Speech given at the 999 Call For The NHS rally, organised by the "Darlo mums" group at Durham Town Hall today.
The NHS - our NHS - is under attack
The attack is coming from three fronts – first from the rightwing media and politicians, who are seizing on every medical incident, every time something goes wrong, as in any organisation it is sometimes going to do, to pound the service for its failings, real and perceived, to drive home the message to the public that the NHS has to change, needs that fictional “private sector efficiency” that we know is code for putting public funds into private profits, slashing pay and conditions or staff and cutting services. And they’re using these failings to claim that somehow we can no longer afford the NHS, when in fact we can’t afford NOT to have the NHS.
And the attack is direct – clinical commissioning groups, under government pressure, are letting contracts, giant contracts usually, for which the majority of bidders are likely to be the multinationals, with the occasional expansion-minded local trust, trying to be behave like a multinational, thrown into the mix. They win a contract, then the local services, small, specialised and expert, get broken up, the staff tossed into the wind, their structures broken – and very, very hard to rebuild. Pulse magazine reports more than three quarters of new contracts are being tendered out.
And the third attack is simple – funding is being cut. The system us bearing the £3bn administrative cost of the Health and Social Care Bill, and the loss of £20bn of so-called “efficiency savings” from 2011 and 2014. We know what those are – it’s simple: cuts, when the service is being asked to do more, and cope with more change, than any institution should have to bear.
And in addition, our NHS has two key problems.
First – rising demand. And this is something that IT can do little about. Although that doesn’t mean WE can’t.
We are an unhealthy society, a society that is asking more and more of the NHS – asking it to tackle problems that aren’t caused by genetics or misadventure or age, but by our unequal, unbalanced society dominated by the interests of giant multinational companies and their profits, not by the needs of people.
Obesity, diabetes, heart disease, stress, mental ill health, malnutrition – all of these the NHS is presented with, and asked to fix, while the tools to genuinely act, to resolve and prevent the problems lies in the hands of others.
Many of these demands could be cut, and our health dramatically improved, by measures far from the purview of the Secretary of State for Health. To pick just three obvious ones:
1. Introduce 20mph speed limits everywhere where people live work and shop. This would encourage active transport, walking and cycling, and vulnerable road users, children and older people, out of their homes and back into society. In my home London borough of Camden, I’ve talked to older residents in despair at the thought of losing their local corner store, because they’re too frightened to brave the high street traffic to get to other stores.
2. Bring in minimum pricing for alcohol and severely restrict its advertising. For a while last summer, whenever I used the Tube in London, I was confronted by human-height glasses of cider, many of them on the new electronic screens that are flooding into the Underground, chewing up electricity for the chief effective purpose of irritation. Everywhere you turned gently beading glass of luscious-looking (although actually awful-tasting) industrial cider. After that, it’s a wonder that our alcohol problem isn’t even bigger. Of course we almost got to minimum pricing – then our Tory/Lib Dem government caved into industry lobbying and backed such delightful contributors to the public wellbeing as the makers of White Lightning against the views of medical professionals and campaigners.
3. Make the minimum wage a living wage – not an obvious health measure but think of the reduced stress, the removal of pressure on relationships, the better diets, that would result from every worker being paid enough money to live on. A trip to the countryside, a holiday, simple hope of a better life, could do more for many than any drug.
There’s much more I could add – insulate our hard-to-heat leaky homes, which would slash fuel poverty rates and our disgraceful excess winter death rate; get the dreadful Atos out of Work Capability Assessments and rely on health professionals treating patients to assess what they can or can’t do; rein in the behaviour of multinational companies producing dreadfully unhealthy processed pap and promoting it as healthy - I could go on, but you get the point.
The NHS might be able to do a little about the rising demand it faces – smoking cessation programmes, addiction treatment - but it’s trying to repair damage done by others, like the boy with his finger in the hole in the dyke, as water floods over the top.
We need to get serious about maintaining and restoring our health. The first political priority should be health, not treating illness, and that means policy action in transport, about food, on housing and wages.
