[This is a presentation I gave at a Save Our NHS Action Day in Feb 2018 – Ed]
I have spent a lot of time thinking about what I should say to you tonight. I am not a natural public speaker. It’s not something I do often, not since university days, and they were a while ago now. I can’t say it’s something I enjoy.
So why am I here? I have spent the last year campaigning to save the NHS, alongside some truly inspiring and knowledgeable people. I gave a short off-the-cuff speech at the Labour NHS rally in Newport a couple weeks ago, something I would never had agreed to if id had time to think about it. But it didn’t go badly, despite my overwhelming nervousness.
The trouble was, when I watched the talk back on video, all I could think of was all the things I did not say. I thought ‘what if that was my one and only chance to convince people, to get them to stand up and take action to defend our NHS, and I missed out so much of the evidence that eventually spurred me into action?’
I care very deeply about the NHS, I sincerely value it I have no idea what I would do without it. Turns out, I feel more strongly about that than I do my own fear of public speaking, because here I am, trying to fill in the gaps I missed a couple weeks ago.
Previously to getting involved with the campaign to Save Our NHS, I had felt bewildered and overwhelmed by all the conflicting information out there on the subject. I still sometimes feel that way, but I have made a concerted effort to learn as much as I can from independent sources about what is happening to the health service my children’s lives depend on.
Despite my difficulty with public speaking, I feel compelled to stand before you tonight, and try to share with you what I have learned. I want to share with you the things I have learnt about the extent of which our NHS has already been privatised, the direction we are headed, how dangerously close we are to losing it completely, and how entirely underhanded the entire process has been. I am compelled because I believe you have a right to know, because I am incensed that this has been happening without our knowledge or consent, and because I believe that once you do know, there’s a good chance that you’ll join campaigners across the country in fighting for our NHS, and then the possibility that we can stop this, that we can ensure our children get to benefit from the NHS, as we did, for generations to come.
If this is all new to you, I want to share what I have learnt in the hope that you will go home and investigate it further. I want you to share your thoughts and your ideas on what needs to be done, with others here tonight, and beyond. I believe that together we have power.
I should tell you that I am not an expert in healthcare, business, politics or anything else that I feel would make me more qualified to be stood before you tonight; I am just an ordinary person like you. I am a mother of 3 kids, and my family rely on the NHS. I already know we have one thing common, because you are here, you’re at least interested in the future of our NHS, and perhaps concerned about what is happening to it.
News on radio, TV and in the press, locally and nationally, is filled with so much information on the NHS. Its deafening. I am paying attention, but there is so much, it’s so constant, it become one constant drone. SO many voices, so many contradicting opinions, ‘facts’, figures, bodies, trusts, lobbyists, politicians, journalists. So many new words, acronyms and things to learn, that are explained, hardly anywhere, because there is this assumption that people know. I think I’m probably of about average intelligence, but I have found it so hard to unravel what is happening to the NHS, and crucially, how it is happening. It seems to me that it shouldn’t be so hard for regular people, the people who both fund and use the NHS, to easily access useful, accurate and complete information about what is happening to it. That struck me immediately when I first got involved with all this, and I must tell you that I have wondered quite often since, if this inaccessibility, this convolution of the truth, all the unnecessary compilations and barriers to understanding, aren’t intentional. Tony Benn said,
‘If the people knew what was happening, they wouldn’t accept it’,
I think he was right.
Last week, for example, I watched a very compelling argument for NHS privatisation on the BBC programme, This Week. The person arguing for was a representative from the ‘independent’ think tank, the Institute of Economic Affairs, or IEA. If I hadn’t been trying to learn as much as I can about what’s happening to our NHS this past year, I would not have questioned her representation of the facts. I should point out that The IEA do not comply with BBC guidelines, stating that such think tanks should be transparent in their funding. For all we know, that report could have been sponsored by Virgin Care.
When I watch stuff like that, I begin to doubt what I have learned about what is happening to our NHS.
Then I remember the doctors, consultants and professionals who are fighting with all their might for us, for our NHS. There are so many of them. People like the doctors who made the film Sell Off – The Abolition of Your NHS, who are currently working on an updated version The Great NHS Heist, a sequel due out this year. They do this because they know awareness is essential for change. Knowledge is power. People like Dr Bob Gill, Dr Youssef El-Gingihy, Dr Chris Day, Prof Allyson Pollock, Dr Moosa Qureshi, Dr Lucy Reynolds, Prof Stephen Hawking… to name just a tiny fraction of them. These people have nothing to gain, and risk so much stand up and speak openly to defend our NHS. They risk their jobs, their reputations, their anonymity, their sainity. They give up their own time and money to campaign tirelessly. They have no hidden agenda. They fight for the NHS because of a sense of duty… the same sense of duty that probably propelled them to become doctors in the first place.
I have seen countless videos, speeches, protests and have read so many articles and books written by NHS professionals trying to defend the NHS from stealth privatisation. Heres one, for example
I’ve yet to see a single one from a person without a conflict of interest or an obvious agenda, arguing the opposite point of view.
