The NHS came to life on 5 July 1948. This year’s birthday celebration occurred at a difficult time, just after the first wave of coronavirus. Things are not going to get easier: there is already a huge backlog of elective and cancer care, as well as the risk of a second wave of coronavirus in the winter.
On 4 July a demonstration was held in Newcastle organised by the North East branch of Keep Our NHS Public. It was a small-scale demonstration, as gatherings of more than 30 people are banned, but with colourful banners that raised important concerns.
Keep Our NHS Public campaigns against the creeping privatisation of the NHS and is worried about the impact of the post-Brexit trade deal that our government is pursuing with the US. The demonstrators called for amendments to the Trade Bill to safeguard the NHS.
When I was an NHS Consultant hospital cleaning on most sites was transferred from NHS-employed staff to private companies: it was a cost-cutting exercise. There was no efficiency gain in the way private companies organised the hospital cleaning: the cost-cutting came from re-employing the same hospital staff on worse terms and conditions. Cleaners were already low earners.
The worst part of the NHS privatisation so far has been the Private Finance Initiative (PFI): it allowed hospitals to be built without the state nominally increasing the public debt. It soon turned out to be a con. Hospitals built using the PFI pay higher annual charges to the private providers, which makes PFI a more expensive way of financing the building of new hospitals. Private providers pay much more than the state does to borrow money and do not have the large scale required to balance risks, whilst they must also provide their shareholders with dividends.
The risk of American private healthcare companies exploiting the US-UK trade deal to take over some NHS services was debated during the last election. This risk arises primarily from the propensity of Conservative governments to expand the role of private providers. A likely consequence of the US-UK trade deal is a significant increase in the cost of medicines, as the Americans claim that their drugs manufacturers are entitled to greater profits. To date, the NHS has been remarkably successful at containing what are sometimes the extortionate costs of newly discovered medicines: reversing this would reduce the financial resources available for patient care.
The private sector is suited to providing goods and well-defined services but not to the complex, open-ended commitments of healthcare. You may get a surgical procedure done in the private sector but, if you then have a serious complication, you end up being a patient in an NHS Intensive Care Unit for whatever length of time is required. The US healthcare system, largely based on private sector providers, performs badly in comparison with largely public healthcare systems like the NHS.
The coronavirus epidemic has demonstrated that our government is ideologically committed to increasing the proportion of delivery from non-NHS providers. When it decided that coronavirus testing had to be expanded, it created three new mega-labs (Lighthouse Labs) instead of increasing capacity in the network of existing NHS laboratories. However, the new labs were not capable of creating the IT arrangements already in place for NHS laboratories that allow their results to be shared with GPs, hospitals and public health teams: this is a critical requirement during an epidemic.
The same mistake has been repeated with the coronavirus Test and Trace, which was set up in privately operated remote call centres. The analysis so far shows that local public health teams have been much more effective than the privately operated service.
Our government has launched a new catch
phrase, “build, build, build”, possibly as a distraction from its mismanagement of the epidemic. Increasing capital spending on infrastructure and new hospitals is good news, but commentators have been quick to point out that what is proposed is not new money but mostly the re-announcement of previous commitments. Both the NHS and social care would benefit from increased capital spending but what they need, more than anything, is an increase in the operating expenditure budget and in staff numbers.
After marching from the Millennium Bridge to Grey’s Monument, the Keep Our NHS Public demonstrators sang “Happy Birthday NHS”. While the 72nd anniversary is certainly a cause for celebration, I feel there may be troubles ahead.