“4,000 NHS jobs to go!” scream the media headlines – then 5,000, 6,000 and upwards. Currently, 7,500 job losses have been announced with ominous hints of many more to come – one report has suggested that as many as 100,000 NHS jobs could be under threat. We are being told that the NHS may overshoot its annual budget by as much as £800 million.
But the “Iron Chancellor” has pumped billions of pounds extra into the NHS and 300,000 additional staff have been taken on since 1998 – so why is there now a problem and why is it so severe? First, let's see what has prompted the cash crisis.
According to the Heath Service Journal (HSJ):
“The Department of Health is making drastic cuts to public health and clinical training programmes because it has over-committed its £12bn central budget for next year by over £2bn. HSJ has learned that budgets for child and flu vaccination programmes, and emergency preparedness for major incidents such as terrorist attacks, will be among those facing the biggest cuts.
“Budgets for the training of doctors, nurses and other clinical training programmes will also be hit, along with funding for the national rollout of foundation trusts and the 11 programme.
“The government is seeking a cut of 15-18 percent across its central budget to try and make its £12bn fund stretch across all centrally committed programmes.” (HSJ, 30th March 2006)
Apparently, the Department of Health began to realise the scale of the shortfall back in November, which led it to impose a freeze of commitments and, as the end of the financial year grew near, a mad panic to get the books to balance.
Having denied that a problem existed, let alone a crisis, Tony Blair was forced to fly back from the Far East to attend an April summit at 10 Downing Street with the Health Secretary and assorted NHS managers. Speaking to the press afterwards he described it as nothing more than "a bit of turbulence!" And anyway most of the job losses would only be agency staff or temporary workers who evidently no longer count as human beings.
The spin line is that there is no fundamental crisis, just a little blip and once Tony has sorted it out with a magic dose of reform it will be back on track, full steam ahead, etc, etc. – just in time for the October 2009 general election where all will be forgotten. This is not the view held by heath service insiders, however, as the HSJ made clear in an editorial dated 12th April: “The service was preparing itself for redundancies as a result of primary care trust and strategic health authority mergers.”
The editorial continues: “In fact it is likely that the headcount reduction will spread much further than the third of trusts in debt. Our own snapshot of acute trusts this week suggests that four out of five acute trusts expect to cut their workforce in the next six months and about two thirds say this will involve redundancies.”
“Reform”
So things are a bit more serious than just a few “temporary” ward closures to survive until the end of a financial year. Since the Tories began introducing the “internal market” into the NHS back in 1989, conflicting tensions have continued to build up with inevitably explosive consequences. No amount of new money from Gordon Brown can solve this problem. Indeed, under the guise of "reform", Blair and his pro-market cronies have accelerated the crisis with evermore new "targets", league tables, structural reorganisations, the continued award of contracts to private companies to run NHS services such as cleaning etc., to say nothing of the whole PFI scandal.
One particularly glaring example (one of many thousands which could be given) was recently given by Dr Tony Marsh, professional executive chair of Godling PCT, in evidence to the Commons health select committee. He complained that 28 PCTs in South Yorkshire and Trent had to pay £700,000 to the privately owned Partnership Health Group, under the terms of their contract, for activity that had not been used.
Another recent report quoted researchers at Australia's Newcastle University on the growing phenomena of “disease-mongering.” This is the tendency by which, in an attempt to boost profits, pharmaceutical companies are promoting non-existent diseases and exaggerating mild problems to create new markets for new, very expensive and therefore very lucrative solutions.
Rather than the private sector helping to support the health service, it is clearly the health service which is supporting the private sector – and doing itself great damage in the process. Why has the government had to send in turnaround teams to sort out financial problems in 18 trusts over the last period? And why might fully half of all A & E departments now be facing closure? According to the president of the Royal College of Surgeons the government could be set to approve “reconfigurations” which would see A & E departments slashed from 200 to just 100.
According to the HSJ again, in a survey published in March, NHS staff believe that the most difficult part of their job is dealing with financial constraints with 64% giving it a “score” of 7 (or more) out of 10.
NHS boss Sir Nigel Crisp has been chosen to be the fall guy on all this, but with a cool £3million retirement payoff he is probably not all that bothered. Meanwhile ordinary health workers who are taking the real brunt of all this continue to be paid a pittance.
Then there is the £6.2bn IT upgrade for the NHS. On paper this seems like a good idea, linking up 30,000 GPs, 20,000 pharmacies, etc. However, when the difficulties faced by the Child Support Agency and Air Traffic Control after their computer system upgrades are recalled, there arises not so much scepticism as downright incredulity that the new system will work. Such a system has never been made to work, even on a much smaller scale as many expert sources, including Computer Weekly, have warned. Yet, once again, the private sector takes the money and delivers zilch!
The absolute disgrace of care of the elderly – which has an effect not only on the working class but wide layers of the middle class as well – has forced a major review under Sir Derek Wanless. According to Sir Derek, just to provide “basic” care for the elderly means that the proportion of national wealth spent on social care will have to double, rising to £27.5bn or 2% of GDP. Meanwhile a whole "grannyfarm" industry has mushroomed to cash in on the market, whilst local councils are busy shutting council run homes to save money and stop businesses complaining about council charges.
Against this background the results of the RCNs “Working Well – at breaking point” survey will come as no surprise. By 2005, nearly one in four nurses reported being bullied or harassed at work, with 45% citing a manager as the source of the problem. The survey also showed that nurses' levels of psychological well-being had worsened since 2000.
Deepest Crisis to Date
What conclusions can be drawn from all this? Clearly the NHS is facing its deepest crisis to date. More than that, we have to ask whether the experience of nearly two decades of market “reform” has reached the point where the NHS is threatened with break up, disintegration and even complete collapse? If the process of “reform” is not checked and reversed then that would seem to be the inevitable outcome at some point.
But here is the rub – we live in a capitalist society where the working class, the overwhelming majority, rely exclusively for healthcare on the NHS. Private provision is simply not an option. The scale of cuts and attacks on the health service represents a finished recipe for class conflict and struggle. Faced with the loss of “free” healthcare, a determined campaign in defence of the NHS is not only necessary in the coming period, it is inevitable.
Unions and Labour movement activists need to organise such a campaign, which will bring the full forces of our class to the fore. This is an issue, which affects more people than anything else – we will all need the services of the NHS at some point – and is central to the aims and ambitions of the Labour movement to establish a better society. We must not let the NHS be “reformed” out of existence.
See also: Britain: Fight to save the NHS by Phil Mitchinson (May 3, 2006)