Maybe its just my echo chamber. Maybe there are a ton of people with different social media algorithms to me, who read different books and watch different news, getting a constant stream of info from non bias knowledgeable sources, who claim that the NHS is fine, much like Teresa May does when she says things like ‘the NHS is better prepared than ever!’, or people who argue for privatisation like the BBC’s IEA representative, but without the agenda. Ive yet to come across one yet.
When there’s so much conflicting information, I suppose it comes down to what I can see and measure for myself, and ultimately, who I trust. If you rely on the NHS, then I think you have to think about who you trust.
I trust real doctors, real NHS professionals and researchers, without an agenda. When my kids are sick, I trust these people. It makes sense that I should trust them when they risk their livelihoods to tell me the national health service as I know it is being dismantled. I trust Prof Stephen Hawking! I can’t think of a single possible reason why he would say things like this
unless he actually believed it to be true. I can think of tons of reasons why Teresa May and Jeremy Hunt might tell me things about the NHS that are not true.
The National Health service as I know it is free at the point of use, it is a universal right to all citizens, regardless of wealth or status. Its hard to imagine a time before the NHS. I try to imagine in 1948, after the war when the country was essentially bankrupt, and everyone said it couldn’t be done, those incredible people that founded this health service of ours, based on the idea that we could all take care of each other! It doesn’t seem remotely remarkable to us now, but it must have been then. The NHS was created by Labour and was vehemently opposed by the opposition, who voted against its creation over 20 times. This was the information sent to citizens to let them know they’d now benefit form a National Health Service:
Imagine it: the day before a national health service, when if you got sick, unless you were very wealthy there was little you could do. Living with the fear that your child could get sick, and you’d be powerless to help. Imagine being the parents of 13-year-old Sylvia Diggory. The first patient to ever receive treatment on the NHS, at Park hospital in Manchester, on 5th July, 1948. Imagine how truly wondrous, marvelous, out of the ordinary, this idea that if you were sick, you would be looked after, actually was! Nye Bevan, a coal miners son who fought hard to found the NHS said it was ‘ a milestone in history – the most civilized step any country had ever taken”. He also said this:
I hadn’t thought about it until quite recently, but it really is a profoundly wonderous human endeavour. From that initial first operation, we have achieved what would have been inconceivable back then. Consistently rated the best overall system in the world by the Commonwealth Fund, in terms of care, affordability and efficiency. Diseases like polio, small pox, things that would have absolutely terrified our great grandparents, essentially wiped out. The workforce healthy so the country could prosper. Amazing advances in medical science. And, most importantly to someone like me, those treasured ideas, the basic goodness and decency in taking care of each other, put into practice so immersivly that it has become woven into the fabric of our society. No wonder we are all so proud of our NHS. We should be proud of our NHS.
What do I mean when I say ours? Ours? I mean that your great grandparents built it, I mean that generations of sisters and mothers and fathers and sons have served as its doctors and nurses and cleaners and porters and administration staff, I mean that we pay for it with our taxes. We built it from nothing, into the institution it is today. In every conceivable way, it belongs to us. It is not for any government to seek to sell it without public knowledge and consent. That is theft.
In many ways, the NHS has been a victim of its own success. It has done such a good job taking care of us, it has become so unimaginable that we would not benefit from it, that people like me are accused of scaremongering for expressing concern for it’s future. But what if we’re right?
We need to face up to the fact that the NHS IS already partially privatised. It IS being privatised further. If we do not fight for it, we will lose it. I want to talk a little bit about how it is happening, how our local situation relates to the national one, and address some of the questions that seem to arise for most people I talk with, as best as I can.
NHS has been effectively abolished. The national in National Health Service has been removed. Now that may seem like a strange thing to say, seeing as you can still go to your local GP or hospital and receive free healthcare. On the surface, nothing seems to have changed. But everything has. It will take many years for this to become apparent. The NHS lives on as a logo, which has helped to keep the public in the dark. – Dr Youssef El-Gingihy
How is this possible? How can you sell a beloved public healthcare system, from under the feet of the people that own it, serve it, pay for it and use it, without anyone noticing? Jeremy Hunt knows. In 2005, he co-authored a book on it in, called Direct Democracy: An Agenda For A New Model Party, calling for the NHS to be replaced by an American style insurance system. Simon Stephens, NHS CeO, who spent a decade as an executive at UnitedHealth – the largest healthcare insurance provider in the US and one of the biggest corporations in the world, certainly knows. Linguist, cognitive scientist and historian and, Noam Chomsky, very simply explains: What is the standard technique for privatisation? 1) Defund 2) People get angry 3) hand it over to private capital. Id say we’re firmly between stages 3 and 4.
