There can hardly be a household that has not been affected by the declining quality of medical services in the UK. From inaccessible GPs and hospital appointments cancelled at the last minute to some of the most harrowing experiences that anyone is likely to undergo. Local campaigns against ward closures, A&E closures, sometimes whole hospital closures have been going on for years. Now they are supplemented by protests over cuts in the emergency services and a whole host of regional issues, including some of the most notorious examples of entrenched malpractices. When the British Red Cross issued a statement in January that the NHS is facing a “humanitarian crisis” (following the needless deaths of patients who’d been stuck on trolleys without treatment at Worcestershire Royal Hospital) it was recognising that the makeshift survival mechanisms of the NHS can no longer disguise what’s going on. Not surprisingly, opinion polls show that the National Health Service is becoming people’s “top concern”. It didn’t really need the BBC to invite everyone to “join the conversation” with their special NHS week. (As they did in February.) Certainly Theresa May and crew have not forgotten the boost Vote Leave got from the false promise that leaving the EU would free up £350m a week for the NHS. (A promise that was immediately denied by Farage the day after the referendum result.)

By contrast with the blatant slashing of Local Authority funds and the ruthless cuts to a whole range of welfare benefits, not to mention the bedroom tax for council tenants, the present government does not want to appear to be undermining the NHS. But the now you see it now you don’t state spending plans up to 2020 (the life of this parliament) can’t disguise the facts on the ground.

Lies and Under-funding

With parliamentary devolution in 1999 the NHS ‘devolved’ into four national constituents, making for differences in the detail of how each service is run and in the timing of government spending cuts. (The Scottish parliament, for example, followed Wales and Northern Ireland in withdrawing prescription charges back in 2011.) But broadly the picture is the same. Since the financial crash the state has reduced its expenditure on health, starting with the Labour government under Gordon Brown. According to the Nuffield Trust, overall health spending fell by £12 per person in the UK between 2009/10 and 2013/14.⁽¹⁾ Since then the post-Brexit government insists that real spending on NHS England is due to rise by almost £10 billion by 2020. It’s a trick of course. Whilst allocating £10bn to the NHS the state will take away half of that amount from the Health and Social Care budget handled by local authorities. Amongst other things, this means reduced funding for the care of the elderly: hardly a judicious move at a time when “bed blocking” by old people who fall ill is being blamed for everything from overcrowded A&E departments to bumping up the cost to the NHS by hundreds of millions of pounds per year. But ever since the financial crash central government has been careful to see that the spending axe is wielded principally by local authorities. That way any resistance is already localised and broken up.

However, this cynical accounting sleight of hand is by no means the end of the projected under-funding of health care. The official auditors reckon that unless something is done, the deficit will amount to £30 billion by the end of this decade. This is less than one-25th of the U.K.’s total public spending in the last fiscal year⁽²⁾ but if left to weigh on hospital trusts and self-managed fund holding GPs the consequence is obvious: an even bigger dilemma for maintaining standards of treatment. Magnanimously, Theresa May has set out to keep the Tory election pledge to direct £8bn of state funds towards offsetting this debt – provided (and here is the rub) – that the hospitals and doctors’ practices find £22bn of “savings”. And so, following an inexorable logic, the NHS trusts (two thirds of them already in the red) are looking for ways to cut spending. Since their biggest single outlay is wages, reducing the number of people on the payroll is high on management lists. Many trusts are going for the most efficient way of all: shutting down whole departments whilst pretending to offer local people a choice between which hospital should close its A&E department, maternity unit, or even be shut down all together.

And Labour’s Record?

Unlike during last year’s junior doctors’ strike, which Jeremy Corbyn hardly brought up in parliament, the leader of Her Majesty’s Opposition has enjoyed taunting May over the state of the health service. Since January he has asked more questions about the NHS than any other topic. Outside of parliament though, he is doing nothing to promote a unified NHS workers’ resistance, just as he avoided unambiguous support for last year’s junior doctors’ strike.⁽³⁾ But then, that would undermine his responsibilities as leader of Her Majesty’s Opposition. It would go against Labour’s whole being as a party for the management of capitalism: the assumption that in any situation there is a state policy option that can equally serve the interests of capitalist money-making and at the same time safeguard the health and well-being (never mind the livelihoods) of the working class. Let’s say it clearly: a health system run by the capitalist state is neither socialist nor a step towards socialism. Moreover, when capitalism itself is in terminal crisis no sector of the post-war welfare state is immune.

