Health Matters - Capitalism is bad for your health

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At the end of March the NHS deficit stood at £1bn; on current projections by the end of March 2016 it will be £2.5bn. The NHS is in financial meltdown, and despite a poll showing that 46% of the electorate regards the NHS as the issue that will decide which way they vote at the general election, all we get from the major bourgeois parties is smoke and mirrors.

The ConDem coalition threw £2bn into the service in autumn 2014 in order to stave off a pre-election crisis. But the financial issues are quite clear: the incoming government will have to find £8bn a year by 2020. This is the figure that Simon Stevens, head of the NHS, has calculated as the future funding gap, and even this depends on an assumption that a further £22bn will be generated through internal savings – a target which is extremely unlikely to be met. The Tories have promised £2bn a year extra while Labour hopes to trump this with £2.5bn; both patently ignoring the actual implications of the Stevens Report. The LibDems say they would meet the full £8bn, but this is just bluster given their record of broken promises.

Labour promises both to repeal the ConDem 2012 Health and Social Care Act and to avoid any massive NHS re-structuring, promises which are mutually contradictory. While the Tories say they will stand by the Act, in practice the regional devolution of services, such as that agreed for Greater Manchester, drives a coach and horses through it and involves yet another massive restructuring with further huge costs. Labour’s shadow Health Secretary Andy Burnham says he will ban competitive tendering for clinical services. In practice this will be a hollow promise since it will require the abolition of Foundation Trust status, the flagship of the last Labour government’s NHS reforms. 25 such hospitals in surplus this year will be in deficit next year because of reductions in the standard tariffs for operations. The only way to avoid this will be to cut staff and services.

The situation of Barts Health, the largest hospital trust in England, is an indication of the problems that the NHS has racked up. It is the 21st hospital trust in England to be placed in special measures after a catalogue of problems was exposed by the Care Quality Commission. Barts Health runs St Bartholomews (Barts), the Royal London, Newham General and Whipps Cross hospitals. Whipps Cross announced its £93m deficit earlier this year. Since then the Barts’ chief executive and chief nurse have resigned, to be followed by the Trust’s chair a few weeks later. Underlying the trust’s financial problems is the private finance initiative (PFI) rebuild of the Royal London Hospital, the largest in the country at a cost of £1.1bn, but with an estimated cost mounting to £7.4bn over the 43-year repayment period. Some floors remain empty as it is too expensive to open them. Labour remains committed to PFI despite the huge financial burdens it places on hospitals.

Privatising cancer care

Labour says it is against privatisation of NHS services. It points to examples such as the outsourcing of cancer services by four NHS Clinical Commissioning Groups (CCG) in Staffordshire. The contract, worth £700m, is to provide diagnosis, treatment and aftercare. This contract is the biggest privatisation of NHS services seen so far with a single private company; the total value of all the contracts for Staffordshire and Stoke on Trent ‘transforming cancer and end of life care programme’ is £1.2bn. Although it is proclaimed as the largest NHS privatisation to date, this is in fact not quite the case. The cost of Labour’s Independent Sector Treatment Centre programme amounted to £1.2bn by 2009; it was then unfinished. The programme was beset with clinical errors and inflated charges and there is no reason to suppose that it will be any different with the Staffordshire contract. It comes at a time when cancer treatment waiting times are rising and cancer survival rates lag ten years behind those achieved by other European countries.

Imposing devolution

George Osborne, Chancellor of the Exchequer, announced in February that £6bn in health and social care spending will be given to the Greater Manchester Combined Authority (GMCA). Having been recently given control over transport and housing, the announcement was accepted with pleasure by the eight Labour council leaders involved, and by the chairs of local CCGs (irrespective of the views of the GPs or any other clinicians or NHS staff). There was only a three-week consultation period on the impact of the changes; it amounted to 12 responses, ten of them from local authority leaders involved in the deal. There was no pretence at local consultation; Osborne knew he could rely on the overweening ambition of local Labour leaders. The plans steamroller through the structures set up by the 2012 Health and Social Care Act; they will amount to a hugely expensive project without any extra money for health care. Manchester has already been cutting spending on social care and contracting out services, and privatising almost all care homes. It is the prelude to the complete breaking up of the national health service.

The next government

Whatever the combination in government of Tory, LibDem or Labour, the NHS is not safe in their hands. In government the Tories and LibDems have continued the destruction of the NHS, putting people’s health and welfare below the interests of the multinationals. In opposition, Labour have mounted no serious challenge because as ConDem health secretaries have pointed out, ConDem policy has been just a continuation of the last Labour government’s.

Hannah Caller and Robert Clough