According to many independent investigations, including one conducted by the Nullfield Trust – the NHS remains fundable through general taxation. It is consistently rated as efficient in comparison to other counties by the Commonwealth Fund. For example, while the US spends 16.6% of its national income on health, the UK spends just 9.9%. Only New Zealand (9.4%), Norway (9.3%) and Australia (9%) put in less. America spends about 30% of overall healthcare budget, on administration costs, compared to our 16%. Privatisation does not equal efficiency and it doesn’t equate to better health care, too. America consistently ranks bottom for health outcomes. Millions of Americans are too poor for health insurance. Millions more have inadequate health insurance.
Despite how effective our system is, the NHS is facing its biggest Funding squeeze in its entire history. Until now, average spending on the NHS has increased by around 4% per year. For the last 10 years, it has increased by an average only 1.1% per year. The ten years up to 2021 are likely to see the largest sustained fall in NHS spending as a portion of GDP in any period since 1951; as demand on the NHS increases, we are not increasing or stabilizing the amount spent on it, but decreasing it. Most independent studies conclude that the NHS has been underfunded consistently for the last decade and is currently facing a 4 billion pound black hole.
Its not just me who thinks the government are misleading you, thankfully, real experts, people you might be likely to think are probably right, think so too. Professor Stephen Hawking has publicly stated that the NHS crisis is a result of political decisions and underfunding, and has publicly challenged Jeremy Hunts representation of the facts, stating the Hunt had been ‘cherry picking’ statistics to justify government NHS strategy. Jeremy Hunt said Hawking was wrong! Wrong about statistics! Wrong about academic studies and what they mean…something I imagine the author of A Brief History Of Time knows something about. Professor Hawking puts it brilliantly when he says that to say we cannot afford to fund the NHS is an exact inversion of the truth.
But The NHS is not just being starved of the basic budget it needs to run on a daily basis. There are other, much more insidious and complex ways hospitals and trusts have been plunged into deep financial ruin.
There have been massive cuts to social care and welfare budgets. We are promised the gaps in services will be plugged with outreach support, community care, the voluntary sector and new communication technology. This happened before with mental health from the 1980s when the closure of psychiatric hospitals was justified on grounds of choice and care in the community. In reality, patients were left with serious illness stranded and unsupported in the community. Patients now have to travel hundreds of miles for treatment, have waiting lists of longer than 12 months in some places (including the island, for secondary mental health care), and that is if treatment is available at all. Cuts in social care puts incredible strain on the NHS, taking the form of things like the ‘bed blocking’ phenomena we have seen, where vulnerable patients, well enough to go home but in need of social care that is now absent from our communities, are unable to be discharged from hospital. It creates a smoke screen, because the government can effectively make cuts to the NHS by proxy. The NHS is forced to pick up the pieces caused by the cuts in other areas.
Private Finance Initiatives, or PFIs. PFIs, put simply, are a method of funding public projects (like schools, hospitals, prisons etc) with private investment. It basically means that private companies stump up the capital to build and manage public services. The often own the infrastructure at the end of the contract and lease it back to the public.
A PFI panel was set up by conservative Chancellor Ken Clarke as early as 1993, and under Blairs New Labour, PFI projects really began to grip our public services. PFI contracts charge eye-wateringly high rate of interest, to a government that has the option of borrowing at the lowest rates possible. It seems to make no sense as a strategy, except to perhaps falsely ‘balance’ the books in the short term. To give you some idea of the scale of how hideously expensive they are, as a country we owe almost 80billion pounds to PFI investors just in the health sector, for projects that initially cost just over 11 billion bounds. Hospitals that cost 11 billion to build, are costing us almost 80billion, that works out at about £4000 per household. Just 4 firms alone will receive over 39 billion from the NHS over the course of the PFI contracts. These contracts often have “facilities maintenance” subcontracted on a long-term basis as part of the deal. This means only specific contractors can change or fix certain equipment or fittings, such as a plug socket or a light bulb, or that only specific contractors can supply certain things. Recent media investigations revealed one hospital was charged £52,000 for a job which should have cost £750.
Whats more, PFI payments were set in line with projected revenues of hospitals, regardless of actual revenue, so hospitals have been expected to make increasingly unmanageable payments year on year. PFI debt payments are paid as a priority – they must be paid before trusts spend a penny on patient care. Across the NHS, PFI repayments have contributed to hospital mergers, closures and downgrades. NHS Campaigner Professor Pollock said
“these mergers will be followed by the final wave of closures in the run-up to privatisation and franchising out”.
Innisfree is a company that is big in the PFI market. It has ‘invested’ in many hospitals, including London Chest Hospital, ran by Barts Health. Barts were paying over 100million to Innisfree per year in interest. London Chest Hospital no longer exists, in it’s place a housing development. Innisfree chief executive David Metter takes home millions in pay and dividends each year.
The NHS is also overcharged for medicine and resources, for example, well known high street pharmacy ‘Boots’ charged the NHS £1,500 for a pot of moisturiser that retails for around £2. Indeed, pharmaceutical companies are known to massively overcharge the NHS for medicine.
