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Credit: Gordon Joly, Link: https://creativecommons.org/licenses/by-sa/2.0/

What’s At Stake: Our NHS

In the last ten years, the NHS has gone through unprecedented upheaval. We are inexorably moving toward a system ruled by bogus choice, competition, market forces and diversity of suppliers. The fear of getting ill that gripped Britain in the past has returned. This government has ushered in a creeping reduction of universality, through the demonization of ill people and the incremental rationing of care. 

The principle of a universal healthcare system free at the point of use is broken. It's time to assess the overall state of the NHS today as we head towards a General Election which will determine its future. 

All the key indicators within the NHS worsened over the last ten years, with waiting lists reaching 10-year highs. 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. What was once confined to winter is now an all-year-round occurrence. 4.4m people are now waiting for operations and the NHS hasn't met waiting time targets for accident and emergency, diagnosing and treating cancer, or surgery for more than three years.

More than a million elderly persons are not having their social care needs met - an increase of 48% since 2010, and so the number of admissions from patients aged 80 and above at A&E has grown by 500,000 since 2010. This puts added pressure on our A&E wards when discharges are delayed due to a lack of available care outside of the hospital. Hence, since 2010, the NHS has lost 10 million bed spaces as a result of delayed discharges of patients, at a cost to the NHS of £4billion.

NHS spending growth is currently on course to be lower this decade than at any other time in the NHS's history, just 0.4% annual increases in real per capita spend. NHS spending, as a share of UK GDP, has fallen since 2010. Two thirds of NHS Trusts & NHS Foundation Trusts are now in deficit, and the total deficit for NHS Trusts has tripled in one year.

Faced with large financial deficits, the NHS managers look at how they can generate private income. Meanwhile, Foundation Trusts are undertaking more privatisation and entering into joint ventures and creating companies to transfer staff. Over one and half million admissions to private hospitals in England each year are funded by the NHS. That is approximately four hundred thousand patients a year, taking money out of the budget-stricken health service and lining the pockets and profits of the private sector. 

And now Boris Johnson has made piecemeal announcements in an attempt to grab headlines that show his concern for the NHS. But he is totally out of touch with the reality of the NHS crisis. The £1.8bn he has pledged is nowhere near enough to reverse years of underfunding and damage. The gap between policy rhetoric and supply reality has never been starker when in February 2017, the PAC noted a black hole of £22billion in the NHS's finances. It used to be the banks that went bust, under the Tories it's our hospitals. 

Since 2010, Tories have handed £98bn of NHS cash to non-NHS providers. In 2018/19 £29 billion was spent by NHS England in the independent sector, which is around 26% of total expenditure. The only progress this government has made is, expanding the private sector in the NHS.

The next Government must commit to prioritising the care for patients, but also the working lives of NHS staff to stem the flow of doctors leaving the profession. They must commit to increasing NHS funding by 4.1% across the UK and repeal the legislation in England that has led to wasteful and detrimental competition in the NHS. 

Prevention must be put at the heart of the healthcare system. The next Government must act where others have failed and taken decisive action on smoking, alcohol misuse, physical activity and poor diet underpinned by the introduction of policies to deliver carbon neutrality as soon as possible to minimise the impact of climate change and pollution of health and wellbeing. 

This election is far more than a single-issue matter. While Brexit looms large –there are other issues at stake, issues that are just as important to the public and health and social care more than most. This election, more than any previous one, endangers the very existence of the NHS.

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

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