England, Wales and Scotland section of International Socialist Alternative

Issue 5 feature: NHS in crisis

As the dust settles from the outcome of the election, the prominence given to the NHS by all political parties has thrust the whole issue centre stage. To assess our future under the NHS, Socialist Alternative looks at some of the campaign themes and charts a way forward:

Just how bad are things?

The NHS is in crisis due to a decade of under-funding, but also creeping privatisation which actually began under the Blair government. Here are some of the facts:

  • £8 billion has been cut from the Social Care Budget in the last decade leaving at least 1.4 million mainly elderly people without any support
  • Hospital Trusts are £14 billion in debt with a backlog of essential building work running up to £6 billion
  • 9,000 acute hospital bed have been lost, including 22% of mental health beds
  • There has been a 1400% increase in trolley waits with 4.54 million on operation waiting lists
  • There are 100,000 staff vacancies across the NHS with 78% of staff saying they face unmanageable workload pressures
  • Since the Tories promised to recruit more GP’s, another 1,000 have given up, leaving primary care in crisis and GP surgeries merging
  • Since the Tories brought in the Health and Social Care Act, 18% of NHS services are now provided by the private sector and rising
  • A & E waiting times have now reached their highest levels since records first began and we are now facing an acute Winter Crisis in the NHS. Recent research by Drs Moulton and Mann has shown 5,500 patients died in the last 3 years due to lack of A & E capacity

So, is the NHS up for sale?

Despite winning the election on the Brexit issue, Johnson’s Tory Government will be approaching the trade talks from a position of weakness. The former UK Ambassador to the USA, Kim Darroch, recently revealed that Donald Trump will put the interests of corporate America first and demand that the NHS pays higher prices for US drugs in a free-trade deal with the UK, and that he would reward his backers in drug firms and farming communities by opening up British markets, while questioning where the UK’s gains would be found. The November 2019 Channel 4’s Despatches programme estimated that the drugs bill could go up 2.5 times from around £17 billion to £48 billion if the US was given unlimited access.

The former British envoy, who left Washington after a leak of his confidential cables to London, said it was doubtful whether the UK had the resources for parallel negotiations with the US and the EU, a strategy championed by Downing Street as a way to give British negotiators leverage in Brussels. The EU will not want to be seen to be making any ‘special concessions’ to the UK for fear that other right-wing populist parties in Europe will seek to begin their own version of Brexit. Johnson needs trade deals with other countries and Trump has already promised a generous deal with the UK.

Strictly speaking that would not be selling off the NHS but opening it up to private corporations to make huge profits. That is not a new thing. The Private Finance Initiative debt in the NHS is around £300 billion with a value of £54.7 bn. To put that into perspective, the PFI debt is 4 times the size of the budget deficit used to justify austerity (Independent 17.2.18). Likewise, private firms have been handed almost £15 bn in NHS contracts over the past 5 years. The value of contracts given to the private sector has soared by 89% since 2015 to £3.6bn a year. This will accelerate under Johnson. All this was made possible by the Health and Social Care Act brought in by the Con Dem Government which obliged all Hospital Trusts to put all NHS work out to private tendering.

It would therefore be more accurate to say the NHS is suffering from creeping privatisation, along with chronic underfunding and unprecedented staff shortages which will undoubtedly get worse under this Tory government (see back page).

Can the NHS be Saved from Johnson’s Government?

There is no doubt this task will now be much harder. The proposed Withdrawal Bill will allow secret negotiations to continue. Many of the new Tory MP’s are firm advocates of a private health insurance system. Despite Johnson’s pledge that they will commit £ 33.9 bn to the NHS over the next 5 years, that will barely touch the huge crisis now facing the NHS as outlined above. It actually represents a real cut in NHS funding when inflation and other on-costs ate taken into account.

NHS England (the national quango appointed by the Tories to ‘run’ the NHS) is now well down the road of centralising and concentrating local NHS services into larger urban areas as well as creating ‘super hubs’ of health care delivery in the community, which will see the disappearance of many local GP surgeries. All these plans will see an acceleration of hospital closures, cuts and privatisation. No-one believes Johnson’s claim that the government will build 40 hospitals; 12 are planned for Dorset alone, and will be cottage hospitals, probably without beds, just for outpatients. The so-called pledge to increase the NHS staff numbers will not be realised due to huge budget constraints and a crisis of morale amongst front line staff. And all these plans are being developed in secret since the introduction of ‘Accountable Care’ bodies which have divided up the oversight and management of health provision across the country. In reality these are appointed bodies with no accountability which have slowly taken over the running of our NHS.

However, the Tories were forced onto the defensive during the election and there will be very close scrutiny of NHS delivery and performance by politicians, unions, community campaign groups and the wider public. There is absolutely no doubt that the British public will fight to save the NHS if they feel it remains under threat. This means that local, regional and national alliances must be forged now to ensure there is close scrutiny of every aspect of NHS care, and resistance organised where services continue to be cut.

So, What Can be Done?

The ongoing strike wave in Northern Ireland shows the way. Determined and direct action can force the Tories back and actually force their hand to go further than they now intend to fund the NHS. Health Unions should immediately convene a Conference of Action, reaching out to all local community action groups. A plan of action needs to be drawn up which will both inspire confidence and offer leadership to save our NHS.

Socialist Alternative supporters would strongly advocate sustained and direct action to push the whole issue to the forefront of consciousness. Unfortunately, the recent Health Campaigns Together National Meeting did not back the proposal from many local action groups for a national demo in the early Spring. Whilst this is a setback, the demand for nationally coordinated protest and strike action must continue. We demand:

  • For a massive national mobilisation to kickstart a national campaign of action to safeguard our NHS called by health unions and national campaign groups
  • Proper public funding of the NHS to bring it up to the European average of 13% of GDP (the UK currently spends around 7%)
  • An end to privatisation, direct and indirect in the NHS; for ALL NHS services to be brought back in house
  • No sell off of any services to private interests; nationalise the big drug companies
  • A decent living wage for ALL NHS staff – end the pay cap now
  • Bring the running of our NHS back under democratic control
  • No to cuts and closures-every local community needs a local hospital with decent primary & community care to protect all health needs
  • Stop all cuts to Social Care, for all residential and community care to be free at the point of delivery


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