Chronic underfunding, debt and hemorrhaging money to profiteers through privatisation, creates the crisis we are seeing in our NHS. Not an aging population (a largely predictable factor) or immigration. Immigrants factually contribute over 30% more to the welfare system than they receive and make untold contribution to the NHS in terms of staffing, research and more.
The underfunding in our NHS is causing the crisis that is putting lives at risk. Last month, 68 leading senior A&E doctors and consultants from around the country wrote to Theresa May. warning that patients are ‘at intolerable risk’ and imploring her government to take action. This is what they said:
“The facts remain, that the NHS is severely and chronically underfunded. Thousands of patients are waiting in ambulances for hours as the hospitals lack adequate space. Some of our own personal experiences range from over 120 patients a day managed in corridors, some dying prematurely.”
You can sign a petition supporting their call to action.
The NHS has fewer beds now than at any time in history, since the 80’s, the number of NHS beds has halved.
Despite over 50,000 operations being cancelled this winter, patients being treated within the ‘safe’ target of 4 hours at A&E units in England is at a record low (77.3%). 19 NHS trusts were on 99% or 100% bed occupancy between 1 and 7 January, with average occupancy at 95%. Three hospitals were completely full during this time. That’s 7000 fewer beds compared to the same time period last year.
On 4th Jan this year, Leah Butler-smith took took this photo outside Queen Alazandra Hospital in Portsmouth.
She had been waiting in an ambulance for over 4 hours, with her elderly mother having a stoke and slipping in and out of consciousness, At the time, there were 25 patients in 13 ambulances qued waiting outside the hospital. She said
“My mother has a fever and has had a stroke. There are 25 or more ambulances and urgent patients waiting outside at this hospital alone. We have consultants wandering around the ambulances trying to ascertain what they can do. You can imagine – knowing we’ve got hours and hours of waiting with mum in a serious condition and seeing the stress of the staff who are overwhelmed and deeply hurt that this is happening to their patients and to them! They are amazing and seriously kind but hearing the facts of what they deal with day in and day out is heartbreaking. The hospital cannot redirect patients to any other hospital as none will accept them”
That day there was an average of ten to 14 ambulances at Portsmouth’s Queen Alexandra hospital queuing to unload patients. It peaked at 25 ambulances, with one waiting five and a half hours. New plans to further cut services at our local St Marys Hospital, will see issues over the Solent becoming more relevant to us, as what the trusts call the ‘Solent Acute Alliance’, involving Portsmouth, Southampton and Lymington, trusts working together to provide care, features heavily in the re-structuring plans for IW patients.
Staff morale is at an all time low. Many are poorly paid, frustrated at being unable to provide the standard of care they aspire to, stressed, scapegoated, sleep deprived, without the proper supporting staff or facilities to do their jobs, and often wracked with guilt over mistakes they made that are not their responsibility, but ultimately the responsibility of government strategy creating untenable and unsafe working conditions. Professionals who speak out about this have been persecuted and scapegoated by the institutions that are meant to safeguard them. Indeed, I have heard on more than one occasion, different doctors say that they feel anyone who speaks out is ‘crushed’. The cases of Dr Chis day and Dr Bawa-Garba, are heartbreaking examples, and anyone who has ever benefited from or relied on our dedicated, knowlegable and often heroic NHS professionals, should be truly outraged and upset by the way these cases demonstrate how both patients and professionals can be treated by the system and our government.
Thanks to solidarity with other medics and the general public, The Bawa-Garba legal challenge has been funded. Go here for updates
Hospitals cannot afford the basic resources to ensure patient care. Privatisation already means that a significant proportion of NHS budgets are eaten by profiteers. For instance, understaffing forces hospitals to employ agency staff, at far greater expense to the tax payer than necessary, a massive proportion of which goes straight into the pockets of the private agencies as profit. £2.9bn is spent every year by hospitals in England on agency staff. The financial implications, and those for continuity of care and patient safety, are massive. This is due to cuts and un-fillable vacancies. 1 in 10 nurses are leaving the profession, more than are joining, for the first time in history. Effective pay cuts, compromised patient safety and unbearable working conditions are often cited as reasons. I cannot describe how low staff morale is, so I wont try, Suffice to say we are letting down the every-day heroes in our communities.
Despite dedicated staff, we have not escaped the crisis on the island. The Isle of Wight NHS Trust provides acute, ambulance, community and mental health services to a population of 140,000 people. Every month, it spends over 1 million on agency staff to run our health services. In October, there were 101 job vacancies across our health services. A report into performance given by by St Marys bosses at the start of this month, said that our hospital is failing to meet basic safety targets, such as less than 60% of our island ambulance reaching their call outs within the 8 minute target. In December, The Trust missed its Emergency Care 4 hour Standard target by more than 10%. Urgent cancer referrals and the number of patients treated within 62 days of screening missed their targets. Some parts of our mental health services were deemed ‘entirely inappropriate’. We are constantly seeing local news reports telling us St Marys is on ‘Black Alert’. This essentially means that services are struggling at patient safety may be compromised as a result. Or this news report, from last year, telling us the IW NHS trust had been put into ‘special measures’, meaning it was in such a bad state (with debts expected of over £26 million by the end of the financial year), that it needed to be monitored and managed by separate bodies until the situation had improved.
