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NHS Isn’t Breaking, It Is Broken

After nine years of the Tory Government, the NHS is not at breaking point, it is broken. A shortage of doctors, nurses, beds and care packages for elderly patients means that black alerts, trolleys in corridors and dangerous safety levels for patients are at a peak. 

NHS England has cancelled tens of thousands of hospital operations, which will create the biggest backlog in the health service’s history. A&E services are in a permanent state of chaos. What was once confined to winter is now an all-year-round occurrence. Mental health services are still woefully underfunded. The closure of more than 4,000 mental health beds since 2010 and a similar reduction in the number of psychiatric nurses have not been reversed. Social care services are in a state of paralysis. All the key indicators within the NHS worsened, with waiting lists reaching 10-year highs.

Before 1948, the have-nots feared ill health. Not for the reasons you or I fear it, but because they had no means to pay for treatment. The creation of a universal healthcare system, free at the point of use, was Britain’s greatest post-war achievement, that is now being set up to fail. The Chronic staff shortages threaten the sustainability of the health service and have led to an increase in doctors’ workload and intensity. Between 2013 and 2015, the number of doctor vacancies increased by 60% and an estimated 10% of all medical posts across the NHS are currently vacant. Nearly three quarters of medical specialties are under-recruited.

The fear of getting ill that gripped Britain in the past has returned. The principle of a universal healthcare system, free at the point of use, is broken. This government has ushered in a creeping reduction of universality, through the demonization of ill people and the incremental rationing of care. Denying surgery to those who smoke or are obese is the thin end of the wedge. Hip, knee and cataract surgery are all increasingly rationed and, recently, the NHS launched a consultation to end the provision of painkillers and basic vaccines. This would see a return to the pre-1948 system.

The endgame of the Tory plan is privatization or the NHS’s replacement with a US-style social insurance system. The government’s new plans for health care, which are being rapidly introduced without proper public debate or parliamentary scrutiny, turn on new models of care which are drawn from the US – the most expensive and unfair system in the world.

The elephant in the room is the trend to reduce public healthcare provision. The systematic closures and restrictions needed to phase out the ‘outmoded’ family GP are hardly making it easier for people to access their own doctor, with continuity of care suffering. The Keogh policy to rapidly erode England’s A&E network has quietly been readopted after having been abandoned for fear of political repercussions. This policy is often overlooked as a factor in increased A&E waiting times, which have now hit the worst ever figures since records began. There is unwillingness from the top to train and encourage new fully-skilled professional staff, opting instead to find cheaper alternatives, such as volunteers, new lesser-qualified roles or profitable apps signifies (despite empty protestations to the contrary) a choice to replace rather than replenish the NHS workforce. 

Thanks to a BMJ study, we can link 120 000 ‘excess’ deaths to health and social care cuts. Yet still, the Establishment narrative focuses on increased ‘demand’, effectively blaming the victims for the government’s decision to roll back the NHS. An exaggerated mainstream emphasis on funding issues also steers the conversation away from the government’s moral and political (although legally eliminated) duty to properly meet our healthcare needs. Instead, the spotlight is misdirected onto matters of financial juggling; enforcing an inappropriate profit-and-loss business mentality, rather than funding actual need. A rhetorical sleight-of-hand which fails to distinguish actual from stated political ends, limits discussion to the means to bring either about. 

The thrust of these changes has been resisted by campaigners around the country. Too many councils, however, are waving them through on a promise of pooled NHS funding for their depleted social care budgets. Similar startegy to Theresa May’s recent bungs to Labour constituencies in Leave areas, but currently more successful.

Resistance to the service’s deliberate overall shrinkage in England is fragmented; the focus is on funding and is failing to deal with the government and NHSE’s agency and political intent. The absurd idea that we still have social democracy, and a government sincerely trying to meet popular need suffocates a genuine confrontation between the two very different health service models at stake - Bevan’s socialist principles versus McKinsey’s healthcare market, a social safety net with gaping holes.

By Dr Kailash Chand FRCGP OBE, Chair healthwatch Tameside and former deputy chair BMA council.

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