Striking junior doctors in 2016, photo Paul Mattsson

Striking junior doctors in 2016, photo Paul Mattsson   (Click to enlarge: opens in new window)

Although the Tories wanted to make this the ‘Brexit election’, the NHS remains a vital issue – in some polls it comes out as the most important issue in the election. A publicly owned, funded and controlled National Health Service meant to provide free health care for all is one of the most important gains in the last 70 years.

But the NHS is in crisis. After high alerts even during the quieter summer months, some hospitals are now declaring “black alerts” – now called ‘Opel 4’ – where demand for services exceeds the ability of the hospital trust to supply them. Hospital waiting lists are at an all-time high of 4.6 million, 34,000 cancer patients are waiting longer than two months for treatment.

Steve Score, Socialist Party national committee, exposes the Tories’ lies, looks at Labour’s approach and explains how a real socialist programme can save and develop the NHS.

Tory lies exposed

Boris Johnson claimed “we are the party of the NHS” at Tory Party conference, echoing Margaret Thatcher’s “The NHS is safe in our hands”, before she began a process of marketisation and privatisation that continues to this day.

Johnson claimed that they would build “40 new hospitals” in ten years. Previously the Tories claimed they will increase overall NHS spending by an extra £20.5 billion by 2024 and that spending on the NHS is “higher than ever”.

But the “40 new hospitals” turned out to be a lie. It was in fact a release of capital funding for new buildings that had been held back, sometimes for years, by government-imposed austerity restrictions.

£20.5 billion extra funding by 2024 is a less than average increase for the NHS over its existence and comes after years of underfunding. The average increase under the Tories has been 1.3% since 2010. But if you consider factors such as the growing and ageing population, as well as the costs of new technology, this is in fact a substantial real cut.

The Kings Fund estimates that the NHS needs long term growth of at least 4% a year and the average growth, under all governments, since its establishment in 1948 has been 3.7%.

There is a backlog of £6 billion for repairs and maintenance alone. Because of day-to-day underfunding of services and hospital trusts running huge deficits – a lot of money (Labour says £4 billion) that was meant to be spent on equipment and maintenance has gone into keeping services afloat by the transferring of funds from capital budgets.

The government claim to increase the number of GPs by 6,000 is unconvincing when the Tories made a similar claim in 2015 to increase by 5,000, and there are now 1,500 less!

There is a massive staffing crisis across the NHS, with a shortage of at least 100,000 of all staff, 40,000 of those are nursing posts. The lack of forward planning in training, the abolition of bursaries for student nurses, the high cost of tuition fees, low and frozen pay for staff, and huge levels of stress from overwork, all contribute to this crisis. NHS staff work one million hours a week in unpaid overtime.

Tory privatisation

Over their years in power the Tories have carried out, and continue to propose, reorganisations of the NHS which push in the direction of more privatisation. The NHS has been divided up. Over 200 ‘Clinical Commissioning Groups’ (CCGs) were created, with ‘providers’ such as NHS hospital trusts, private companies and other organisations competing with each other to get contracts from the CCGs.

It took the competitive market approach a step further and brought increased privatisation. The unpopularity of privatisation with the public has forced the Tories to play it down, with health Secretary Matt Hancock promising “no more privatisation on my watch”. It is of course another lie.

The language and focus of various plans have more recently been on “integration” of services including with social care. The latest bodies being proposed are ‘Integrated Care Systems’ or ‘Integrated Care Providers’. It all sounds nice but, in reality, these are more bodies in the same competitive mold, with even less accountability.

Labour’s record and Labour’s programme

Labour has promised an increase in funding of £26 billion extra in England by 2023-24. (All these figures are for England with equivalent increases on top in Wales, Scotland and Northern Ireland). This is a welcome start and better than the Labour promise in the last general election.

In addition, Labour promises to increase funding in mental health services that are in a dire position after years of drastic cuts, spend £15 billion capital spending on hospital buildings over five years, scrap prescription charges and hospital car parking charges and reinstate nursing bursaries.

Labour also promises to reverse the privatisation that has crippled the NHS for many years. This is also very welcome, especially because privatisation soared under previous Blairite Labour governments.

While Thatcher laid the groundwork by introducing the ‘internal market’ it was the Blair government that ramped up the ‘Private Finance Initiative’ schemes, continued by subsequent Tory governments, that handed over control to private companies and have cost the NHS dearly.