Consider hospitals, including those special financial measures (there have been lots over the last year) are charged penalties for failing to meet certain targets. Once a hospital finds itself in spiraling debt, its very difficult to navigate their way out again. If a lack of funding means you miss targets and are then fined, it simply creates less resources and more missed targets. Its a viscous circle. Once a trust is in spiraling, insurmountable debt, normally cause by a number of combining factors, its easy to see how selling assets can seem like the only option.
Consider also, that NHS hospitals are taxed at a much higher rate than many private hospitals. Honestly, you couldn’t make it up, and sadly, you don’t need to, because research revealed private hospitals get discounts worth £52m over five years. More than one in four private hospitals are charities, giving them an 80% rebate in business rates, but NHS trusts have to pay in full, and will face a £300m increase in rates over the next five years.
People get angry…you hand it over to private capital.
Have you seen ads like this popping up all over the place lately?
It seems that, although the NHS is in crisis, As Prof Hawking suggests, there is a better option…. for those who can afford it, of course.
Sometimes you don’t get time to wait until you can afford it. On a radio phone in on the NHS Crisis a few months ago, a chap called to account his experience, and it has stuck in my mind ever since. He was diagnosed with operable cancer. With the right, timely treatment, he would survive and go on to love his wife and family for years to come. Without the right treatment, he would be dead within 3 months. The NHS waiting list for the treatment he needed was around 6 months. He would be dead by then, probably. He was told, if he could find £100,000 , he could have his operation, in the very same hospital, by the very same surgeon, the following Tuesday. Luckily, he had a brother who was able to remortgage his house for the money, and thankfully the operation was successful. If you were in a similar position tomorrow, do you have a house to re-mortgage to pay for your care, to bargain for your life? Can you imagine how those doctors must have felt, telling him and his wife he’d be dead shortly, if he couldn’t stump up the money, not knowing if he would be able to or not?
The privatisation of public services is flawed from the outset. Private companies exist solely to generate profit. They don’t care about you. They will priorities profit over patients. Their success is measured in dividends, stock prices, salary increases and bonuses, not in lives saved, or families comforted, or children relieved from pain and able to live more fulfilling lives. It’s our public servants, our doctors, our specialists and our nurses, that strive to put us first.
If NHS privatisation does not benefit us, who does it benefit? Obvioulsy, the multi-millionaire bosses from the global corporate giants that will own it. But less obviously, an investigation by the Union ‘unite’, found 65 conservative MPs and 6 liberal democrat MPs/former MPs financial links to companies that stand to significantly benefit fron the privatisation of our nhs. . These included Jacob Rees Mogg, Sir Vince Cable, Jeremy Hunt, former PM David Cameran, Nick Clegg, Phillip Hammond…I could go on and on. Media investigations suggest the same. People like Richard Branson would certainly benefit from NHS privatisation. He already is.
Last year, a record £3.1 billion of taxpayers money was spent on healthcare outsourced to private companies, who won over 70% of contracts, on behalf of the NHS. Virgin care alone won over 1billion in NHS contracts, and even sued the NHS, winning over £300,000, when they didn’t win a contract!
According to a report by Center for Health and the Public Interest, private companies made a pre-tax profit of £831 million from the NHS between 2011 and 2017. That’s £831 of public money, your money, that should be spent caring for sick people, instead spent lining the pockets of corporate executives and share holders. When we receive these private services, we don’t realise we are being treated by a private company because they are fully permitted to use the NHS logo.
Spiraling debts are used to sell our hospitals. The Naylor review not only recommends selling off billions of pounds of NHS estate, land and assets, it actually incentivised it. Hospitals, strapped for cash, are forced to sell the land from under them to buy for example an MRI scanner or some other essential expensive piece of kit, and for every £1 raised through selling assets, £2 extra is given in government funding. When the private sector owns the land, it leases it back to the NHS, or else turns it into luxury apartments when the hospital is closed. You can see why campaigners refer to the Naylor Review as the NHS Land Grab.
Strategic decisions and organisational reforms legislated for by our government and previous governments have paved the way for stealth privatisation to take place. Over the last 10 years or so, there has been what Dr Youssef El-Gingihy calls a ‘revolving door’ for high level management of our NHS, a door that sees many highly influential and powerful decision makers at the top of the NHS chain or as government policy advisers, also working for top global giants in private health care. As I have previously mentioned, Simon Stephens, current NHS chief is one. Oliver Letwin, who became one of David Camerons top advisers, wrote a pamphlet in 1988, “Britain’s biggest enterprise: Ideas for radical reform of the NHS”, in which he outlined his plans to privatise the NHS. These plans have since become Tory policy. In 2004, he reportedly told a meeting ‘the NHS would cease to exist within 5 years‘. Shamefully, he was right. Here’s Dr Bob Gill, asking Letwin if he’s pleased with the direction the NHS is headed:
In recent years, the government and NHS executives have been legislating and strategizing at an accelerated pace in preparation for the final push to privatisation, as outlined in Letwins pamphlet. The 5 recent big pushes are as follows:
- Health and Social Care Act 2012
- Naylor Review
- Sustainability and Transformation Plans
- Five Year Forward View
- Introduction of Accountable Care Organisations
For a more in depth look at how our NHS has been secretly abolished, read Dr Youssef El-Gingihys book, How To Dismantle Your NHS in 10 Easy Steps. For a quick summary, go here.
