Is the NHS still lifting “the shadow from millions of homes?” The quote comes from Aneurin Bevan, Minister of Health in the post war Attlee government, speaking during the second reading of the NHS Bill, April 1946, against strong opposition from the Conservative Party – which under Churchill voted against the formation of the NHS on 21 occasions during the Bill’s passage through Parliament. Times change.
“The NHS is safe in our hands”: Margaret Thatcher claimed in 1982, as would any Prime Ministerial candidate today. The evidence suggests otherwise. Unless safe describes the experience of elderly people at the onset of the COVID pandemic in care homes, or stroke and heart-attack victims waiting hours for an ambulance. The shadow has returned.
A wait of over a year for a major ‘elective’ operation? “Well, perhaps you would like to go private?” Or you can sign up for one of those offers of private insurance that come through the letter-box - about 13% of UK adult population have private health insurance, c. 8 million people, a significant increase since COVID. Need some routine dental work? “I’m afraid you are no longer on our list… but we can take you on as a private patient”. Is there anything more revealing about the nature of our society and politics than where the Conservative Party has taken the NHS in the last twelve years?
During the two televised Tory leadership debates the main contenders had hardly mentioned the NHS until audience questions drew out the customary, vague assertions that the NHS is a great national institution and a top priority. No mention at all in the second debate. Given the age distribution of Tory Party members, and their habit of voting, this omission was a little puzzling. It shouldn’t have been. That phrase “the NHS is safe in our hands” died on contenders’ lips because it was obvious to the studio and TV audience that the NHS had been anything but safe in their hands. It had been in their hands for over a decade; it was falling apart.
Amongst David Cameron’s more disastrous misjudgements on forming a coalition government with the Lib.Dems. in 2010 was to make his Shadow Secretary of State for Health, Andrew Lansley, Minister of Health then pay minimal attention as Lansley made his mark by strengthening the magic genie of competition in the health system through his 2011 and 2012 Health and Social Care Bills.
Lansley also, and not unreasonably, wanted GPs to take control of NHS budgets for ‘hospital services’ and community health programmes. This could have been done relatively easily by enhancing the role of doctors within the existing Primary Health Care Trusts (PCTs), giving them control over finances and commissioning decisions. Instead Lansley dismantled the PCTs, creating huge numbers of expensive redundancies – many redundant staff were later re-employed under different job descriptions - and building new structures with confusing lines of authority, including consortia of GPs, at a cost of c. £5 billion to the taxpayer.
Implementing the Lansley plan was a massive distraction for NHS staff at a moment when they should have been focussed on modernising services; a huge opportunity cost, that accelerated the decline of our health service. By April 2012, only two years into the Cameron government, 96% of the 497 delegates at a Royal College of Nursing conference were voting no confidence in the Health Minister. There had already been a 3,000 drop in the number of nurses. In June, the doctors in the British Medical Association called for Lansley’s resignation. In September Cameron realised what a mess Lansley was making and moved him to become Lord Privy Seal and Leader of the House of Commons.
Jeremy Hunt took over and between 2012 and 2018 failed to tackle staff shortages or to resolve the urgent problems in social care. The Nurses Bursary Scheme was scrapped to save the government £800 million, resulting, it is estimated, in a 40% drop in applications and a long term shortage of nurses. Despite health and social care being perennially linked on paper, they remained ‘siloed’ in reality. Local Health and Social Care Committees met but their budgets remained separate with Local Authorities in charge of the vital social care services which were, and are, mostly in private hands. (It took until this July for 42 huge Integrated Care Systems to be put on a full statutory footing after the 2022 Health and Care Act was passed in April). Beds are still being occupied by patients fit to go home awaiting provision of social care. Ambulances stack for hours outside hospitals. Hunt left Britain unprepared for the pandemic in more ways than one.
But has the Opposition better ideas? It seems obvious that ‘bed-blocking’, with all its knock-on effects, can only be resolved when care workers are paid a decent living wage. In an under-reported speech in a January 2022 speech, Sir Keir Starmer presented what he called the Labour Health Contract, breaking the mould in two senses. First he pledged a New Deal for social care workers and a five point plan for the sector. Second, in an attempt to counter the perennial distorting emphasis on hospitals, ( the 40 imaginary, often promised new ones is a perfect example), Starmer spoke extensively about prevention, stopping people getting sick in the first place and moving beyond a ‘National Sickness Service’ towards a National Health Service with an emphasis on health and well-being.
No-one pretends prevention is easy. Behavioural change never is. But it can be achieved. From the Hollywood movies of the 1950s and 60s with everyone puffing away merrily we are down to 14% of adults smoking in the UK today. Government can make significant interventions in improving air quality, more effectively controlling the great corporate pedlars of cholesterol, alcohol and sugar – as Mr. Kellogg has noted - and providing the public with an accurate diagnosis of the real basic problems. For example, it is not that we have an aging population but an aging population bringing to old age a cluster of often preventable disease and disorders. Nor is it families eating cheap, processed, rubbish food; it is widespread poverty and inequality.
One thing is sure: we need a new set of hands to restore the safety of our health service and to lift the shadow over millions of homes that again hangs over us.
See TheArticle 20.07/2022