Politicians are on the hook over the National Health Service, and campaigners need to keep them there. That was the message from Dr John Lister to a packed public meeting in Shrewsbury on the the NHS and how to defend it.
Dr Lister, an academic, author and expert on the NHS, said the 2012 Conservative-LibDem Health and Social Care Act was supposed to make it possible for Government ministers to stand aside when hospitals closed, because it removed the duty on them to provide a comprehensive health service.
But they have been forced by public pressure to delay or stop closures, mergers and service withdrawals, he said.
Dr Lister said Accident and Emergency attendances are increasing, waiting times are increasing and emergency hospital admissions are increasing.
(The Government’s target of a maximum four hour wait in A&E was met for only 77% of patients in September – nearly 6% less than in the same month last year, according to NHS statistics. Emergency admission to hospital have increased by 4.9 percent over the past twelve months)
He said there had been nine years of deliberate below demand and below inflation funding for the NHS. “We have a growing population, and an ageing population, but standstill funding”.
NHS trusts owe the Government £14 billion and last year paid interest on that debt of £292 million according to Health Service Journal. If these debts were called in they would go bankrupt.
Dr Lister added that there are now 6000 fewer mental health nurses than in 2010, yet none of the schemes announced by Boris Johnson recently were for mental health.
The list of services being contracted out includes imaging, pathology services, and patient transport services which have “an unbroken record of failure”.
Hospital cleaning is still being contracted out, despite the growth of hospital-born infections since hospital cleaning was first privatised by Margaret Thatcher’s government. “Microbes and cockroaches love privatisation,” said Dr Lister.
In Shropshire emergency demand is continuing to rise, and yet Future Fit will remove beds and nurses. The plans for community services designed to reduce pressure on acute services have been dropped for lack of funds, and building a new centre will take away money from community services such as mental health. Future Fit needs £100m more than the £350 loan offered, and where would that money be coming from?
After nine years of driving down resources Boris Johnson has announced £1.8 billion of new money – a fraction of the cost of clearing the backlog of much needed maintenance work, said Dr Lister. Six hospital schemes have been given the go ahead, and another 34 are on a list which might go ahead in 2025. “He appears to be unlocking the logjam but in fact is consolidating a problem.”
The impact of the 2012 Health and Social Care Act was explained at the meeting by Professor Allyson Pollock, director of Health in Society at the University of Newcastle.
Professor Pollock was joint author of the NHS Reinstatement Bill, a version of which was presented to parliament by Wolverhampton MP Eleanor Smith last Autumn with the support of Jeremy Corbyn but fell this month when the parliamentary session ended.
As well as removing the duty to provide a health service from the NHS – a duty governments have held since 1948 – the 2012 Act uncoupled services and planning bodies from their local communities.
Services no longer have to cover all residents in an area, and foundation trusts are allowed to generate up to 49% of their income from private nations.
Contracting out, or “commissioning” is virtually compulsory, and the level of services and entitlements we once had is being steadily reduced, she said.
“The NHS has been broken up, privatised and undermined. The only way to get it back was to produce the NHS Reinstatement Bill.”
Gill George of Shropshire Defend our NHS said Future Fit would take the existing problems of crisis, rationing and privatisation and make them worse. In the last four months A&E attendances at SRH Shrewsbury rose by 17%, and at PRH Telford by 20%. Interest on the £350m loan for the plan will take £11million a year out of patient care, and the SATH health trust is already borrowing £20 million this year “just to keep the lights on” she said.
“As well as the underfunding of the NHS as a whole, we are experiencing the additional underfunding for rural areas and small district hospitals. And this is a deliberate political decision.”
To patients it means worse outcomes, and more pain and disability. The stroke service has been centralised, yet there is a crucial window of time after you have had a stroke to administer the clot-busting drug which is less likely to be achieved if patients have to wait longer for diagnosis and treatment. The criteria for hip and knee replacement operations have been tightened. “This means that if you can scrape together £12,000 you can go to the Nuffield and get it done privately. If you are poor you have to live with unnecessary pain and disability.”
Bellevue Labour councillor Kate Halliday talked about the closure of Shrewsbury’s Whitehall Medical Practice in September despite a growing patient list, and statements from other local GP services that they would not be able to cope with the extra load if it closed.
The Clinical Commissioning Group gave only nine months instead of the usual twelve months notice of the new contract, and added into it the job of taking on patients with a history of violence. There were no takers so the practice had to close down and the doctors, nurses and other staff lost their jobs.
Andy Burford, a Labour councillor in Telford and Wrekin and chair of the Health and Social Care committee, recalled that Future Fit started with good intentions of community investment. He said local initiatives in adult social care were showing that good community services could reduce demand for emergency and acute care, but they would not succeed without investment.
“We must hold our MPs to account for failing to protect our health services. It is not all over with Future Fit and the fight for our local NHS.”
The meeting was held on 14 October 2019 at the Gateway in Shrewsbury and was organised by Shrewsbury and Atcham Constituency Labour Party