In 2012, the government introduced Health and Social Care Act. This was the beginning of the death of our public health system. It effectively abolished the NHS in legal terms, opening up contracts to competitive tendering and allowing trusts to make up to half their income from private patients. It removed the legal obligation to provide health care. Health inequality increases as private, for-profit providers ‘cherry-pick’ lower-risk and paying patients, whilst higher-risk and poorer patients, or those needing emergency care, rely on an under-resourced public health service. The Health and Social Care Act effectively legislates against free, universal, comprehensive healthcare.
We have seen the implementation of what Simon Stephens has called Sustainability and Transformation Plans, or STPs. Sounds good, doesn’t it? Coming from an exemplary corporate background, I suppose we should expect such excellent branding from Mr Stephens. Campaigners have renamed STPs, perhaps more honestly, Slash, Trash and Privatise plans. STPs, along with The 5 Year Forward View, form NHS ENglands vision and plan for the NHS over the next few years. They involve £22 bn of efficiency savings (or cuts, to you and me, taking the total for this decade to more than £40 bn), further privatisation, and a mass centralisation of services, meaning further hospital closures. To islanders like you and me, for now at least, that means travelling to Southampton (a hospital also facing cuts!) for potentially life saving treatments at our most vulnerable, as well as for elective surgery (as we already often do).
I don’t want to entirely tear down the entire ethos behind these plans. Where possible and safe, we must strive to make our health service as efficient as possible, and we must adapt to the changing needs of a population. There are some reasonable arguments for why, in some specific cases, the centralisation of some services might be useful, for example, for very rare illnesses affecting only a small number of people, or in some specialised areas, it makes sense to have 1 centralised service covering a wider area. But cutting critical preventative services, forcing patients to travel long distances when they are seriously ill for no clinical reason, and making it much more difficult for people to access essential services, is dangerous, cruel and is not in the best interests of any of us.
Hundreds of GP surgeries have closed since 2010, and last year saw over 60 NHS trusts facing downgrades, closures and mergers. England has one of the lowest number of hospitals in comparison with population, lower than Poland, Czech Republic, Estonia, Mexico and Korea. Should we be seeking to close more hospitals? Campaigners have stressed that STPs are driven by cuts and not clinical evidence, shrouded in secrecy, and were not subject to proper public consultation or scrutiny.
ACO’s are non-NHS, commercial bodies, that if introduced, will run Health and Social Care services. They are based on the American system Mr Stephens is so au fe with. This means unaccountable companies, for profit, not the public interest, would control health care provision in this country. They are being introduced on the grounds of patient choice, but the truth is, for those who cannot afford healthcare, the choice will not be bewtween different treatment options based on personal preference, but will be a choice based on what is (or is not) affordable, exactly as is the case in America.
ACOs (or Integrated Care Organisations, as they are now trying to rebrand them) split the health budget into smaller risk pools, rather than a national shared burden, meaning that, once the money has run out for you area….well it’s run out. If there should be an epidemic of some kind, or a big accident, or anything else, and the budget ran out…what would happen? As far as I know, no government official has answered this question yet, unsurprising considering it has not been properly scrutinized in parliament. But this Labour MP for West Wirral, Margret Greenwood, did manage to confront the government about it
Accountable/integrated care is an American model of healthcare associated with organisations such as Kaiser Permanente, an American healthcare provider, infamous for dumping patients on the streets of Los Angeles, in their dressing gowns, bewildered, ill and vulnerable, because their health insurance poilcies had expired. The US healthcare market is saturated, and American healthcare and insurance corporations need to expand into the UK, Europe and Asia to satisfy their ever-expanding appetite for profit.
A group of eminent doctors, consultants and researchers, including Professor Stephen Hawking, just won the second part of a legal battle to challenge the governments plan to replace NHS Trusts with Accountable Care Organisations (ACO’s). The legal action is entirely crowdfunded by people like you, people who love the NHS.
