It won't be the reds, blues, purples, greens or yellows who'll save England's NHS - it will be us

Every party attempted to rebrand the NHS as 'theirs' this conference season. But even Labour's promises leave worrying gaps. It's up to us - as campaigners, citizens and workers.

Peter Pannier
17 October 2014

Image: Lifeworks campaigners, who have saved their clinic from the chop after a 4 month sit-in.

This week around half a million members of GMB, Unite, Unison and the Royal College of Midwives took strike action over an Osborne-imposed virtual pay freeze that has seen their purchasing power decline 12% since the election. Picket lines were well attended across the country - including at my local Stroud Maternity hospital, where new mothers and pregnant women dropped by to demonstrate solidarity, and horns sounded as passing drivers showed their support. Unite have hinted at further strikes - and we should all lend our support, union members or not. 

The NHS strike provides a tentative glimpse of the movement required to defend and rebuild a comprehensive, universal, free health service, owned and run within the public sector.

There have been recent victories. Union and public campaigning stopped the sell-off of George Eliot hospital in Nuneaton, though not before £1.78million was wasted on the commissioning process. Cambridge mental health drop-in centre ‘Lifeworks’ was saved from closure after a four month sit-in by patients.

Last month NHS Direct Action occupied Conservative Party Headquarters during their party conference, unfurling banners proclaiming “When they sell off the NHS — We Bleed, They Profit”. Nearly 4000 people recently filled a rugby stadium in Whitehaven to protest at threats to West Cumberland Hospital. This Saturday trade unionists from across public and private services march, saying 'Britain needs a pay rise'. On Monday Occupy Democracy will host an NHS day as part of its temporary occupation of Parliament Square. These campaigns might not have produced similar ‘victories’ (yet), but many are nonetheless inspiring. 

Inspiration is sorely needed. The NHS has been hit with ‘efficiency savings’ (ie, cuts) of £20 billion less than it needs to keep up with demand. £2.7 billion (20%) has been stripped out of adult care services, a back door hit on the NHS left to pick up the pieces. Effectively Osborne has - according to the Telegraph, of all papers - ‘abolished the NHS ring fence’.

Money is increasingly being diverted to private providers and PFI repayments, to the consultants, lawyers and contesting contacts.

As a result, “the NHS and our social care services are at breaking point”, according to the chairs of various Royal Colleges. Waiting lists are at their highest since 2008, with more than 3 million people now waiting for treatment. 543 GP practices in England may close within the next year because of a shortage of GPs. NHS England predicts that 98 surgeries are likely to be in such serious financial trouble they are at risk of closing, and this is just the tip of the iceberg. Essex Council told patients to ‘Treat your own Dementia’, and Nottingham’s ‘mutual’ physiotherapy services offer patients factsheets instead of ‘hands-on’ physiotherapy.

Conference season saw every single party claim to be the party of the NHS, ready to fix the crisis. Shadow Health Minister Andy Burnham says the 7th May will be a “Day of reckoning on the NHS”, and is asking potential voters to “Help the party that founded the NHS give it a new beginning”. 

Jeremy Hunt claimed that “it will be the Conservative Party that completes Nye Bevan’s vision for an NHS that treats every patient with dignity and respect”. Even UKIP attempted to get in on the act, with MEP Louise Bours offering in her conference speech “a message for Len McClusky and Unite – “UKIP will fight alongside you to ensure the NHS is excluded from this [TTIP] agreement”, in what the Telegraph described as “an audacious bid to supplant Labour as the party of the NHS”. (Though Bours’ speech also served up a xenophobic ‘minimum health standard’ implying migrants are unhealthy, and said nothing on reversing privatisation).

The Green Party say they are “the only party committed to keeping the NHS in public hands”- and along with the National Health Action Party, have at least both signed up to the new NHS Reinstatement Bill.

Hunt demands we “stop scaremongering about privatisation that isn’t happening”, and the Liberal Democrats claim they “stopped Conservative privatisation plans” (utter nonsense), but the evidence is everywhere.

Non-emergency ambulances have been privatised around the country, including to scandal-hit G4S. Serco may be leaving the UK clinical services market for now, after “losses of £17.6 million on three of its NHS contracts”, having been fined for failing to meet performance standards, but Virgin now runs over 100 health services and 358 GP surgeries (including the surgery in Cameron’s Witney constituency).

Burnham stated in his conference speech that "the market is not the answer to 21st century health and care". But Labour’s policy is merely "the NHS as our preferred provider" where other providers - both private and so-called ‘mutuals’ - will continue to bid for contracts, and will sometimes win (Burnham was heckled about this). And without additional reforms Burnham’s preferred provider policy may well be ruled illegal.

One worry regarding Burnham’s talk of ‘integration’ is that purchasers and providers could be ‘integrated’ under the effective control of private companies.

Outgoing Chief Exec of NHS England David Nicholson said we should look “closely at US organisations Geisinger and Kaiser Permanente” as models of ‘integration’. In other words, that “companies would decide if the NHS will fund a treatment for their customers, and then perform it too.” Labour’s Oldham report valorised privately owned similar models.

Such models may be on their way already. Burnham doesn’t address the ongoing privatisation of the purchasing (or ‘commissioning’) itself. This year NHS England offered up £5bn worth of contracts to run outsourcing services for CCGs.

(Incidentally, there’s nothing in what the Lib Dems are saying about ending the purchaser-provider split to suggest this isn’t what they intend either.)

As for ‘integrating’ health and social care, the merger of two near-bankrupt services merely produces one bankrupt service. Labour haven’t definitely ruled out means-testing being brought into the NHS from social care. And whilst community services are in reality amongst the hardest hit by cuts, people being treated ‘at home’ or ‘in the community’ means nothing more than code for ‘closing hospitals’.

Perhaps most worrying of all, Labour has not disavowed the work of Liam Byrne (and indeed Iain Duncan Smith) that appears to pave the way for the introduction of conditionality from the Department for Work & Pensions and access via benefit cards, as in Australia.

None of the big three parties is offering to solve the financial crisis in the NHS. While Miliband made headlines over a promise of £2.5bn for the NHS from a Mansion Tax and a Tobacco levy, the details are unravelling, it’s not the most progressive option and it’s not actually that much money.

Burnham hinted as much in his conference speech: “with the best will in the world, the NHS won’t be able to do it all."

With Ed Balls’ ‘Zero-Based Budget’ (not to mention his advice from PWC), will the NHS be able to do much of anything?

In short, the Labour Party is not currently offering renationalisation or ‘reinstatement’ of the NHS, despite the impression it is attempting to give. While a Labour (or Labour led) government will bring a different approach to the NHS, it will require pressure from below to keep the party to its current promises.

It will require greater pressure still to force the party to go beyond its current offer and remove the internal market, recruit sufficient staff, and pay those staff properly. The weakness of the offer on the NHS is one reason why it isn’t even clear that Labour will form or lead the next government, or have a majority large enough to push through the changes we want.

We must organise on the basis of not merely relying on politicians to fix things for us - and on the basis of clear demands. I set out how in part 2.

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