The second overarching problem for the NHS is demoralisation. Staff have been pushed from pillar to post, seen through communal professionalism questioned, been lectured by ministers and officials about the “need to care” when that’s what they do every day, in spades. They’re not sure if their job will be there next year, have seen their real pay sliding fast, felt unappreciated and undermined.
And they’ve been asked too often to do the impossible – with not enough staff, not enough resources, to deliver a quality service – the kind of quality CARE they became a health professional to provide. To take just one example, consider our midwives. They are leaving the profession, or thinking of leaving, in droves – caring for women in labour, and before and after birth, is an exacting job, built on a close and trusting relationship with patients. Too often instead they feel like they’re part of a production line.
So we have to admit there are problems in the NHS, visible most clearly in A&Es. That reflects the disastrous, on-the-cheap construction of the 111 service. We’re not trusting a call centre worker with no medical training and a clunky computer system in front of us – either the system sends us to A&E (often unnecessarily) or we vote with our feet and go anyway. And it reflects the fact that there’s a lack of beds to put the patients who need them into – we’ve got far fewer than most developed countries: increasing allocation of wards to private patients, a parasitical private care home sector that often can’t cope with the patients for whom it is supposed to be caring.
And there have been places – Mid Staffs the most obvious – where the system has gone under. The government’s response is punitive legislation that could see staff accused of “failing to care” facing up to five years in jail. It’s all too easy to see where this could lead – junior, overworked, overstressed staff failing to do the impossible, and then facing public hatred and a jail term as a result.
Nearly half of wards in England have more than eight patients per nurse, seen as a conservative minimum ratio for safety. Nearly 5,000 nurses have left since 2010 – many of them older, experienced staff. Last year two-thirds of nurses said they’d thought of leaving the profession. And the number of district nurses is down 40% - care in the community, which could also take pressure off hospital beds, isn’t happening.
We have, or had, in our publicly owned and publicly run NHS the first or second most cost-effective health system in the world, a system where treatment was available to all on the basis of need, under which world-class healthcare was available to the richest and the poorest on equal terms. It was, and still remains a treasure, and the tarnish it has suffered from 15 years of nibbling away at its foundations and meddling with its structures by successive government is only on the surface. The core still remains. It can be restored, must be restored.
In 2010, after increases in funding after the starvation of the Margaret Thatcher and John Major years, there were record satisfaction levels. By 2012 those had dropped, but for most of us the NHS still “works”. There might be an irritating struggle to get to see your GP, there might be a long wait for a minor ailment in A&E, but if you have a serious illness, a critical injury, the NHS can do more for you, better than it’s done before.
But left on its current trajectory, that’s going to become less and less true.
The “Croydon list” of 211 medical procedures the NHS won’t fund, was regarded as radical, but is now a starting point. Cataracts – one eye’s enough. Hip operations – are you really in agonising pain?
Your local hospital? Unless it’s a giant regional centre, it’s all too probably under threat. I’ve marched, written letters, acted to protect the Whittington Hospital in North London more times than I can remember. Take it away and the people of Haringey borough, who used to have six hospitals and now have none, would face a journey of three buses – an impossible journey for many for reasons of cost, energy or time for many, to reach their so-called “local” hospital. And that’s the story up and down the country.
And we’re seeing the idea free at the point of service under sustained attack. Professor Malcolm Grant tells the Financial Times that he wouldn’t want to introduce charging – “co-payments” is the magic word to watch out for – but a future government will have to. The King’s Trust has suggested charging migrants, drunks and the obese, the Nuffield Trust attacked the holy grail by suggesting charging for GPs. There’s talk in the Labour Party of the NHS of means testing – despite the fact we know that services for poor people become poor services, and that some in need will always fall through the bureaucratic cracks.
A recent Mori poll showed that 60% still agree with the statement that “the NHS is a symbol of what is great about Britain and we must do everything we can to maintain it”. (But the number who think “we probably can’t maintain it in its current form reached 30% this year, up from 21% last year.)
