Image: Jeremy Corbyn, newly elected Labour Party leader. Source: Flickr/Chris Bennett
The English NHS is likely to stay centre stage in political fights. New Labour leader Jeremy Corbyn’s first official visit as Labour Party leader was to Camden & Islington NHS Mental Health Trust yesterday. His new shadow chancellor, John McDonnell, last night highlighted his opposition to the EU/US TTIP trade deal which many see as a huge threat to the NHS. And - uniquely amongst leadership contenders, Corbyn is a signatory to the NHS Bill 2015 – which aims to reinstate the NHS and was re-tabled in Parliament by Caroline Lucas, Green MP with cross-party support on July 1st.
Yesterday, Corbyn wrote “We as a labour movement have to be strong enough to stand up and ensure that we have a system that prevents anyone falling into destitution, supports those going through mental health crises and ends the internal market and privatisation of our health service."
Later today, parliament will debate a vote of no confidence in health secretary Jeremy Hunt, Health Secretary, after two petitions calling for such a debate attracted over 300,000 signatures - though the Government has relegated it down from the main chamber of the House of Commons, to the significantly more low-key Westminster Hall venue. Doctors have been asked to ensure their MP attends this debate and to ensure the focus is on Hunt and his record.
NHS campaigners will be out in force to show the Government the depth of feeling for the NHS and against Conservative ideological direction at the Tory Party conference in Manchester on 3-7 October.
The greater openness of political debate, first in the Scottish independence referendum and now in the Labour Party leadership election, means that many more will be ready to get involved. And we must be ready to respond to every anti-NHS argument.
The ideological untruths and practical assaults on the NHS and public sector that we saw under the coalition government are being ramped up under the new Tory government.
If a public service is starved of essential finance for long enough it will start to fail – and the NHS is no exception. Just earlier this month, GPs in Worcestershire were told not to refer patients to local NHS hospitals for three months so that they could clear a backlog – and encouraged to pay private hospitals to take patients in the meantime.
The NHS is ‘broken’, wrote James Bartholomew in the Telegraph electing to place the NHS bottom of the pile of European health systems. He concludes that the 'failed' NHS must be replaced by a compulsory insurance system, such as that of Switzerland.
In the UK of course, there is a compulsory contribution to the NHS from public taxation made in the UK. The great difference is that the UK system is not run for profit and is free at the point of need.
This principle makes the NHS far more cost effective - out-performing Switzerland in effectiveness and value for money according to a 2015 Commonwealth Fund report.
No doubt other systems have lessons that we can learn from.
But Bartholomew’s argument is a purely ideological one. Like the Government, he wants us to equate publicly funded health systems with failure.
His 2004 book The Welfare State We’re In was praised by Thatcher’s guru, Milton Friedman, as “a devastating critique of the welfare state”. During the 2010 pre-election period, Bartholomew advocated the abolition of the NHS on Radio 4.
Our NHS has been amazingly effective despite ongoing underfunding compared to other advanced national health systems. Just why is it that the NHS has lower number of doctors and acute hospital beds per 1000 population and second lowest number of MRI scanners per million compared to other advanced European health systems? It is a failure of funding rather than a failure of the NHS. It receives less funding than the OECD average and less than the European comparators.
Nonetheless, the Commonwealth Fund’s comparative analysis of 11 advanced national health services, using data and surveys from 2010-13, placed the USA bottom and the NHS top. The NHS was best in 8 out of 11 criteria and was the most cost-effective national health system.
In fact, despite significant underfunding, the NHS has punched above its weight for three generations.
It is now under threat from cleverly disguised ideology, worsening cuts, PFI payments and privatisation, not from its ‘failure’. The failure to adequately fund front-line NHS services over the last five years has increased waiting lists. We need more GPs, hospital doctors, more nurses and therapists and better equipment. Not an insurance based system such as the USA or Switzerland. The USA spends double the UK on health but over 30% of that funding is wasted on private insurance administration and profit margins. In insurance-based health systems, the incentive of profit regarding who gets investigations, procedures and treatments, can be a more powerful motive than what is best for the patient.
Efforts to privatise whole swathes of health services have failed to deliver more effective care and are proving more costly. We now face a national health service increasingly without national coordination of standards, with shrinking resources and accelerating fragmentation. This will devastate patient care pathways which rely on many services cooperating together (including social care).
We must get back the NHS. In the example of New Zealand we can see the immediate benefits if we succeed. New Zealand privatised their health service in 1993. Perverse incentives dominated and costs escalated. The new 1999 government looked this failure in the eye. They made a political decision to act on the evidence and renationalised their health service in 2000 with clear benefits. Following the calamitous Christchurch earthquake of 2010, public conclusions were that the privatised and fragmented health service would not have been able to respond to such magnificent effect as New Zealand's reinstated NHS.
There is one category where the UK comes out close to bottom in international comparisons like the Commonwealth Fund (though still above the USA).
It’s ‘healthy lives’, a category which reflects more specifically health inequality: the effects of poverty, education and societal attitudes to promoting early child development (see the Marmot Review).
The greatest single determinant of health outcomes is of course poverty. The impoverishment of the British people through austerity, unemployment, low wages and zero hour contracts, the mental and physical stress that places on us, coupled with the assault on the funding of the NHS and escalating privatisation, means that the battle to save our NHS is more important than ever.
With additional reporting by Caroline Molloy.
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