The Battle for the Future Direction of the NHS
The people and those that work in the NHS are being treated with contempt. The government has continued to pursue its project which, put simply, is that of making the health service a reservoir of lucrative business projects for the private sector. The STPs have come on the scene, and are couched in technical and deceptive language that appears to put the health of patients in the first place, but have the aim of driving this ambition as far as possible .
For the people’s campaigns, trying to find out the content of the STPs has been like extracting teeth. Initially, the draft STPs were discouraged from being published, Freedom of Information requests were met with blank replies, and enquirers were told that no minutes of the relevant board meetings existed. Given that they are supposed to be so crucial to the people’s health, it is outrageous that the people and health professionals and campaigners have been kept in the dark, have not been party to what is being prepared, and have no input and control over what is being proposed or decided on in their name. Far from the people themselves having a decisive say in the decision-making, the working class and people are being sidelined and left to organise protests against what has been already decided. But they are summing up that what is required is a complete reversal in the direction that Westminster is taking the NHS.
What is being said in some quarters is that it is necessary to be pragmatic about the proposed STPs, get involved in them, slow down their implementation, and make the issue that the problem with the STPs is just the lack of investment in them. But where is the voice of progress, the voice of working people, the voice of those whose life is the health service? What do they have to say about the direction of the NHS?
Long ago the red warning light went on about what is happening to the NHS. Recently, it has even been revealed that Thatcher herself had a mission to completely dismantle the NHS, privatise health care and make health insurance compulsory. Just as the smashing of the power of the miners needed planning, a plan that was 10 or more years in the making, so did the wrecking of the health service. Thatcher first had to deal with the opposition within her own Cabinet, and time was running out. But the neo-liberal conception of the purchaser/provider split within the health service was planted at this time.
This purchaser/provider split, this “internal market” in the health service, has grown to gargantuan proportions. It was consolidated under the Blair “New Labour” government, a government which itself introduced PFI, the Private Finance Initiative, to put hospital trusts massively in debt to the construction and other monopolies. Hospital trusts themselves have taken on the mantle of businesses, particularly the Foundation Trusts to which all hospitals are supposed to aspire. Presently they are being encouraged to “merge”, take over so-called “failing” hospitals, set up hospital “chains” and so on. The fact is, however, that the “market” is rigged. “Payment by results” does not result in providing hospital trusts with the funding required to meet the needs of society for health care. What one notices is the increasing absence of any public authority and real planning for a comprehensive and sustainable health service now replaced by competing “public” and ever more private corporations for “health contracts”.
When a Trust Special Administrator was appointed in south London when the Queen Elizabeth Hospital was in so-called financial difficulties, largely because of crippling PFI debts, the TSA arbitrarily lumped the Queen Elizabeth together with Lewisham Hospital. Closures were mooted at Lewisham A&E and Maternity services to resolve these “difficulties”. The Save Lewisham Hospital Campaign took on the Health Secretary, holding a People’s Commission, and winning victory in a Judicial Review of the decision, that the Health Secretary had acted beyond his legal powers. So of course the government changed the law, and furthermore absolved the Health Secretary of responsibility for the NHS as a whole as a result of this and the Health and Social Care Act, 2012.
The STPs can be considered as the situation at Lewisham writ large across England, with 44 of these regional plans, known as “footprints”. These ad hoc, non-statutory and unaccountable regions themselves have to come up with plans to make the provision of health care “sustainable”, to “transform” the provision of health care to make it “financially viable” in the face of a projected cut to the annual budget of the NHS of £22-30 billion a year by 2020/21. What we have seen as these plans are revealed is the obfuscating jargon and statistics. They are couched in terms of the well-being of the people, the “path to excellence” and so forth. In other words the wrecking of the NHS in England is proceeding under the cloak of high ideals. It must not pass!