The National Health Service Crisis
by Kelvin Hopkins
Decades of Underfunding
The National Health Service is working under relentless and severe pressure which has been increasing year by year leading inexorably to the current crisis. This has been brought about simply by desperate underfunding inflicted by successive governments.
It is astonishing that despite the Health Service being starved of resources it has continued to function, working miracles on its pitiful funding. It has worked through the Covid pandemic as well as ongoing pressures across the whole range of wider health needs, but we are all now facing inevitable shortages in provision despite the heroic efforts of the thousands of National Health Service staff who need all our support as never before.
The cause of these immense pressures can be very easily demonstrated by comparisons with other nations. Statistics published by the Health Foundation and the Financial Times show that average(median) annual spending on health in 14 EU countries between 2010 and 2019 was 21% higher than in the UK.
This was a funding gap of £40 billion each year, a cumulative total of £400 billion over the decade. This equates to £62 million for each of the country’s 650 parliamentary constituencies every year, over £600 million for the decade. It is not surprising that the National Health Service is struggling to cope with all our health needs despite the magnificent efforts of all NHS staff.
The enormous gap between UK health funding and that of other countries is a national scandal, nothing less than a social crime for which the present and previous governments must be condemned. The government knows that the only solution is a substantial increase in public spending on The National Health Service to meet the nation’s health needs and to begin to close the yawning and shameful gap between Britain and other countries.
Health Provision Comparisons Between the UK and Selected Neighbour Countries
The following statistics are taken from a 2018 report by The King’s Fund. They are selected to give the clearest picture of just how far we in the UK have lagged behind other European countries. In all measures we are at or close to the bottom of the European league tables and far below the averages of the 14 comparator nations in the King’s Fund report.
| Numbers Per Thousand of National Populations | Numbers Per Million People | ||||
|---|---|---|---|---|---|
| Doctors | Nurses | Hospital Beds | CT Scanners | MRI Scanners | |
| Germany | 4.1 | 13.3 | 8.1 | 36 | 33 |
| France | 3.1 | 9.9 | 6.1 | 17 | 18 |
| Belgium | 3 | 10.8 | 6.2 | 23 | 12 |
| Netherlands | 3.5 | 10.2 | 4.2 | 14 | 12 |
| UK | 2.8 | 7.9 | 2.6 | 9 | 7 |
| Averages of 14 Comparator Nations | 3.6 | 10.2 | 4.3 | 24 | 15 |
These statistics show in stark terms how far the UK has fallen behind other comparable and neighbouring countries in health provision. At their most extreme they show that Germany had 46% more doctors per head, 68% more nurses, 3 times more hospital beds, 4 times more CT scanners and a staggering almost 5 times more MRI scanners than the UK.
But the UK is far behind even the national averages of the 14 comparator nations on all measures.
While the data is correct only up to 2018, no-one is claiming that the situation has improved since then. Indeed, the numbers will have changed a little since 2018 but the comparisons will be similar. It is possible that the UK’s relative position may have further deteriorated and updated figures will be of interest.
Privatisation Inflicting Further Damage
The National Health Service has already suffered costly damage from creeping privatisation and it is now necessary not just to stop this process but to reverse it. Private health is much more expensive and less efficient than public provision. Those nations with largely private health demonstrate this beyond argument with the USA the clearest example.
Among the European nations Switzerland has predominantly private health and is far and away the most exceptionally expensive provision in Europe. A programme of insourcing of privatised components of National Health Service provision is essential.
We must stress that publicly provided health means not just health which is free at the point of need but also provided by publicly employed staff at all levels motivated by their commitment to the public service ethos and not employed by companies driven by the profit motive.
Indeed, the key reason why the National Health Service has coped as it has under enormous pressure despite decades of serious underfunding is precisely because it has been a true public service and thus much more efficient than private systems.
The precious and vital commitment of National Health Service staff must not be abused or put at risk by low or inadequate pay. The government must accept that public spending on health must rise substantially both to support staff incomes as well as to expand the workforce, bed numbers and health technologies to necessary levels. The massive gap in health funding between the UK and comparable neighbour nations must be closed.