The fact is that Labour is just as responsible as the Tories for the shape of the NHS today. When Tony Blair first came to power in 1997 after telling voters they had “only 24 hours to save the NHS”, his government encouraged Thatcher’s self-managed hospital trusts and fund-holding GPs to saddle themselves with more debt via the so-called Private Finance Initiative (PFI) scheme. (Corbyn now wants a fund set up to bail out trusts who are mired in debt due to these schemes.) The Blair government concentrated on headline news success stories, such as reduction in waiting times for hospital appointments as it injected more funds into the NHS to try and catch up with average EU spending on health per capita. It didn’t stop the loss of around 32,000 hospital beds over Blair’s first ten years in office. (Presented as efficiency measures in the light of 24 hour turn-over times after operations.) The pattern continues today: retrograde steps presented as efficiency savings. As we write the Daily Telegraph is running a story on the 13,681 hospital beds that have been eliminated over the past six years. Anyone who nonchalantly talks of “bed blockers” would do well to bear these stats in mind.

Like capitalism as a whole, NHS medical treatment is a contradictory and mixed bag. State of the art equipment and advanced treatments for once fatal conditions exist side by side with overcrowded waiting rooms where anonymous patients are called for a brief encounter with an anonymous doctor. In fact the British NHS measures up poorly against most other rich states. It has the second lowest level of physician cover among OECD countries, for example while overall spending on health is below the OECD average. In terms of treatment outcomes the UK is in a far from enviable position with amongst the highest numbers of avoidable death rates in Western Europe.⁽⁴⁾

Clearly the NHS crisis has reached tipping point and there can be no going back. Certainly not to Aneurin Bevan’s vision of a universal service free for everyone at the point of use. (The vision was never the reality. Right from the start hospital consultants were allowed to supplement their income with fees from private patients, all courtesy of NHS hospital equipment. Today well over 10% of the UK population are covered by private medical schemes.) But this is not because the Labour Party has abandoned socialism. Socialism is not about a political party benignly managing the capitalist state. Moreover, although increasing involvement of finance capital with its aim of turning a profit for its investors is an obnoxious excrescence on anything pretending to be a health service, “creeping privatisation” is one of the consequences rather than the underlying cause of the NHS crumbling. (In future we’ll be dealing with the question of care for the elderly and the role of finance capitalism.) State-run or private, capitalist health care has to be revolutionised. Like the overthrow of capitalism as a whole, this can only be done when the people whose labour power keep it going say enough is enough and take the running of things into their own hands ­– and in the process get rid of the sham parliamentary democracy which conceals the dictatorship of capital.

In the meantime, a step on the way would be for all NHS workers to join together to refuse to implement the current cuts. This is a far better way to get the support of local communities than the sham public meetings with questions by appointment only that are being put on by local Trusts. These are all about NHS managers deciding where they can cut without too much fuss. More important, a combined fight at the same time organised collectively by all grades of staff and every branch of the service is a far more serious way to fight. Naturally anyone pushing for such a way forward has our support.

Notes:

(1) The Nuffield Trust, Health Spending per Head by Country of the UK, 26.11.14. Available online. The Trust points out the variations between countries of the UK. Scotland, starting from a higher base, reduced health spending by £51 per person whilst spending in Wales fell sharply by £125 per head of population. Northern Ireland managed a nominal increase of £40 per person.

(2) An estimate based on figures from: ukpublicspending.co.uk

(3) Corbyn appeared at the last demo of the doctors in Whitehall on 26th April last year. Until then he had limited his comments to calling for Jeremy Hunt, the Health Secretary, to reach a negotiated settlement with the BMA and avoided raising questions in parliament on the doctors’ strike days.

(4) In a comparative study published jointly by The Health Foundation and the Nuffield Trust, the UK came out as “Worse than most countries” for:

• Asthma admissions
• Patient-based ischaemic stroke – 30-day mortality (in hospital and out of hospital)
• Patient-based haemorrhagic stroke – 30-day mortality (in hospital and out of hospital)
• Patient-based AMI – 30-day mortality (in hospital and out of hospital)
• Admission-based ischaemic stroke – 30-day in-hospital mortality
• Admission-based AMI – 30-day in-hospital mortality
• Breast cancer five-year relative survival
• Cervical cancer five-year relative survival
• Colorectal five-year relative survival
• Breast cancer mortality
• Cervical cancer mortality
• Inpatient suicide among patients diagnosed with a mental disorder

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