The NHS is under threat today, precisely because it is failing to deliver what the people of this country expect of it.
A report in the Guardian this morning says:
Just 24% of people across England, Scotland and Wales – the fewest on record – are satisfied with the [NHS], according to the latest British Social Attitudes research.
Satisfaction has plummeted by 29% since before Covid-19 emerged in early 2020 and by an enormous 46% from the highest-ever 70% recorded in 2010, when the Conservatives took power. It fell five points alone from 29% in 2022 to the 24% seen last year.
I am not surprised. Nor, I suspect, will any other long-term NHS observer be so. This is the inevitable outcome of Tory policy on the NHS.
That policy was predicted many years ago by Naom Chomsky, who said:
There is a standard technique of privatization, namely defund what you want to privatize. .... [F]irst thing to do is defund them, then they don't work and people get angry and [then] they want a change.
The Tories have now defunded the NHS sufficiently to leave it in a state of such chaos that it does not work for too many people, meaning that they are angry with it and are open to change. Bizarrely, the Tories have laid the groundwork for the NHS privatisation that Labour's Wes Streeting seems so desperate to deliver.
The important point to remember is that none of this was an accident. All of it was deliberate. All of it was policy. I explored these issues back in 2018. I think that very little has changed since. As I said then:
The NHS need not be under threat. The NHS could be and should be, well funded. It could be and should be the basis on which opportunity for new generations in need in this country could be built. But that requires a new generation of economists, politicians, healthcare professionals and others to believe, as some did in 1948, that they can make a more effective difference in people's lives through the provision of state-provided healthcare than they could by promoting a market-based system. Those who believed that in 1948 were right. The current threat to the NHS suggests that their vision is at risk. That vision of universal care for people who are, whatever their economic situation, considered to be of equal value, needs to be restored. Nothing else will tackle the threat to the NHS.
The profoundly worrying thing is that this does not appear to be a vision that Labour shares.
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Labour have no plans to privatise the NHS. Stop lying Richard.
https://labour.org.uk/missions/nhs/
You call that a plan?
No one in the NHS does
Outsourcing – directing resources to the private sector – while starving the public sector of funds IS privatisation by the back door. Outsourcing is choosing the private sector over the public sector. Outsourcing doesn’t help the NHS but undermines it. We have been told by Reeves & Starmer that there’s no money to restore and improve the NHS (or anything else). So, there is no real plan for the NHS – Streeting’s plan is all about enriching private healthcare companies. It must be hard for those few remaining centre-left Labour supporters to deal with the cognitive dissonance arising from all this. My guess is that it won’t take too long after Labour is elected for reality to sink in, or will they just double down and declare themselves born-again neoliberals?
Yet everything Streeting says publicly about restructuring and private partnerships says the opposite,
Outsourcing, in principle, overlays a profit margin filter/layer on budgets, both revenue and capital.
It can only add to costs, not reduce them, unless you screw labour costs into the ground.. which then leads to low morale and staff flight, as is currently happening. Only connect.
What it really means is that all aspects of the NHS, including the service ethos, are reduced to transactionalism. The NHS means more to us than that.
There is another aspect to ‘outsourcing’ where the NHS is concerned. Private health relies for its resources on the NHS, in effect cannibalising the NHS. Those NHS staff, trained and developed by the NHS but working in the private sector, just further reduce NHS capacity.
To add to that, the private sector prefers to take the more straightforward, ‘commodity’ work like cataracts or hips and knees. Show them complex, multiple morbidity, aged patients and they run a mile, let alone try to tackle A&E. That would completely mess-up the ‘efficiencies’ that they and their supporters claim they offer. And when it goes wrong, guess who has to clear up the mess, which is why most private hospitals are not too far from an NHS hospital.
The NHS has to take whatever is thrown at it – the private sector picks and chooses. It picks the easier stuff from the NHS, which makes the NHS performance, using the daft metrics that have been imposed look even worse.
‘Private healthcare interests encompass far more than private hospitals and general practitioners. It extends to pharmaceutical companies, medical technology firms, medical staff recruitment agencies, private care home companies, and investment companies with substantial stakes in the profitability of private healthcare entities’.
From the 2022/3 register of interests of MPs at Westminster –
‘Sir Keir Starmer, the Leader of the Opposition and a prospective Prime Minister, has found himself enriched by the tune of £157,500.00 from donors associated with the private healthcare sector. Yvette Cooper, the Shadow Home Secretary, boasts an even more substantial sum of £295,205.00. Meanwhile, Dan Jarvis, juggling his role as the Mayor of South Yorkshire, has managed to secure a handsome £137,500.00 in donations from the private health industry. As for the Shadow Secretary of State for Health, the individual who would be entrusted with overseeing the NHS under a Labour government, his pockets have been lined with an impressive £193,725.00 in contributions’.
