and priceless. If politicians and voters who increasingly proclaim their patriotism squander this great achievement of the country they love, it will be a tragedy of epic proportions, and one in which we will all suffer.
© Bernadette Meaden has written about political, religious and social issues for some years, and is strongly influenced by Christian Socialism, liberation theology and the Catholic Worker movement. She is an Ekklesia associate and regular contributor. Her latest book is Illness, Disability and Caring: A Bible study for individuals and groups (DLT, 2020). Her latest articles can be found here. Past columns (up to 2020) are archived here. You can follow Bernadette on Twitter: @BernaMeaden