“I am concerned that accountable care organisations are an attack on the fundamental principles of the NHS. They have not been established by statute, and they appear to be being used for reducing public expenditure, for cutting services and for allowing private companies to receive and benefit from significant sums of public money for organising and providing services. I am joining this legal action because the NHS is being taken in a direction which I oppose, without proper public and parliamentary scrutiny, consultations and debate. I want the attention of the people of England to be drawn to what is happening and for those who are entrusted with responsibility for the NHS to account openly for themselves in public, and to be judged accordingly.” – Prof Stephen Hawking
Despite signalling the final nail in the coffin for the NHS as we know it, he introduction of ACO’s has NOT been properly debated in parliament, and without the legal action taken by Hawking and co, would not be subject to public consultation. Take a moment to really think about that. They have tried to completely change our health care system, and have intentionally done it without consulting parliament! This is a complete affront to democracy. It is this point that I really hope you take home with you, especially if you think that the NHS is not a political issue ( a view I once held myself), that what is happening to it is not a political choice. Pending the consultation and the outcome of further legal actions, ACO’s are due to be introduced this year. That’s how close we are to the abyss. If I am completely honest I am very cynical that this reluctant public consultation will be anything more than the usual lipservice, and the plans will continue whatever the outcome, but i do urge you to take part.
How does the national situation impact the local one?
As we have seen, our hospital and health services are under incredible pressure. IW Labour Spokesperson Julian Critchley, recently told local press that Our IW Clinical Commissioning Group (the people who decide how money is spent on healthcare services locally) were considering 5 options for the future of health services on the island. The 5 options they were to consider, ranged from minor tweaks and smaller cuts, right up to option 5, (at the insistence of NHS England, the national government tier of NHS management) which planned the removal of around 50% of services offered at St Marys, essentially meaning only basic A&E and maternity units would remain on the Island.
We are told by men in suits that these reforms and changes are to provide a better standard of care. In reality, our services are failing because of the reasons outlined above, and our NHS trust is expected to face a £23.6 million funding gap by 2023. This is why they want to cut your services, be under no illusion that it’s because they want to make sure you are recieving the best care possible. If this were true, they’d properly fund and resource our NHS.
On Friday 26th Jan it was announced Option 4 would be recommended. If I seem vague about by whom, it is because a concerted effort by island campaigners has so far failed to reveal the composition of the ‘Local Care Board’. It seems remarkable to me that information regarding the nature of a group making such crucial and important recommendations is not easily accessible. This is the Acute services Redesign document for option 4
It means an 11% cut in local services, on top of the cuts we have already suffered over the last 8 years. It would mean more than 8,000 seriously ill patients and their families, would have to travel on unreliable ferries, often in emergencies, just to receive the care that should be a basic right. Of these 8000 patients, 1,300 are expected to be people needing emergency surgery, 1.800 newborn babies with complex conditions, including all babies under 32 weeks and 1,200 sick island children in need of care (Source: BBC).
The risks associated with this are unknown. I have seen on social media, lots of people say things like ‘but it doesn’t make sense because the transportation with cost the NHS a lot of money’. I think it’s that old thing again, not being able to imagine life without the NHS, without someone looking after you when you need it. Unthinkable. Yet there are no current plans to fund transport for patients or families, there is no money and it is not within the NHS remit. There is suggestion that the voluntary and charitable sector will plug this gap, along with ‘remote’ care, like Skype appointments which is of course, unacceptable, especially when you consider the islands elderly population, cuts to all other services and poor transport links. 48% of elective surgery is already carried out on the mainland, and patients journeys are not funded unless certain criteria is met, and even then often only partially funded. It’s important to note too, the world of difference between someone travelling for elective, planned surgery, and someone traveling in a critical condition requiring urgent emergency care, as is proposed under option 4. When it was asked at a meeting if option 4 was part of a softening up on the journey to option 5, which would mean just a basic A&E and Maternity ward on the island, it was not explicitly ruled out.
Many of our local services have already been cut or transferred to the mainland. More and more patients from the island are having make expensive journeys to unfamiliar surroundings, on unreliable and uncomfortable ferries to receive their basic rights as citizens to health care. Some Island families cannot visit loved ones who need them when they are ill, because they simply cannot afford to. The travel itself, along with the added stress and isolation, can exacerbate health issues, especially for patients that are already vulnerable, and there are no plans to provide funding except for those claiming certain benefits.
The 5th Option that was considered (the one that would leave only a basic A&E and Maternity Unit) is understandably frightening for islanders. It alludes to the direction we are headed. Option 4 (10% cuts) certainly looks positively desirable in comparison, especially if you gloss over the fact that it follows previous cuts. Or maybe in years to come, when option 5 is a likely option, we’ll have all become accustomed to the idea and less inclined to fight it…
Either way, the writing is on the wall.
Our Island MP and others will implore you to believe these changes will provide a better service, that the motivation behind them is better care for you. The truth is that between 2015 and 2020/21, millions of pound are to be cut from health services on the island, in line with the Sustainability and Transformation plans for our NHS. It seems inconceivable that these cuts, coupled with increasing demand, could equal better health care.
The NHS should be and should always remain publicly funded, publicly accountable, free at the point of use and a basic right for all. It is those founding principles that make it such a source of national pride. Those principles have meant for the last 70 years, if your child fell, or you had a car accident, or you were born with a medical issue, or you suddenly had a heart attack, no matter who you are or where you come from or how much money you have, the NHS would be there for you. I truly fear that if we stand idly by and do nothing, the NHS will be gone. I cannot afford to hedge my bets that all the campaigners are wrong.