They – the privatisers, the government, the health multinationals - want us to get the message that we can’t afford the NHS, so it can be replaced with more expensive, and more unequal, alternatives.
But we still spend only around 9% of GDP on health, about half what the Americans spend for their dreadful, unequal outcomes, mother and baby mortality rates at levels worse than much of the developing world. And we spend about 3% less on health than France and Germany, with their insurance-based systems.
And think back to the foundation of the NHS – just after the Second World War, in a nation exhausted by war, near bankrupted by war. Then the NHS was created, and suddenly patients who’d suffered for years, for decades, from treatable conditions could get them treated. Cataracts were removed, letting the blind see. Prolapsed uteruses were treated – and agony and shame ended. Parents didn’t have to delay, worry, wait, and see their children die as a result.
We must not go back to pre-NHS conditions – to the days when your ability to pay determined the quality of treatment, or whether you could get treatment at all.
We will must fight back, we will fight back, in fact that’s what we’re all doing today – and well done to you for that!!
Things are bad, but they’re not irrecoverable. There are actions we can take.
First, I’m going to say TINA. It’s a favourite claim of the neoliberals, the globalisers, the privatisers, about our economy – There Is No Alternative. On the issue of the nature of our low-pay economy and horribly unequal society, that’s not true.
But in the case of the NHS it is. There is no alternative!
TINA. Say it loud, say it often. There is no good alternative to a publicly owned and publicly run NHS, free at the point of use.
Then we back, loudly and vociferously, Lord Owen’s bill to restore the secretary of state’s duty to secure a comprehensive health service, and to remove the hugely destructive, competition enforcing Clause 75 from the Bill.
I promise you that a commitment to do both of those things will be in the Green Party’s 2015 general election manifesto – and I’d urge you to push for them to be in every party’s manifesto.
And we point out the absurdities and sheer, disgraceful waste, of the system introduced by the Tory/Lib Dem government. This government started with 290 NHS managers earning over £200,000; there’s now 500.
Let’s quote and keep quoting the departing head of NHS England, Sir David Nicholson, told the health select committee: "We are bogged down in a morass of competition law. We have competition lawyers all over the place telling us what to do, causing enormous difficulty
Let’s learn and tell others about how two Blackpool commissioning groups were referred to Monitor's competition arm by Spire private hospital for, it claimed, failing to send it enough patients. One of the group’s heads explains – this is because headache care has been improved and made more cost effective with community care diverting patients from the hospital’s neurologists, and GPs doing work, better and more quickly, than its orthopaedic specialists had done. These are the kinds of genuine reforms we want to see in the NHS – but the system doesn’t want!
And let’s highlight the way in which instead of public servants being appointed to key NHS posts, we’re seeing people from the private sector shipped in, bringing their ideology, their links to old workmates, their biases into the system. Let’s appoint on merit from within the system – people who know the NHS, who value the NHS, who understand the worth of the publicly owned and publicly run NHS.
And let’s state, loudly, clearly and simply, that the profit motive has no place in health care. Think of a fragile, prematurely born neonate, struggling for breath, in need of high cost, careful, considered treatment – do you want an accountant standing over the nurse’s shoulder, counting the costs, taking would could be treatment resources for private profit? Think of an old person at the end of their life, seeking a peaceful end, a good death, with care, compassion, human attention – services that can’t be – or certainly shouldn’t be rationed, subject to efficiency drives and cost-cutting.
A publicly owned, publicly run NHS free at the point of service.
A more equal society, protected from the “industrial epidemics” of obesity and alcoholism, with people-friendly roads and strong communities, jobs that you can build a life on, a society living within the limits of our one planet in which everyone has access to the resources for a decent life.
I’d urge you today to think about those, to commit to those, to fight for those – to say we want a society that works for common good, not private profit.
Let’s commit to, and create, a healthy future society.
This speech was delivered in Durham, England on Saturday, November 23, 2013.