‘on just the donations to the shadow Labour front bench, it’s a staggering £783,930’.
https://archive.ph/5LGRU#selection-1473.0-1473.330
Follow the money.
The link doesn’t work.
Schofield:
The link worked ok for me, but try this: https://archive.ph/5LGRU
Thanks Therese I managed to get the web link to load albeit slowly.
The NHS was the envy of the world because it worked.
Over the last 60 years, the UK population increased by about 30%, which some have complained is a problem.
But that also means that the economy should have grown by at least 30%, and economies of scale should have benefited the NHS.
It is clear that the NHS budget is seen by some as better in the pockets of the few rather than the many. While some may genuinely believe that a private healthcare system is “more efficient”, all the evidence points to the opposite, as we see today.
The Labour frontbench has received over £600,000 in “donations” from private healthcare companies, and ever since Blair, Labour has turned Tory.
And the effectiveness of private healthcare is in no doubt. “The Lancet journal reveals a troubling connection between hospital privatization and a decline in patient care quality.”
It is clear that the NHS is being dismantled and sold for profit.
Sources
“NHS drops from first to fourth among rich countries’ healthcare systems” (2021), The Guardian
https://www.theguardian.com/society/2021/aug/04/nhs-drops-from-first-to-fourth-among-rich-countries-healthcare-systems
“Labour front bench takes £650k from health privateers – more than Tories” (2024), Skwarkbox
https://skwawkbox.org/2024/01/17/labour-front-bench-takes-650k-from-health-privateers-more-than-tories/
“Oxford Study Links Hospital Privatization to Lower Care Quality, Challenging Market Competition Claims” (2024)
https://medriva.com/news/healthcare-policy/oxford-study-links-hospital-privatization-to-lower-care-quality-challenging-market-competition-claims
How to Dismantle the NHS in 10 Easy Steps, by Youssef El-Gingihy (2024)
https://amzn.eu/d/9wfPWlE
Thanks
When you say ‘defunded’ the NHS, you mean anctually increased spending in real terms each and every year since they came to power, including massive additional funding during COVID?
That’s what the statistics say:
https://researchbriefings.files.parliament.uk/documents/SN00724/SN00724.pdf
Do you have different data that we should be aware of?
You ignore population change, an ageing demographic and medical advances when oppting for a siomple number. Is that because you do not care?
It’s funny how you weren’t honest about NHS funding until called out on it.
Shouldn’t medical advances mean that we can do more things, more cheaply rather than have to mean higher costs?
The issue with the NHS is that productivity gains appear to be non-existent and people expect to have the latest treatments regardless of the costs – in which case funding will never be enough.
But to suggest that the Tories have taken money away from the NHS is a blatant lie – the data clearly shows an increase in real terms.
Trolls write many crass comments on here, but your suggestion that “shouldn’t medical advances mean that we can do more things, more cheaply, rather than have to mean higher costs” has to be one of the most stupid ever offered. It would seem that you can only appraise the world through the lens of supposed productivity, which I note in another blog this morning to be a false God. The reality is that in the real world, with which you are very obviously unacquainted, medical advances means that we can do things that were impossible beforehand, not that we can do what we previously did more cheaply. The consequence is that medical advances mean that we increase the demand for medicine. You might be unaware that we have moved beyond bloodletting now, but let me assure you, we have.
https://policymogul.com/key-updates/5834/a-decade-of-cuts-has-left-a-37-billion-hole-in-our-health-and-education-services-says-labour-
And yet Paul many healthcare workers have seen real terms pay cuts. How do you explain that?
And what do you mean by “real terms”? Healthcare costs (and the demand from an increasing and aging population) do not increase at the same rate as a can of beans.
To put it another way, is it enough? And is it being spent well, rather than say millions and millions on buying useless PPE from friends and family?
“When you say ‘defunded’ the NHS, you mean actually increased spending in real terms”
That’s what the government said about spending in education.
But in both cases, there is a decrease in spending PER PERSON (as Richard says, because of population growth).
I’m not sure that dissatisfaction with the NHS as it currently stands inevitably means that people are open to change in the model. How many times have things like straw polls shown that people would be happy to pay more tax in order to keep the NHS properly funded?
Of course people are dissatisfied,but I think they’d just like to get back what we’ve been used to.
Dan Neidle did polling on this issue recently and found that the number of people really willing to pay much more tax to pay for the NHS was very small indeed.
That’s interesting, Richard. Thank you.
To what extent, Richard, do you think that that attitude has been established through the use of terminology such as taxpayers’ money, taxpayer funded and tax burden which, it seems to me, have become more and more prevalent across the media to the extent that they are now ubiquitous. I get the feeling I could spend all day firing off complaint letters pointing out how biased and inaccurate this choice of language is.
They are part fo the whole narrative of individual priority that so undermines the idea of society – as Thatcher always wanted
Maybe he only polled people who understand govt money creation. Context is all in these things.