The isssues above and much more will be analysed in Rebuild Britain's forthcoming Health Pamplet.
Rebuild Britain's Health Service
A historical perspective on the state of our health service
by Jenny Pearson
The creation of the National Health Service was a magnificent achievement. Previously health care was unaffordable for most working people. A visit to a doctor could cost as much as half a weekly wage. Consequently many illnesses remained untreated and either improved over time or deteriorated. Finance was provided by insurance companies for those who could afford them, local councils and some charities.
The Beginning
Aneurin Bevan was born in 1897, the son of a coal miner. He was one of nine siblings only three of whom survived. He left school at the age of thirteen and followed his father into the mine. It was during this time that his socialist aspirations developed and he became immersed in trade unionism. He became leader of the South Wales Miners and was involved in the General Strike of 1926. In 1929 he was elected as Labour MP for Ebbw Vale.
William Beveridge, concerned to improve the general health and wellbeing of the nation due to the austerity and decimation of the war produced his report in 1942.
The Beveridge Report advocated that all working people should contribute to a state fund to be used to provide health and social care for all.
The Labour Party won a landslide victory in the 1945 General Election. Their manifesto promised universal health care influenced by the Beveridge report. Clement Attlee became Prime Minister and Aneurin Bevan Minister of Health and Housing, who was to create the National Health Service.
The idea of State control was accepted by the majority partly due to the fact that under rationing during the war the health of the nation had improved.
There was however some resistance to the scheme mostly from the Conservatives but also from the British Medical Association who were keen to keep their private practices.
There was also some division within the Labour Party itself. Bevan eventually won the support of the medical profession by allowing the consultants to work both inside and outside the NHS, and treat their lucrative private patients at the same time. GP practices remained as private businesses but contracted to provide health care.
NHS Finally Born
The new Labour Government however was determined to establish a Welfare State, ‘Homes For All’, new towns and even some prefabricated housing to help with the housing crisis. Many of these were still standing decades after the war and were dilapidated but still used for homeless families. The Nationalisation of industries was thought to improve working conditions in key areas. However, an organised workforce leads to strength in Trade Unions which later Thatcher sought to destroy.
Nonetheless, despite some resistance, The National Health Service was finally born on July 5th 1948, health care available for all. It was not popular in some quarters and also with some doctors because of the enormous cost and soaring demand. So it has never been fully funded but even so it was a pioneer of its time for health care.
Funding and the Workforce
Comparisons can be made with the massive national debt following World War 2 and the debt caused by the Covid 19 pandemic. Similarly, rebuilding through massive investment is needed now more than ever. Britain had to be rebuilt both structurally and industrially after the war.
Britain needed workers and was prepared to keep them healthy as they were needed to work in many sectors. The shortage of labour led to the introduction of the British Nationality Act. This entitled all Commonwealth citizens to British passports and therefore to come and work in Britain.
Mass immigration followed and they mostly worked in the transport sector, building and the newly created National Health Service. Many came from the Caribbean Islands which had been underdeveloped by Britain and was in crisis and with massive unemployment. This also contributed to racist uprisings.
Underfunding and Covid
The blatant underfunding of the National Health Service has never been more evident than during the present Covid 19 pandemic. The thousands of deaths caused by a blundering government trying to cover up it shortfalls with secret private contracts has shocked the Nation. Countries with greater manufacturing capacity and better public services did better during the pandemic.
The philosophy of the present government seems to be to throw caution to the wind in favour of herd immunity against Covid 19. This idea was initially discarded but the impatience to open up their capitalist economy it seems to be back on the table.
If a herd of cows develops TB the sick animals are euthanized. With herd immunity in humans it seems the old and weak can be sacrificed.
Decline and Privatisation
The Health Service has been in decline for many decades with many sections of it being taken over by private companies. Some of the earlier changes came in the 1970s when areas such as housekeeping and catering within hospitals was hived out to private companies, many of which retained some of the same staff but with worse conditions of work and less stable contracts. Another example is the closing of geriatric hospitals where there was specialist nursing and the needs of these patients was understood. This led to these patients occupying acute beds in General Hospitals as they were not catered for elsewhere. Many local cottage hospitals were closed when they had played an important part in community medicine.