Blairite privatisation

Outsourcing of non-clinical services of all kinds to private companies has meant they extract profits from the NHS, and cut staffing and service quality in order to increase them. Often these companies have failed to do the job, forcing hospitals to take services back in-house. This has taken place under governments led by all three main parties.

It was under Blairite governments that, using the excuse that waiting lists couldn’t be quickly reduced any other way, that some operations (the cheapest and easiest ones) were handed out to private hospitals, again at the cost of the NHS. This has led to a blossoming of those companies and a shift of staff and resources away from the NHS.

Now, after years of cuts, the number of procedures carried out by private companies is rocketing. There were 613,000 people treated in private hospitals last year, three times the number nine years earlier.

Massive cuts in the funding of social care have a huge impact on the NHS, with long delays in elderly patients being discharged from hospital for example, because the care services are not available. The excuse given by NHS management for not increasing the number of beds in line with a growing and ageing population is that more patients will be helped at home, yet nothing is done to make that possible. To solve the NHS crisis, proper provision and funding of social care is vital.

Labour has promised to provide free personal care for those with the most severe needs, which is much needed. But that will require a massive reversal of the cuts made to local council budgets over many years.

Whether the NHS is ‘up for sale’ has been part of the election debate. Labour has pointed to the discussions between Boris Johnson and Donald Trump about a possible trade deal with the US after leaving the EU. Trump first made comments implying the NHS would be “on the table” then later denied it.

At the moment, big US companies can bid for NHS contracts only if they have a subsidiary based inside the EU. As part of a new trade deal, access for those companies could be made easier. Although the real issue is to end privatisation full stop, whatever the country of origin of the companies. The truth is that the NHS is already ‘up for sale’ and has been for a long time.

What could also be a threat in a new trade deal could be regulations allowing US pharmaceutical companies to charge the NHS higher prices for its drugs. Labour says that the drugs bill for the NHS could rise from £18 billion a year currently to £45 billion.

In Britain, the NHS is able to use its monopoly position to negotiate on drug prices, advised by the National Institute for Health and Care Excellence. If it was a totally ‘free market’, as in the US, prices would be even higher. Any deal involving an increase in costs to the NHS must be resisted.

But that drugs bill is already too high. It represents a huge draining of resources from the NHS into the profits of the big pharmaceutical companies. Patent rules allow companies a monopoly position on new drugs so that they can hugely hike their prices. Labour has proposed regulation changes and the establishment of a publicly owned manufacturer to help combat this (see Socialism Today, issue 233, November 2019).

How to defend and rebuild the NHS with a socialist programme

Piecemeal measures will not be enough to solve the crisis in the NHS. Piecemeal measures are inadequate to deal with the power of ‘big pharma’. The Socialist Party proposes the nationalisation of the pharmaceutical industry to enable its integration into the NHS, improve research and development and allow the resources and profits of these companies to fully benefit patients.

On privatisation, shadow Chancellor John McDonnell has said that Labour would bring private contracts “back in-house” when they “come to an end”, allowing privatisation to continue for some time. He may argue that time is needed to expand NHS services so that they can absorb the extra work. However, what is really needed is the rapid nationalisation of the bigger private companies, with compensation based only on proven need, to ensure their capacity is absorbed into the NHS.

Corbyn government

The election of a Corbyn-led Labour government would be a big step forward. But we also know that many of the Blairite Labour MPs voted in the past for cuts and privatisation. It will need a mass movement in support of the NHS to ensure their programme is carried out and that we get the improvements we need.

If there isn’t a Labour government after this election, we will need that movement even more. Over the last few years there has been local strike action taken by different groups of workers in the NHS in defence of jobs and conditions as well as the NHS as a whole. We have seen national action by junior doctors as well. There have been many local campaigns established to fight particular cuts and closures. Some have successfully fought those attacks.

If a Tory or other variety of pro-big business government comes to power, we will need national action led by the trade unions in the NHS, and backed by the movement as a whole, linking up with the local campaigns through organisations like Health Campaigns Together.

The immediate task over the next few weeks is to fight for a Corbyn government. But there is no doubt that capitalism casts its greedy eye over national resources spent on the NHS. For big business, profit comes before everything.

We need a fully funded, fully publicly owned and genuinely free National Health service with democratic working-class control and management. Health is a vital human need and can only be secured by ending capitalism and replacing it with a socialist society.