I like the term “individual priority”. Parliament has become the Houses of Individual Priority or rather Home of or so it increasingly feels!
I wrote Julia Patterson (EveryDoctor.org) a month or so ago & warned her as follows:
1 This government KNOWS it is going to be literally hounded out of office & will NOT engage in anything remotely constructive re the NHS (and all other public services)…arguably they will do the opposite in terms of continued destructive action, to make the task of ensuing government as difficult as possible. Cynical? Possibly, but I believe it to be true.
2 Labour, if elected (said to be a certainty) do not seem to be intent on doing anything other than continuance of current policy. I see little or no evidence of Labour’s copied philososphy changing. I hope I am wrong but fear I am not.
3 If you corner any of these politicians, they will offer the usual blandishments that they are not going to privatise the NHS, that it will always be free at the point of use etc….in other words they are all adept at kicking complaints into the long grass. If anyone is daft enough to believe, disillusion takes over the following day when it is discovered for example that more GP practices and/or more patient services & data have been sold to private corporations.
4 To sum up these points, there is no overt policy of privatisation that you can object to, just stealthy attrition that no-one can object to in law….I am certain that I have nothing to teach you (i.e. Julia) on that point…..but it makes it very difficult to address…..
5 More strikes etc also gives the government time to misinform & disinform via incessant propaganda that invariably will lead to public disenchantment with the NHS……..no-one should underestimate the supervening power here: look what happened to shipbuilding, coal mining & steel industries, & the utter debacle of Brexit….
6 THE MOST IMPORTANT “WEAPON” IN THE GOVERNMENT ARSENAL, HOWEVER, IS THE PORTRAYAL OF HOW NATIONAL GOVERNMENT FINANCE WORKS. THAT PORTRAYAL IS PARTLY BASED ON INCOMPETENCE & CULPABLE IGNORANCE, BUT MOSTLY OUTRIGHT LIES.
GOVERNMENT & OPPOSITION THUS HAVE VAST NUMBERS OF THE PEOPLE CONVINCED THAT PUBLIC SERVICES (inc NHS) CANNOT POSSIBLY BE AFFORDED & MUST BE OUTSOURCED TO PRIVATE MEGA-CORPORATIONS WHOSE SOLE MODUS OPERANDII IS PROFIT & SELF-ENRICHMENT.
7 Now here is where you can (& surely must) add another & much more powerful string to the bow of your campaign by confronting that model, that portrayal, with the real model of how National Public Finances ACTUALLY works…..
About 4/5 days ago, I received another of her regular e-mail output, this time citing the BMJ report, a lot of which was welcome in terms of refuting the alleged advantages of dismantling the NHS. The problem with it was this bit in the BMJ summary:
“…We therefore conclude that, with little compelling evidence to suggest that switching to a social health insurance model would justify the upheaval and costs of doing so, funding for the NHS should continue to be raised from general taxation. This is also the view of the public, across all demographics, including individuals’ political allegiances, with around 82% supporting a tax funded NHS….”
I replied citing extracts from the synopsis of your TW Report, plus my own remarks about how & why “Spending must & always does precede taxation” & summarised my response to her with this:
“My point here is to get you & every doctor on your EveryDoctor website to understand that as long as you are all subscribing to this false notion of a “tax funded” NHS, you are playing right into the hands of the politicians & the money masters who control them. As long as you adhere to this false tax-funded NHS notion, they will simply go on telling you that the NHS is “unaffordable” & must be “outsourced” i.e. privatised. And frankly as long as you continue with this false notion, you are reinforcing their position & allowing them to perpetuate this “unaffordability” nonsense…..Perhaps you may care to take up these issues with the BMJ.
You really have to start exposing the culpable ignorance of, & often outright lies from, our politicians about Spending & Taxation Myths, & the Ludicrous Narrative of National Debt. Please get after the money/affordability issues.
NB You cannot win otherwise, however well-researched & well-crafted your campaign is….”
I hope I was not too hard on her (feeling slightly guilty after all the work & effort she has put in) but I really do believe that trying to vie with the government & their plutocratic/oligarchic/corporate neoliberal backers i.e controllers, ON THEIR OWN TURF, HAS NO FUTURE, NO CHANCE OF SUCCESS – they will rely totally on attrition, misinformation, & the resigned apathy & acquiescence of the public…..
Richard, you are about to elevated to OAP status (House of Lords peraps?), you won’t last for ever, you have done an enormous amount already, but you cannot do this on your own…..the debate now has to centre on what & how your readers & followers can do to help…..
It is of course enormously comforting to realise that many people are thinking along similar lines about the “state of the nation” if I can put it that way, (because it is about so much MORE than the NHS) but it is simply not enough to live in the bubble of self-affirmation…..what can we do to help get the message across?
Waddydyallthink?
Excellent questions
But as I keep saying, I am not the man to run an organisation
If others think that is needed they need to organise it. At 66 I known what I mam not good at and am no longer inclined to try