People are dying as a result of the current government’s political choices. One of two things has to change: the government’s policies, or the government.
Diagnosis: Acute exacerbation of chronic deliberate neglect of health
Causes include:
- Insufficient funding.
- The launch and maintenance of a damaging internal market in health services.
- Abdication of public ownership and responsibility.
- Disregard for workers’ conditions, training and pay leading to worsening morale and difficulty recruiting and retaining staff.
- Policies promoting poverty and inequality and disregarding public health.
- Poor funding and provision of social care.
The above circumstances represent a political choice by the government to accept worsening health outcomes. For years, many of us have been warning that these exact issues will lead to a crisis in health in the UK. Why did the government ignore us?
We have all watched with a lot of pain and sadness the latest crisis in the NHS unfold. We have entered this year’s winter disaster with too few beds in our hospitals, too few doctors and nurses in our acute services, and too little, too late from the government. It is heartbreaking to see too many patients treated in corridors, or ambulances not being able to get into hospitals. A&E staff do all they can to keep patients safe, but they should not be forced to treat patients in such risky circumstances that are ultimately less safe than what is ideal (and possible). Tens of thousands of people have had routine appointments and procedures cancelled. That’s tens of thousands of people who will suffer more pain and worse management of their chronic conditions. That risks these patients developing acute problems and many of them may end up needing emergency care as a result. This is a full-blown crisis. It was avoidable, had politicians listened.
NHS “leaders”, such as Simon Stevens, Bruce Keogh and Malcolm Grant, are talking about having to make “tough choices” about what the NHS can do under current circumstances. They are essentially laying the groundwork for rationing (a.k.a. reducing, shutting down, defunding) services. Cancelling all those appointments or procedures was one such choice. Another more chronic issue is for example how NHS drug and alcohol services have been forced to shut down and have been replaced by well-meaning but poorly-funded, fragmented and volatile charities. As such occurrences increase, private providers will increasingly provide services the NHS no longer will, profit will play an even larger role in health service delivery, the market will be distorted further, and inequality of services will increase. This will exacerbate the “inverse care law” that already exists, where services are often lacking where they are needed most desperately.
The government has coupled the above failures with completely ignoring social care, and implementing policies that are increasing poverty, worsening living standards and exacerbating social inequality. Worst of all, they continue to ignore those who have unfortunately been proven right on the crisis. Jeremy Hunt reassures us that 50% of hospitals are managing, i.e. 50% of the house is not on fire. He tells us there are more doctors and nurses training (while we are seeing far more staffing gaps and worse retention than ever before). Even worse, after the latest budget, the government’s response was childish and immature. “If only NHS leaders didn’t shout so much, they would have got the funding, we couldn’t show we could be told what to do” (paraphrasing the article here). This is irrelevant when it comes to hospitals being too full, unsafe staffing levels and cancelled appointments. Patients’ lives depend on this. If saving face is part of the government’s decision-making process, it is not fit to make decisions.
The knowledge is well-established about the levels of funding required to maintain or improve services, and about the damaging impact of the internal market in public health services. Basically everyone is calling for more funding and warning of a crisis if needs are not met: unions, political parties, service providers, royal colleges, professional organisations, thinktanks, managers, nurses, doctors. The public is even willing to pay more tax. The government is choosing not to listen to anyone but its damaging ideology and flawed plans.
One of the only solutions the government has suggested so far is to reduce demand, or to “do more with less”. These two things are impossible. Something else has to happen. Just as the government is currently making a choice with all of this to accept decreasing health standards and outcomes, we are at perfect liberty to choose one or more options to come out with a positive outcome for this country’s health:
- Increase income tax for the rich, corporation tax, or both. Raising a special tax just for the NHS is not enough - social care, housing and other social determinants of health all require better funding too.
- Reduce spending on things that do not contribute to our wellbeing: fossil fuels, harmful military interventions, Trident, Brexit.
- Tackle tax loopholes. Get the tax we are owed from Lewis Hamilton, Lord Ashcroft, Apple and the Queen.
- Bring down the government, and bring one in that improves the welfare of the entire public, not just a rich few.