I am so, so grateful, so thankful, I feel so very fortunate, to have been born in a country where I benefit from the safety net that is our NHS, where my family is cared for by its wonderful staff. The thought of my children not having the sense of security provided for me, fills me with dread. That is why I am here tonight, and that is why I urge you to act to defend your NHS.
The last thing I need to tell you, I am hesitant to say, because i know immediately it will alienate me from some of you, and have others questioning my motives, but it is arguably the most important thing I have to tell you, so Im obligated.
If you want the NHS to be universal and publicly run, vote Labour. I was involved in the campaign to Save the NHS long before I was a Labour party member, infact one of the things that spurred me to become active within the Labour Party was my involvement with other NHS campaigners who are also Labour Party Members. I do not campaign to save the NHS to promote Labour, but rather I campaign for Labour because I believe that is the only real option to save our NHS. I would not say this to you unless I felt it was true and crucial. Until Jeremy Corbyn was elected leader and Labour became a true party of the people. I would not have said this to you at all (and incidentally, I wouldn’t have voted Labour). I do not believe electing a Labour government tomorrow would magically resolve all the problems that face our National Health Service. But I do believe that a Labour government under Jeremy Corbyn would be true to the original founding principles and underlying ethos that remain the beating heart of our public health service, and I believe Labour are the only party that would be true to this ethos and have any hope at all of removing the Tories from the steering wheel. The Labour 2018 manifesto represents, for the first time in my adult life time, a true democratic choice. A choice between a government that believes in publicly run and publicly accountable essential services for ordinary people, or a government that prioritises profit over people for an elite few. I don’t feel like we ever had a real choice to make before, but rather the illusion of one.
Don’t let anyone convince you that it isn’t political. The crisis in our NHS is caused by political will, and can be reversed by it. Labour today, will truly pursue a public agenda, as opposed to a Tory neoliberal agenda on behalf of the corporate elite. The corporate elite don’t need the NHS, and would rather profit from selling you private healthcare. Labour will pursue an agenda for people like you, like me, who need the NHS, and under our current electoral system of first-past-the-post, in our current political climate, a vote for the Greens or Lib Dems is essentially a vote for the Tories, because Labour are the only part with any hope of removing them from power. I wish i could be more idealistic about it, but i cant, not while people are suffering (and in some cases, its not too extreme to say dying) because of their policies. We on the left, those of us who believe in a fairer, kinder, more proseperous world for ALL, cannot afford to be divided now. We must unite and rise together. We must take action. We must be proactive in creating the world we want to live in, together. Dr Youssef El-Gingihy puts it much better than I ever could, here:
The general election provides us with a real choice for the first time in a generation. Jeremy Corbyn’s progressive, anti-austerity vision breaks with the consensus of decades of neoliberal policies. The ideological gulf with the Tories is evident in the manifestos, particularly on the question of the future of the NHS.
This ideological watershed between Labour and the Conservatives extends beyond the NHS. However, the portrayal of Corbyn’s vision as radical is a distorted exaggeration. Polling shows that majority of the public – and even Conservative voters – are in favour of much of what Corbyn is proposing, whether it be renationalisation of railways and public utilities or keeping the NHS in public hands.
The Conservative agenda will promote neoliberalism-max with more privatisation, deregulation, austerity and the shrinkage of public sector. Theresa May’s hand-holding with Trump is emblematic. May has refused to rule out the NHS as part of a free trade deal with the US. Meanwhile, Jeremy Hunt tweets that he wants the US and UK health sectors to work together.
You cannot say that you have not been warned. So if you vote Conservative then you are voting for a dystopian, cruel and pessimistic vision – a private healthcare insurance system, more inequality and poverty, more wealth siphoned up by the corporate and financial elite, wage stagnation, collapsing living standards, deteriorating public services and greater divisions in society.
If you vote for Corbyn’s Labour then you are voting to restore a public NHS and for a transformative agenda towards an optimistic, positive and green vision of 21st-century Britain. In fact, this progressive vision is the only way forward. The neoliberal orthodoxy of deregulated free markets is economically, socially and ecologically unsustainable. It will lead to widening inequality, ecological catastrophe and the amplification of terrorism and migration crises.
You can write to Bob Seely, our MP, and to various government ministers, including Teresa May and Jeremy Hunt, by going to here. Please sign this petition, and support the ACO legal challange and Dr Bawa-Garba cases if you can. Follow The Great NHS Heist, and look out for the new film release later this year, watch $ell Off the movie here. Tell your friends and family. Go to events, rallys and protests wherever you can, do whatever you can in your community to protect and preserve our NHS for generations to come.
[We raised over £60 on the event day, and I am currently accepting donations for jam/chutney/cupcakes, with a running total now in excess of £100. Proceeds will be split and donated to The Great NHS Heist and the ACO Legal Challenge fundraiser before the deadline in 27 days. I will keep you updated. Thank you for your support – Ed]