NHS: The “5-Year Forward View”

The Rationing of Health care and the Delaying of
Operations Should Not Be Happening in a Modern Society


Massive London demonstration March 4 – It is Our NHS!

Simon Stevens, NHS England’s chief executive, announced on March 31 that the NHS is significantly relaxing the requirement on hospitals to treat, within 18 weeks, 92% of patients in England who are waiting for a hip or knee replacement, cataract removal, hernia repair or other “non-urgent operation”. He claimed that rolling back the target, which has stood for the past ten years, was necessary so that hospitals could “concentrate on more urgent priorities”, particularly in terms of “easing the strain on overloaded A&E departments, as well as enhancing access to GPs and improving the treatment of cancer and mental health care.”

However, not only does the announcement expose the incoherence of the NHS policy objectives announced by government and NHS alike, but also the whole aim of wrecking the national system of health and social care in England in favour of the privatisation of care and the interests of private providers.

Firstly, this latest announcement starkly contradicts an earlier policy objective that was so prominently promoted by the Government – especially in relation to the junior doctors’ dispute – for hospitals to operate elective care seven days a week to purportedly reduce waiting lists and improve patient survival rates from operations. Of course, the reality was entirely the opposite. Rather than put in the investment necessary to achieve 7-day elective care, the government continued its massive cuts, which have pushed hospitals to the brink of disaster over recent months.

Secondly, NHS England’s “5 Year Forward View” launched in 2014 outlines how it intends to transform healthcare by 2020, with strong hints that greater rationing of some types of care was imminent. The plan refers to a system where more patients will be offered online advice, where GPs are being expected to refer fewer people to hospital and that NHS England will expand the use of “referral management processes”, which are private companies that decide whether a doctor’s referral to a consultant, or to have an operation, is justified. However, it is clear that Stephens has gone further than this with his “new” plan to no longer guarantee a timescale for “non-urgent operations”. He says this is consistent with the “5 Year Forward View”. It is therefore of no surprise that the private health companies are the ones that will profit out of this misery as patients who have savings will have to pay huge sums for treatment while those who cannot pay will continue to suffer. Apart from the increasing number of people who will be forced to pay privately for operations, Stephens also hinted that the private sector’s direct involvement in the NHS would also be the beneficiary of the rationing of “non-urgent operations” when he said that he expected that “the number of operations that the NHS pays for will continue to go up.”

Thirdly, while Stephens talks about delaying “non-urgent operations” and mentions operations that are already subject to long delays, he refuses to address the fact that “urgent” operations are now already included in these delays as the continued cutbacks and “cost improvement programmes” to intensive care units and acute beds is implemented right across England.

Reporting on the announcement, the British Medical Association (BMA) pointed out that the inability of the NHS to meet all of its waiting time targets showed that it was at breaking point. BMA council chair Dr Mark Porter said: “Achieving one delivery promise only by missing another is a textbook example of rationing access to care. It should not be happening in today’s NHS.”

It is this observation that gets to the nub of the problem. The rationing of healthcare and the delaying of operations, even if they are “non-urgent”, should not be happening, not only in today’s NHS but in any modern society. Such an outmoded and outdated conception is only consistent with a capital-centred view of the economy, where public services like the NHS and all social programmes are considered a “cost and a burden”. Such a view refuses to acknowledge that there is such a thing as society and the social responsibility for every human being to build an economy that meets the claims of the people. It is a barbaric remnant of the past in the modern age, where people who need a hip or knee replacement, cataract removal, hernia repair or other “non-urgent operation” should join a long queue and suffer, or pay the private healthcare and insurance monopolies from which only the rich benefit. In other words, today’s NHS and society should be directed towards recognising the right of all to a modern health and social care system.

What has also to be recognised in building the movement to safeguard the future of the NHS is that today’s NHS is based on the conception of the NHS which was formed in 1948. But even in 1948, the conception of the NHS was never fully recognised as a right of all human beings and the rich were able to ration healthcare and delay operations while they were also able to jump the queue by paying for private care. This therefore raises the most important question that it has to become a right on a new basis today. Modern Britain and the developed world is even more at the stage where the productive forces have become completely socialised and every section of society and every community is dependent on that socialised economy. Such a society requires social relations for that socialised economy that serve the interests of all. In other words, it requires modern arrangements in empowering the whole population to chart the direction for society and its economy, where health and social care is recognised and guaranteed as a right.

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