Do not let the fear back in

Aneurin Bevan, founder of the NHS, said the NHS was “in place of fear”. Now the NHS is being dismantled and the fear is back.

Autumn 2022 is an Autumn of Resistance. Let’s fight for the NHS! It is too dreadful to think of losing it.

It’s hard to believe but a national health service – once by far the world’s best – no longer exists in England. It has been replaced by forty-two local systems, effectively postcode lotteries.  The health and care Act applies only to England but Scots, Welsh and Northern Ireland Health Services are also under attack from the privatisers to a different degree.

Ordinary people in workplaces and in communities can win back the NHS and restore it as the best in the world. It will take a phenomenal level of organisation to make this campaign huge and sustained, but our grandparents fought to establish the NHS, in far worse conditions, when the country was recovering from total war.

We can win back the NHS. We have public opinion behind us. We have an amazing NHS workforce who have withstood the whirlwind of austerity and pandemic. We could not ask for better. The biggest obstacle in our way is fear, fear that we as ordinary folk cannot defeat this government and their big business mates in finance and in the media.

Funding healthcare is an investment in this country’s health, wealth, and happiness. It returns far more to the Government’s finances than it costs.

https://www.brookings.edu/blog/future-development/2020/07/21/how-investing-in-health-has-a-significant-economic-payoff-for-developing-economies/

OECD studies suggest an even bigger returns on healthcare investment. “Mounting evidence shows that investments in the health sector pay handsome dividends. The returns on investment in health are estimated to be 9 to 1”.

The Government can and must pay for the NHS

We fundamentally and loudly reject the idea that governments must borrow on the international markets to fund the NHS. This is not so. Governments, especially those with a central bank like the Bank of England, can simply choose to spend money. Where did they get the money to bail out the banks, to stuff the energy giants’ mouths with gold, or wage war in Iraq and Afghanistan? How did war torn Britain afford the NHS in 1947? Huge amounts have been spent by successive LibDem/ Conservative coalition, and Tory governments on Quantitative Easing – literally stuffing money into the pockets of the wealthiest – why can adequate funding not be found for our NHS? The Bank of England says Between 2009 and 2021, we bought £895 billion worth of bonds through QE.”

Nor does health spending account for more than 40% of Government spending. https://fullfact.org/health/health-spending-40-percent/. The NHS cost in the financial year 2018-19, the gross expenditure of those 230 NHS trusts, came to £87.4 billion.

So Quantitative Easing cost 10 years full NHS spending on those figures. That money went to subsidising rich people’s wealth on the assumption it would kick start the economy. It did not. Nor did it ‘trickle down’. In contrast spending on the NHS does give a return in wealth health and happiness.

Poverty is reaching back to 1930s levels, and we face a winter of cold and underfunded healthcare. Poverty wrecks health. Epidemic-levels of fuel poverty affecting half of UK households will cause a ‘significant humanitarian crisis with thousands of lives lost and millions of children’s development blighted’, warn health experts in the latest Marmot review 1 Sept 2022

Now is not a time for retreat on the battle to restore the NHS.

Bevan and the thousands of campaigners behind him had a vision of a country where no one would be left behind, and where no one would be fearful of becoming ill because they could not afford to pay a doctor. No one would be denied the best care and treatment.

We have a right to world class health care, free at the point of need. We inherited this National Health Service free at the point of need, publicly owned and publicly provided, universally available, providing comprehensive treatment. It became a centre of research and a centre of excellence. Staff training and education was an essential part of it, as were decent wages and conditions. The figures below show that just a few years ago it was the best healthcare service in the world – before the Conservatives started looting it.

The US model of healthcare is far more expensive and less effective both to the individual and to the Government. A family that can afford health insurance will expect to pay roughly the same as it pays for their mortgagee and that will not cover all their bills, not all their treatment. Health care costs are the largest cause of personal bankruptcy. The US maternal deaths data in childbirth are dreadful.

Many US residents, seeing the cost of treatment, decide to die rather than lose their family home to medical bills. Millions of Americans – as many as 25% of the population – are delaying getting medical help because of skyrocketing costs.

The US Government funds healthcare for some poorer people. “The United States spends more on health care than any other country. Annual health expenditures stood at over four trillion U.S. dollars in 2020, and personal health care expenditure equalled 10,202 U.S. dollars per resident”. 30 Aug 2022.

The USA spends 18% of its (huge) Gross Domestic Product on healthcare, which does not cover everyone. The NHS costs less than 12% of UK GDP and provides universal care (except for the vicious anti-migrant charging).

This huge expenditure, both personal insurance and government spending, does not provide universal care and leaves many without treatment. The money goes to the big corporations. Yet this is the model being forced onto the people of the UK.

The UK Bevan model of health care is more equitable and more cost effective. The NHS needs more funding but not on that scale!

Healthcare funded by the Government, free at the point of need, provided as a public, national, comprehensive service, is far cheaper to run than the big-business-based US model on which this government is reshaping our NHS. This is openly discussed within the NHS. The US system is based on American accountable care organisations, where the government spends twice as much per head of total population but still provides for only a small proportion of American people – and does that by funding big business. In the end ”the less the care they give, the more money they make”. Denying and rationing care whilst funnelling money into private companies is now the UK government’s policy.