The closure of beds seemed to be an efficient way of saving money. It was then that the terms ‘overspending’ was used to replace that of ‘underfunding’! The fabric of our hospitals is a disgrace with some buildings being propped up with scaffold poles. This, the previous Health Secretary described as ‘Safe’. Recently, the Government has declared that hospitals should be built more cheaply than was originally planned.
The Private Funding Initiative (PFI) was a government policy aimed at creating a private-public partnership where private firms are contracted to manage specific areas of health care. It was launched in 1992 by John Major but expanded considerably by the Blair government as part of a wider programme of privatisation. In fact it is just a way of the government abdicating state responsibility for the Nation’s health.
Many medical disciplines are franchised to private companies outside the NHS which are still free to the patient but the NHS pays the private company. These are clinics outside the hospital walls usually specialising in one main thing such as endoscopy, ultrasound or X-ray and other diagnostic services.
Many private companies are benefitting from creeping privatisation and outsourcing of services from the NHS. Drugs which formerly cost only a few pence have risen by thousands of percent when bought by the NHS e.g. Paracetamol which costs 3 times as much on prescription. Also drugs to treat HIV /Aids, Malaria and tuberculosis when sold in the UK and South Africa are charged at grossly inflated prices compared to the cost of production.
One particular drug company has been fined over £100m by the competition watchdog for increasing the price of thyroid drugs more than 10 fold. Advanz pushed the price of thyroid tablet packs from £20 in 2009 up to £248 in 2017 making the drug unaffordable for the NHS.
Pathology laboratories are becoming larger and more automated. Laboratory workers are requiring more qualifications but are becoming deskilled. Large central hubs do the major testing while smaller spoke laboratories do the routine, the result being that there is less breadth of experience and less chance of promotion within an ever diminishing career structure. Private technical companies are gradually taking over these laboratories and reducing standards.
The Covid 19 pandemic has been a boom time for private companies involved in testing for coronavirus. Laboratories could be set up without going through competitive tendering procedure. In some laboratories there are few qualified staff, standards are low leading to many unreliable results.
The National Health Service is not alone in its privatisation, it goes parallel to many other aspects of public services such as railways, prison services and the Post Office. Charities have usually had a more minor role in procuring services such as non-urgent hospital transport, however, they are also now used to provide vital hospital equipment. Advertisements for donations for research are constantly being plastered across the media and television screens.
Rebuild the Health Service
The main reason for Britain leaving the European Union is for workers to take control of their future. Renationalisation of industries and services is a priority and saving our precious National Health Service is vital. It is at present underfunded and understaffed. The present sinister undercurrent of privatisation is making us ask the question as to whether the NHS is for sale and in whose interest?
To rebuild Britain a healthy workforce is needed. The big difference between now and post war is that now profits are being made elsewhere because of globalisation and the government is expecting to revert to laissez faire capitalism.
Rebuilding The National Health service is integral to the whole of rebuilding Britain. Consecutive governments have gradually eroded and cut away at it in the name of improvement. Britain needs to train more of its own health workers for all disciplines. Recruiting staff from overseas leaves their home country devoid of trained staff.
A starting point is the present dispute over pay. 3% is an insult. A sustainable workforce requires decent pay that values skills. The NHS has depended on good will for too long. Derisory pay offers to health staff have been routine for over forty years. Morale is at rock bottom as a result, in part, of repeated real-term pay cuts, as in other public services.
Thousands of doctors and nurses leave the health service every year. The Covid pandemic made this situation worse but it wasn’t the cause. The Government was totally unprepared for such an event as it did not have any plans despite warnings and quickly rewarded their mates with private contracts without tender to fix the problem.
Britain had no manufacturing base to turn to for instant help with equipment and PPE. Now we have a shocking 5.3 million people on hospital waiting lists. Accident and Emergency departments are reporting their most intense workloads on record. If our NHS is to survive it must have massive investment.
The socialist impetus that lay behind the creation of the NHS must not be allowed to die.