NHS on critical list

NHS in peril as Tories elect another leader

For months demands to replace the tax-funded NHS with (more expensive) social insurance models, such as Germany, or (even more costly) systems with more private sector involvement (like Netherlands and Switzerland) have been growing in the Daily Mail, the Sun, Daily Telegraph, Times and other papers.

These commentators have been able to feed on and exploit a non-stop diet of bad news stories about the declining performance of the NHS, as the consequences of a full decade of real-terms cuts from 2010-2019 have been followed by the Covid pandemic, and more recently Rishi Sunak’s spending review a year ago.

Critics of the NHS delightedly trumpet long waiting lists, but also highlight delays for emergency ambulances and lengthy trolley waits in A&E – even though the NHS is the only provider of emergency services, and there is no private alternative.

They also gloat at lengthy waits for cancer care, and the dire state of mental health services – again ignoring the fact that only the NHS has the resources and the responsibility to take on all-comers, irrespective of the complexity of the case and ability to pay, while the private sector is able to pick and choose only the simplest and most profitable cases.

Even the Daily Telegraph has admitted that when the Cameron government took office in 2010 the NHS (after a decade of above-inflation annual increases in spending had rescued disastrously poor performance prior to New Labour taking office in 1997) was performing well. But they also insist that the current parlous state of the NHS is irreversible, that it is an outdated relic of the 1940s, and that more “reform” is essential.

What are the facts? The decade of decline in funding from 2010 reduced NHS acute hospitals to almost the lowest provision of front line beds in any equivalent country by 2019, and axed thousands of mental health beds. More beds closed during the Covid pandemic – and numbers of occupied beds have still not recovered to pre-Covid levels.

It’s this lack of capacity, plus the lack of capacity in social care and community health that explains the problems admitting emergency patients, and the logjams in A&E.

Under the Cameron government training for nurses and doctors was cut back, and bursaries scrapped – and racist immigration laws brought in, followed by the Brexit vote. All this served to discourage qualified staff from overseas and especially EU countries from coming here, and persuaded thousands working in the NHS to leave.

Moreover NHS staff were subjected to year after year of real terms pay cuts. The predictable result has been growing gaps in staffing – and 132,000 vacant posts at the last count, with no government plan for the longer term.

NHS trusts have for years been starved of both revenue funding and capital – leaving many unable to carry out even urgent maintenance and replace clapped out equipment.  The backlog bill is now £9bn and rising. Since the 2018 collapse of Carillion as the leading company involved in the Private Finance Initiative (PFI) no major new hospital projects have been commissioned, leaving Boris Johnson’s pledge of 40, then 48 new hospitals as empty words.

But all of these factors have now got even worse, especially under the brief Truss premiership. Inflation continues to roar upwards, completely wiping out the limited increases in spending announced by Rishi Sunak, and forcing desperate health workers to ballot for action to demand a pay increase.

The 42 newly-established Integrated Care Boards that have run England’s health services since July already faced a daunting demand for “savings” of £5.5 billion this year, because Sunak wanted to “claw back” all of the extra spending allocated to the NHS to deal with Covid.

Truss proposed going further, to cut £10 billion per year of the “health and care levy” from the NHS, to give it to social care – equivalent to an unprecedented actual cut of 7 percent in NHS spending. Jeremy Hunt as Chancellor has scrapped the levy but not confirmed alternative funding, while warning that every government department must find ‘eye watering’ savings.

This could lead to desperate measures including imposing charges for GP visits, or charges for NHS hospital treatment, as well as the total closure of NHS provision of some services.

The economic melt-down appears to lend credibility to claims the UK can ‘no longer afford the NHS’. But of course on that basis it could not afford a German or a Dutch system either. They spend more per head on health than the UK.

With the news media fixated on yet another Tory leadership contest as the crisis worsens, we need to brace ourselves for the worst.

The SOSNHS campaign has argued the need for a £20bn cash injection as a down payment to stop the decline and begin to expand NHS capacity once more. Such large sums are needed to catch up after a decade of decline.

There’s no doubt the NHS could, once again, be rescued by sustained investment and a fundamental change of policy, and rebuilt as a public service. However with more musical chairs of Prime Ministers and cabinet roles apparently still bringing no chance of any real change of government or positive change of direction … it could keep sliding downhill all the way.

About the author

John Lister


John Lister is editor of Health Campaigns Together news bulletin, and co-editor of The Lowdown, offering free to access fortnightly online news on the NHS. He is joint author of NHS Under Siege (Merlin Press, May 2022).

About the organisation

The words "HEALTH CAMPAIGNS TOGETHER" in blue. The word "TOGETHER" is in bold and the first "O" is a heart with the words "#ourNHS" in.

Health Campaigns Together

Health Campaigns Together campaigns against cuts to the NHS and privatisation.