Health Service: remorselessly deepening crisis

Every politician knows that the NHS faces financial collapse in 2015. As a proportion of GDP, health spending reached a peak of just under 9% in 2009; it is now predicted to fall to under 8%. The scale of service cuts required to meet a £20bn funding gap for 2011-14 is already huge, with soaring waiting lists and extended A&E waiting times. With flat-level funding expected for the three years from 2015/16, the overall gap will reach a massive 23%. General practice services are facing disintegration with some practices unable to offer a consultation for two weeks. NHS Monitor is requiring foundation trusts to rework two-year financial plans submitted in April because their assumptions are unrealistically optimistic. These are the consequences of slashing state welfare: the ruling class may be sitting on ever-growing and obscene levels of wealth, but it will always ensure less and less is spent on the working class. Hannah Caller and Robert Clough report.

It is estimated that funding for general practice is due to fall by 17% in real terms by 2017/18, or £1.59bn. However, the Royal College of General Practitioners expects that over the same period the number of patient consultations will rise by 20%, from 340 million in 2012/13 to 409 million. Currently the funding for general practice is 8.39% of the NHS budget; this will be cut to 7.29%. The share of funding spent on general practice has been falling since 2005/06. To stand still, general practice would need £11.47bn or 9.81% of the projected NHS budget of £116.86bn by 2017/18. This will be disastrous for the care that people will receive: around 90% of contact with people in the NHS is in general practice. The Labour Party is suggesting it will add a pitiful £100m to the primary care budget to ensure everyone has a GP appointment within 48 hours.

Too few nurses
The Royal College of Nurses have shown that there are 20,000 frozen nurse posts and that the senior nursing roles, including clinical nurse practitioners, are the posts most likely to be frozen or cut because they have the highest salaries. There have been 3,000 nursing posts cut from mental health services – not just frozen. There are legally binding minimums for staffing levels in airplanes, creches and football grounds. The National Institute of Clinical Excellence (Nice) has started a consultation over a proposal that there be a minimum of one nurse per eight patients on hospital wards. This has no evidence base, would be no more than a recommendation, and in many cases would not allow a nurse to give sufficient time for adequate care every hour of their shift. It is no more than fig-leaf to cover up for deteriorating services.

None of the bourgeois parties is prepared to say taxes must rise to pay for an adequate NHS, despite the fact that a recent poll reported that 80% were in favour of such a step. The ConDem coalition has invited Labour MP Frank Field to flesh out a proposal to raise national insurance contributions by 1% instead. This would in effect be a regressive tax, penalising the poor the most, particularly when Field has said this would be linked to income tax cuts. The regressive character of his plans are particularly evident for those now over pension age: they would be asked to continue to pay national insurance, if they wanted free care – otherwise they would have to start paying for health services. Other proposals include charges for GP visits ranging between £10 and £25.

The solutions offered by politicians in power and in opposition are not human solutions that prioritise people and their health, but are capitalist measures encouraging privatisation and competition, and while giving the appearance that the NHS is properly supported in the run up to the general election.

Fight Racism! Fight Imperialism! 239 June/July 2014


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