On the NHS’s birthday, it’s time to think global

The same neoliberal policies that are harming the NHS are being exported overseas (including by the British government), making it far harder for poorer countries to achieve universal healthcare.

Sean Roberts
5 July 2019, 9.43am
The London Olympic opening ceremony showcased the NHS to the world.
Mike Egerton/PA Images

Today – 5th July – is the NHS’s 71st birthday. The NHS is, of course, an institution that is dear to the hearts of the British public, and, ostensibly at least, to the hearts of our political leaders. So it was unsurprising that last year’s 70th birthday provided an occasion for a good deal of celebration, including much self-congratulation about the UK’s global leadership in providing its citizens with a universal, publicly-funded health system that is the envy of the rest of the world.

One year on, it’s a good time to reflect on how all this back-slapping measures up to the reality. And when we do, we see a rather less uplifting picture. Years of chronic underfunding have resulted in massive staff shortages (and low staff morale), increases in already-alarming waiting times, patients being treated in corridors due to lack of beds, etc. In the past few days, the Chief Inspector of Hospitals asserted that ‘the mounting pressure on the system is having a direct impact on how people are experiencing inpatient care’, the Health Foundation think tank argued that an additional £8 billion funding is needed or else the Government’s long-term plan for the NHS will fail, the Chief Executive of NHS England has decried that the hospital bed cutbacks have gone too far, and the Chief Executive of the NHS Confederation acknowledged that “Hospital bosses face crippling staff vacancies, rising demand for care, lack of investment in buildings and equipment, and the drastic cuts to social care and public health that are fuelling extra demand on A&E and other frontline services.”

All of which confirms what patients of the NHS have known for years: the values of universal, free access to quality services that underpinned the creation and early history of the NHS are no more than an increasingly distant memory. The neoliberal drift can be seen more and more even in our framing of patients as ‘consumers’ of healthcare rather than patients, health becomes our own personal responsibility rather than a collective one in the public good.

And there is no great mystery concerning the reasons for this sad state of affairs. Successive governments have pursued a relentless agenda of privatisation of health services – not least the promotion of Public-Private Partnerships, despite the mounting evidence of their long-term, massively detrimental effect on quantity and quality of services. Combine that with the deleterious impact of the Government’s austerity programme, and you get the health services that we see today.

Sadly, the scenario is much the same at the global level. Next week, Westminster MPs will be debating ‘Universal Health Coverage’ – the aspiration that everyone in the world will have access to the good quality health services they need, without incurring financial hardship. And later in the year, governments will get together at the United Nations to renew their commitments to achieving UHC by 2030 (UHC being the core health-related target in the Sustainable Development Goals).

Unfortunately, as with the celebrations of the NHS, these commitments bear little relation to what’s going on in the real world. For example, according to the World Health Organisation, at least half the world’s population cannot obtain access to essential health services; and 800 million people spend at least 10 per cent of their household budgets on health-related costs, with 100 million being pushed into extreme poverty by their health expenditures.

Last year, the respected health journal The Lancet published extensive WHO research into the costs associated with achieving UHC. The research estimated that the annual cost to poor countries of meeting UHC targets by 2030 would be $112 per person. This is a significant increase on previous estimates, and would leave poor countries facing an annual funding gap of up to $35 billion. The WHO estimates that poor countries will need to spend up to 20% of GDP on health in order to bridge this gap – which of course is economically and politically impossible.

So what does all this mean for the fight to ensure that everyone, everywhere enjoys the right to health? To save the NHS, we need to ditch our obsession with privatisation, and instead provide the level of investment that is needed to restore the original values of a universal, publicly-funded health service. And the answer is essentially the same at the global level. Again, we have to desist from promoting the discredited Public-Private Partnership approach as the means to achieve UHC. And we also have to abandon the other elements of the neoliberal economic agenda that is depriving governments in the Global South of the financial resources they need in order to provide universal, free, high quality, and gender responsive public services. This means radical reform of the iniquitous global tax and trade regimes, a progressive and just approach to addressing the global debt crisis, regulation of the profits of large corporations, and bearing the appropriate burden of the costs of climate change. Health is a human right which can be achieved for everyone, everywhere. It is a political choice which leaders in the Global North can make but are refusing to do.

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