‘The privatisation of the NHS in England, through the outsourcing of services to for-profit companies, consistently increased in 2013–20. Private sector outsourcing corresponded with significantly increased rates of treatable mortality, potentially as a result of a decline in the quality of health-care services.’ https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(22)00133-5/fulltext

There is no private healthcare model waiting in the wings. All we will have when the NHS is completely broken is fragmented broken care. This is disaster capitalism in our time.

The NHS was brought into being on 5th July 1948. Its political architect and its driver was Nye Bevan (for more information on Aneurin/Nye Bevan see here). The founding of the NHS came after decades of people struggling to get access to health care. The miners in Bevan’s hometown had a local health service free at the point of need; friendly societies and charities and some local authorities provided elements of care. The Cooperative Women’s Guild were fearsome in their organisation of working-class women to demand free healthcare, especially maternity and baby care.

The NHS became something more than a basic medical service, something, with all its many faults, which was quite wonderful. The fear of poverty caused by ill health and the fear of loved ones dying from lack of medical care disappeared. The number of women dying in childbirth and the numbers of babies dying at birth began to fall dramatically.

Annual death rate per 1000 total births from maternal mortality in England and Wales (1850-1970) (Registrar General Reports) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1633559/.

(The big drop in mortality in the thirties came from understanding of how puerperal fever was spread by doctors and later by the introduction of anti-biotics.)

The damage now being done to the NHS is conscious and vicious. It’s not a mistake, it’s not ignorance. It is a robbery of our resources to make big companies rich.

Conservative MPs know this. Some Labour MPs know this. There is a huge and powerful system lobbying for NHS resources to be diverted into big companies accompanied by very slick public relations exercises. This clique is comparable to the tobacco lobby groups in the 1980s. Meanwhile our people suffer and die, from NHS shortcomings and austerity.

The trade unions and labour movement could challenge lies about health care and build resistance. Sharon Graham from UNITE has spoken out. She said:

“While our members and their families in England are being told to expect NHS waiting lists to rise for years to come, the government’s priority is to pave the way for further disastrous privatisation. Every time private companies run NHS services they put profits before patients who pay the price. So, MPs must put their constituents before their private sector mates and vote to junk the Bill. Of course, it is unlikely they will, and Unite will have to continue to fight these big corporate money moves step by step inside the NHS.”

We need all the unions to speak up. Too often they are silent. The fight for the NHS must go into every workplace not just those in the health service. In the USA unions negotiate healthcare conditions in pay talks because there is no freely available national system. We do not want to go down that road! Michael Moore’s film Sicko showed all the failings of the US health system.

Already there are millions too ill to work in the UK. Waiting lists and appalling social care will make this worse.

The problems in the NHS are huge. It is short of staff, and these are deliberately underpaid. Mental health services (including for children) have been profoundly damaged, at a time of increased stress and anxiety. The boards of the forty-two new so-called integrated care systems have been told to make huge “savings”. Maternity care is in chronic and sustained crisis. Donna Ockendon wrote one major report, there was a parliamentary select committee, the Royal College of Midwives has released reports, well respected journalists have written reports, and women have given accounts of their experiences. But there is little reaction from the Government. So what if babies and mothers die or are injured? So what if midwives leave in protest? These things matter to ordinary people but not to this government.

Social care, long privatised and hedge fund exploited, is not a functioning national service. And requires an article on its own. Independent living is a crucial demand for disabled people but what we had of that is slipping away.

This government is bringing back the fear that we thought had disappeared in 1948 and the problems in health and care lie squarely with them. There were things the last Labour government did that helped the privatisation project along, but the blame for today lies squarely with the Conservatives. They have brought in the markets and privatisation, starved the service of funds, diverted money and responsibilities to their cronies in big business, failed to plan for the workforce, and far from managing Covid they have used the pandemic to further plunder the NHS’s slim resources.

Now the NHS is being robbed and misused. The health of the country, the wealth of the country and the happiness of the country is suffering badly. Deborah Harrington’s brilliant video is a great introduction to the developments which led to the Tories’ recent Heath and Care Act.

How you can be part of the NHS resistance:

• Join a union.
• Raise the issue in your union repeatedly.
• Get involved in Left Unity.
• Join a local health campaign group. (Contact us and we will put you in touch with a group in your area.)

If you are an NHS worker vote for strike action. Help our phenomenal NHS staff see their power. Challenge the unions to oppose every cut, every privatisation, locally and nationally. The time for the Social Partnership is done. If NHS workers are in “partnership” with the pro big business NHS hierarchy who have led us to this calamitous set of problems, what good is it doing?

The government says any pay rises must come from existing NHS trust funds. That is preposterous and must be challenged jointly by unions and by community organisations. The government must pay, just as they do for war and for giveaways to their cronies.

It’s time to heed the example of the generation that defeated fascism, and to fight for health care for all, free at the point of need, fully funded, publicly provided and not for profit.

• Keep our NHS Public Northern Conference for the NHS Campaign in Leeds on 22nd October.
• National anti-austerity march in London on 5th November.
• TUC event in Blackpool on 12th November.
• London national conference for campaigns for the NHS also on 12th November.