In June the government challenged NHS England to come up with a 10-year plan. It also offered guaranteed real funding increases over the next 5 years. That looks like an opportunity to undo some of the recent damage to the NHS. But NHS workers, and all of us, can’t sit back and assume others will make improvements by magic.
In his 2002 Budget Chancellor of the Exchequer Gordon Brown announced a 1 per cent increase in national Insurance contributions for all employers and employees. This was “hypothecated” – specifically to support the NHS. The aim was to slash waiting times across the board to a maximum of three months by 2008; it worked.
For example during 2008/9 a number of trusts reported waiting times for hip and knee surgery had fallen to below five weeks. But now patients wait six months on average for those treatments. Targets for A&E and for cancer treatments including chemotherapy and radiotherapy were being met or exceeded 10 years ago. Now they are almost universally not met and may be abolished to save political embarrassment.
Perhaps there is now an opportunity to reconsider the sources of funding for the NHS. A greater feeling of ownership of, and therefore responsibility for, the service would flow from hypothecating more, or all, of the funding, through national insurance payments possibly.
The £8 billion plus raised on Brown’s initiative increased NHS recurrent revenue by around 9 per cent a year at 2002/3 prices and was indexed annually for wages and prices. The announcement broke Labour’s Election pledge not to increase taxes, yet it was universally popular.
That 40 per cent increase in real terms over five years was unprecedented in the history of the service. Critics claim that it funded an explosion of PFI contracts for new hospital buildings, updated capital equipment and fixing substantial maintenance backlogs. All these were hangovers from the Thatcher era.
PFI contracts were not good value and brought other problems, but urgent remedial action was needed in a climate of international pressure on public borrowing. And this so-called “PFI drain” needs to be set into context. Associated costs are estimated to be around £2 billion for 2018/19. That’s less than 2 percent of NHS annual allocations.
Rebuilding Britain is not a spectator sport. We have to seize opportunities as they arise and rectify weaknesses when we’re strong enough. Equally that is what the enemies of our class seek to do to us.
The Cameron-Clegg administration came to power in 2010 and set about reversing the gains the NHS had made. Expenditure increased by only 1.3 per cent a year, well below inflation. But the damage was far deeper thanks to deliberate policy decisions.
Up to that time the NHS, which has consistently met its savings targets, was allowed to retain them to address issues of unmet need. Instead the coalition Chancellor George Osborne debited any savings from central allocations with the effect of cutting funding long-term and removing incentives for efficiency. He also froze wages across the board and increased pension contributions whist abolishing final salary schemes.
Elsewhere government grants to local authorities were cut back year on year, curtailing their ability to adequately fund social care. These cuts created further pressure on NHS capacity.
The seeds of the current health care crisis lie in those decisions. Bailing out failing banks and propping up finance capital were prioritised over services to people. The ruling class was intentionally taking back ground from us.
"There’s intense pressure from workers for government to support the NHS."
Theresa May has made a spending pledge of £20 billion over five years. That’s an average increase in real terms of around 3.4 per cent a year. She and her ministers know there’s intense pressure from working people to support the NHS. The people want tangible benefits from Brexit. And the junior hospital protracted doctors’ dispute over deployment in 2016 brought home the consequences of decision made about the NHS. A debt of gratitude is owed to them.
Obviously we welcome that pledge, but it will not transform the NHS. By 2023/24 it will in effect restore the funding position in cash terms to where it was 2002/03. The wages cap has been lifted; that will be funded by the Treasury rather than being met from existing NHS resources. This is a step forward, but there is much more to do.
We await the government Green Paper on the settlement for social care, first promised in the 2010 Conservative Party Manifesto following the Dilnot Report. It’s essential for the future of the NHS to resolve that question.
The NHS Manpower Planning Strategy was promised for publication in July. It is a key part of future plans but is yet to emerge. In reality there are many hard winters and missed targets ahead. NHS workers must remain vigilant.
• International Monetary Fund head Christine Lagarde said in September that Britain must raise taxes, increase NHS efficiency and make cuts elsewhere to pay for additional NHS funding. Being wedded to the EU and critical of Brexit, Lagarde predictably said that there would be no “Brexit dividend” for the NHS because our economy would dive.
The NHS needs more cash now certainly, and gains from Brexit will take time. But as the IMF record of economic prediction is so dire, why would the Treasury listen to them – unless it’s an echo of their own point of view and to provide another Brexit scare story.