Which Direction for NHS England?

“Five Year Forward View”


October 18, demonstration through London

The chief executive of NHS England, Simon Stevens, has presented the government with a five-year plan which he claims would relieve the pressure on hospitals and GP practices and provide patients with better care.

“We have no choice but to do this. If we do it a better NHS is possible,” he told The Guardian. “If we don’t the consequences for patients will be severe.” An extra £8bn on top of the NHS England’s £100bn budget will be required by 2020 to fund the plan, known as the Five Year Forward View. It will also require the full support of future governments to be successful, Simon Stevens warned. He said the NHS was now at a “crossroads”, and the country needed to decide “which way to go”.

The plan was drawn up by Simon Stevens in partnership with five other national bodies: Public Health England, the regulator Monitor, the NHS Trust Development Agency, Care Quality Commission and Health Education England.

In the House of Commons on October 23, Secretary of State for Health Jeremy Hunt, in answer to an Urgent Question put by Andy Burnham, the Shadow Secretary of State for Health, said that the report “recognises the real challenges facing the NHS, but it is essentially positive and optimistic. It says that continuing with a comprehensive tax-funded NHS is intrinsically do-able, and that there are ‘viable options for sustaining and improving the NHS over the next five years’.”

This is not to put a forward-looking view on the viability of the NHS, but is an archaic rendering of the requirements of meeting the claims of the population for health care provided as of right by the government as the representative of society. In particular, it puts the onus on the claims of the government on the social product through taxation to fund the right of the people to health care. It lets the monopolies, who benefit from the wealth created by a healthy workforce, off the hook.

There is much scaremongering over the funding of the NHS. The government is not averse to increasing funding for the NHS provided it serves its neo-liberal agenda of privatisation and monopoly right, just as it is not averse to providing funding for its pro-war agenda. The scaremongering is designed to underpin this agenda, and blame the people and health care workers for the crisis in the NHS. It is also designed to spread disinformation over the fact that the health service adds value to the socialised economy and to all of society.

Thus, when Jeremy Hunt comments on the report’s statement that “decisions on these options will need to be taken in the context of how the UK economy overall is performing” by saying, “In other words, a strong NHS needs a strong economy,” he is putting the cart before the horse. In fact, a strong economy, geared towards benefiting working people, needs a strong NHS, in which health care is recognised as a right.


Health workers’ strike, October 13, Birmingham

However, the report goes far beyond this issue of funding. As Jeremy Hunt said, it “proposes detailed new models of care, putting out-of-hospital services front and centre of the solution, delivered through greater integration between primary, community and specialised tertiary sectors alongside national urgent and emergency networks. These can help to reduce demand significantly for hospital services and give older people in particular the personal care that we would all want for our own parents and grandparents.”

It is very necessary to be vigilant about this agenda of integrating social care and health care. In itself, it sounds very just, since it is a scandal that social care is not funded in the same way as health care, and that social care itself is in crisis. Yet it has to be measured against the reality. The just-sounding proposals may remain policy objectives, while the actual measures taken are likely to be the ones connected with the closing and running down of hospitals, while the increasing onus on GP surgeries remain pie-in-the-sky as the crisis in training and recruiting GPs intensifies. The perspective that GP surgeries can become “mini-hospitals” thus can represent what is in fact the worst of both worlds – neither properly functioning hospitals nor properly functioning surgeries. Of course, the way the government intends to square this circle is actually to intensify the direction of putting both health and social care under the direction of the health monopolies and their spin-off advisory bodies.

The government cries crocodile tears over the quality of care in society and in the NHS, for instance Jeremy Hunt cites the report as talking about “reducing variation in the quality of care, in the wake of the tragedy in Mid Staffs, and about how the new Care Quality Commission inspection regime is designed to drive up standards across the system. It says that to do this we will need to move to much greater transparency in outcomes across the health and social care system. Finally, the report makes important points about better integrating the public health agenda into broader NHS activity, with a particular focus on continued reductions in smoking and obesity rates.”

But it refuses to accept its responsibility for health care through NHS England as a public good. Instead it promotes the conception that the problems in the NHS are not of its making, but lie either with allegedly uncaring health workers or are the fault of the population for either not looking after themselves or for simply growing older.

The question is indeed what is the direction of travel needed for the NHS. When Andy Burnham in reply said, “what clearer illustration could there be of the serious loss of public accountability arising from the Government’s reorganisation?” he touches on a serious issue at the heart of the matter. But he does not question the “direction of travel”, because, as the Shadow Secretary of State says, “the report endorses Labour’s vision for new models of care, including hospitals evolving into integrated care organisations with more salaried GPs”.

The change of direction in NHS England which is required is to detach it from the neo-liberal agenda and capital-centred thinking and requirements, and declare that health care is a right which the government is duty-bound to guarantee. The marginalisation of the people from decision-making has to be reversed, and health workers and professionals genuinely be empowered to participate in setting the agenda for the health service and having a decisive say in its running. Crucially, the fight must be carried forward for the people as a whole to be empowered to decide the direction of the health service and of society.

For a Change in Direction of NHS England and of Society!
For a Human-Centred Health Service and Society!
Demand that the Government Recognises Health Care as a Right!

– See more at: http://www.rcpbml.org.uk/wwie-14/ww14-33.htm#second

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