This year-round NHS winter crisis is intentional

By Claudia Webbe MP 

The only solution that will genuinely fix the NHS is to restore it to a single, national service free to all and in genuine public ownership, writes CLAUDIA WEBBE MP

As usual at this time of year, the headlines are full of the so-called “winter crisis” in the NHS, with talk of “pressures” and “demand” recited almost unchallenged as the cause of the disaster.

But it is vital to be clear that the NHS is not merely collapsing, it is in a state of induced collapse. When the Conservative government came into power in 2010, a healthy NHS quickly went into such decline that what were at first regular “winter crises” became year-round crisis and then collapse.

Public satisfaction with our health service went into freefall, from a record high of over 70 per cent in 2010 to the current day reality of 36 per cent between 2020 and 2021 and arguably even far less now.

Seven million people are waiting for NHS treatment, over 400,000 patients have been waiting longer than a year. What was once one of the most highly regarded and most efficient health services in the world is now a shadow of its former self.

This has not happened by accident. The NHS has been fragmented by government policy, services and hospitals have been closed by policy and much of what remains has been privatised, while wages have been cut in real terms for years, leaving more than 130,000 unfilled vacancies and staff unable to cope with the inhuman demands put on them.

All this has been done intentionally, to cause collapse as an excuse for more and more privatisation — and all in the full knowledge of what the consequences would be, for those who need the NHS and for those who work in it and the deaths that it would cause.

According to the President of the Royal College of Emergency Medicine, 500 people a week are dying needlessly waiting for emergency care.

The Conservatives’ priorities are wrong, their ideological pursuit of privatisation to enrich their donors is driving the NHS to despair.

Now their next phase is under way, with further closures of services to concentrate what remains of the NHS into regional centres, leaving many people far from the care they need. Rationing and the so-called “postcode lottery” are now common.

In an illustration of the perversity of the system the government created — though hardly ever mentioned by the “mainstream” media — providers are financially incentivised to cut costs, and withhold treatment, through so called integrated care systems (ICS).

These integated care systems, which even the King’s Fund acknowledges, are based on a US “accountable care” system that is designed to withhold treatment and slim down healthcare in order to cut costs and share the profits with private providers

How does this work? A group of providers are allowed to keep some of what they manage to avoid spending from a pooled healthcare budget. In conjunction with national shrinkage targets, the result has been fewer services, fewer beds and fewer hospital accident and emergency units.

Since 2021, Tim Ferris, of the Massachusetts General Physicians Organisation, has been NHS England’s “national director of transformation” applying this scheme.

But before that, he’d been invited to Britain to explain how the system works. He said: “If we can keep our spending below [set costs] then we will share in some of the savings, and that’s the basis for the accountable care organisation contracts.”

NHS England’s strategy unit has made clear that cash for cuts is central to the purpose of integrated care systems: “Risk and reward-sharing is a key feature of the policy agenda for accountable care organisations in the US and integrated care systems in England.

“It is a simple and attractive concept, offering a commissioner the opportunity to co-opt and incentivise a provider to moderate growth in healthcare demand by sharing in the savings or cost over-runs.”

Instead, in Parliament MPs were told this was about “integrating” services, allowing the government to avoid a proper debate on the real policy, that of closing and downgrade services.

In his Oscar-nominated film Sicko, which examined the perverseness of the US healthcare system, Michael Moore warned us how rewarding such reductions in state care had ballooned the US healthcare industry: “Patients were given less and less care […] while health insurance companies became wealthy.”

Far from being just an absence of resources, this US-mimicking policy direction, with nationally mandated reductions in services, is designed to bar and discourage patients from accessing services, running the NHS like a business on minimal capacity, instead of like a public service. This is the real core of where our NHS is today.

Trusts that don’t reach government cost-cutting targets are punished still further with reductions in finance, with obvious adverse consequences for patients and staff.

My constituency of Leicester East has been hit, as hard as any, by the huge health inequalities that this has created, while simultaneously every hospital in the area has opened foodbanks for its workers.

None of this is just “happening” — the government and media use Covid as an excuse but the collapse goes back much further than the start of the pandemic.

We’re rarely reminded of it now, but the years leading up to Covid were marked by year-round “winter crisis” levels of collapse that seemed to reach record proportions annually — and the Tories cut a staggering 2.7 million “bed days” from NHS capacity during the pandemic, leaving an already decimated NHS with barely half the number of beds per thousand people as compared to other Organisation for Economic Co-operation (OECD) EU countries.

The average number of beds per 1,000 people in OECD EU nations was 4.6, but the UK had just 2.4. The British government has simply not put the money in to achieve parity.

The government makes noises about occasional, inadequate additional funding, but as long as services remain fragmented and privatised that just means more money goes into private profits and pointlessly duplicated management. Talk of more privatisation as a solution is simply an excuse to accelerate the demise of our national treasure.

The only solution that will genuinely fix the NHS is to restore it to what it once was and always should be: a single, national service free to all and in genuine public ownership.

It’s self-evident when looked at logically — private companies will always be looking at their profit margins and for every pound that goes to private providers only a portion will be used to provide care while the rest is taken as profit.

In a publicly owned NHS, where the profit motive is rightly excluded, every penny that goes in is spent on care and if there is any surplus it is reinvested straight back into more and better care.

As socialists we have to be resolute and committed not only to bringing the NHS back into public ownership, but to create a national care service to go alongside it and provide care for those who need it, when they need it, for free.

Not only would this immediately alleviate a huge amount of pressure on the NHS — because the care system would not be collapsing as it is now — but only those who needed an NHS bed would be in one.

Any politician claiming to have a fix for the “problems” of the NHS that does not include renationalisation at the very least is failing both NHS staff and patients and adding to the misinformation that has been inflicted on the public for far too long.

Claudia Webbe MP is the member of Parliament for Leicester East. You can follow her at www.facebook.com/claudiaforLE and twitter.com/ClaudiaWebbe