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A belated awakening for Labour

With the cash-starved NHS crumbling from within, has the Labour leadership finally realised that only increased funding can save the service, asks JOHN LISTER

It seems that the Labour leadership is slowly and grudgingly waking up to the fact that it has to commit to substantial increases in NHS funding if it wins office in 2015 — otherwise it’s clear our health services are unlikely to survive the spending squeeze planned by George Osborne.

So far health workers have borne the brunt of the unprecedented squeeze on NHS spending since 2010, which has resulted in flatline real-terms funding — the meanest ever five years since the NHS was established in 1948.

But as anger mounts on NHS pay and the prospect of zero or minimal increases in the five years to 2021 and as unions stage protests and prepare to ballot for strikes, the pressure of the financial squeeze is starting to tell on other parts of the NHS as well.

Some GPs have begun belatedly to wake up to the fact that far from being put in charge of the new, fragmented, market-style NHS created by Andrew Lansley’s Health & Social Care Act, they too are being starved of cash to deliver their basic services to patients. 

Primary care services account for around 90 per cent of patient contact with the NHS, and numbers of consultations have been going up — but the share of NHS spending on primary care has been falling steadily, to just 8.5 per cent.

Royal College of General Practitioners chair Maureen Baker has declared that the service is “in crisis,” and has called for a campaign for a greater share of the funding. 

“The service is stretched very thin, people are working ludicrous hours and are asking if they are actually safe doing so.” 

To make matters worse, continued and widening inequality in the allocation of GP services mean that millions of patients in the poorest areas are finding it harder to get to see a doctor, even though they are likely to have greater health needs.

This problem is compounded by the government decision to remove the guaranteed minimum income for practices in some of the poorest areas, meaning that existing GP practices in east London and elsewhere could be forced to close.

While a valiant minority of progressive GPs are speaking out and fighting back, most are passively hoping for the best. 

However a few of their more reactionary colleagues are making the problems even worse and energetically pursuing the agenda set by the Health & Social Care Act — for local clinical commissioning groups to lead the way in privatising and fragmenting services, creating a competitive market.

Time and again clinical commissioning groups are making clear that they take no responsibility for the viability or quality of services from existing NHS providers. 

In Norwich, the chief executive speaking for the clinical commissioning group, while GPs remain passive and silent, claims local providers can achieve the impossible — improve the quality of care for a rising number of patients with fewer, less well qualified staff, while absorbing the equivalent of 20 per cent real-terms cuts over five years.   

His solution? Urging trusts to employ cheaper Band 4 staff to replace more costly better-qualified staff on Bands 5, 6 and 7 — staff nurses, community nurses, health visitors and therapists.

Where is the evidence that quality of care would not be seriously undermined? There is none. 

But of course it’s easy for him to propose this. He is a commissioner, not responsible for delivering any front-line services at all — any cash pressures on clinical commissioning groups are simply dumped onto local providers of services — hospital and mental health trusts and community health services. 

The buck stops with the providers. If anything goes wrong, they take the blame, as clinical commissioning group bosses and NHS England sit back in their offices and contemplate their spreadsheets. 

A similar sense of this divide emerges from Jeremy Hunt’s recent interview with the Health Service Journal, in which he dodged all of the hard questions on funding and refused to address the growing gap between NHS resources and pressures on the system. 

Instead, burying his head deeper in the sand, he insisted that “safety and technology” would be the key to surviving the freeze.

However the boss of the Foundation Trust Network Chris Hopson, representing the hard-pressed providers having to deliver on the ground, is saying almost the opposite. 

He echoes warnings that this year’s financial pressures will be even worse than last year, which saw four in every 10 hospital trusts in deficit. 

Hopson says the key factor making things worse has been the need for increased spending on staff to meet new safety standards coming out of the Mid Staffordshire and other scandals. 

He concludes: “We urgently need a funding and payment strategy that better matches the reality of what providers are being asked to deliver.”

Nor is there any sign that technology will be the way to save money. Instead the Health Service Journal reports trust after cash-strapped trust pleading to the Trust Development Agency for loans — not for bold new plans but to help them replace clapped-out equipment and pay bills as the deficits mount even further, with the NHS price paid for each treatment set to fall each year.

Other headlines show targets for swift access to cancer treatment are now being missed. There are desperate shortages of mental health beds. And hospitals neighbouring A&E and other services which have been downgraded and closed in cash-driven “reconfigurations” are now facing the consequences — the latest being Manchester’s Wythenshawe Hospital, picking up the fallout from downgrading A&E at Trafford General.

Similar botched “reconfigurations” are still being driven forward, including plans to close A&E services at Hammersmith and Central Middlesex Hospitals on September 10 — despite the evidence that St Mary’s Paddington, which is supposed to take the extra caseload, is already stretched to capacity.

Why the desperation to ignore the evidence and press through plans based on little more than wishful thinking, a wing and a prayer? 

It’s the economics, stupid. As Labour’s leaders seem to be belatedly recognising, the NHS is being deliberately starved of cash by a Tory-led government, reducing the share of GDP spent on public-sector provision and funnelling more health spending to its private-sector friends.

If they refuse to challenge Osborne’s spending plans, Labour’s leaders will condemn themselves to political irrelevance. 

Even Ed Miliband’s feeble promise to establish a right to a GP appointment within 48 hours appears less credible when tied to complex assumptions about marginal savings from the costly trappings of regulators in the new NHS market.

Anyone with any sense knows that if Labour had not pumped extra cash into the NHS in 2000-09 it would already be in a state of total chaos. 

By contrast Osborne’s plans threaten effectively to reverse these increases by freezing NHS spending at 2010 levels for a decade.

Miliband has to scrap these limits and find more money. But the suggestion that is apparently being discussed is the wrong one — raising National Insurance. 

Top earners get away lightly on National Insurance, while those living off dividends and other unearned income pay nothing. 

Much better would be collecting the estimated £120 billion of tax that is already due but not paid by wealthy scroungers. 

If further tax income is still required to rescue the NHS and public services, the first step should be a “Robin Hood tax” on financial transactions, a policy opposed by David Cameron but endorsed by other major EU countries — this could raise billions at no cost to working people.

But before raising any extra tax, Labour needs to tackle some policies left over from its time in office, which the Tory-led coalition has taken much further.

Huge efficiency savings could be made in the NHS through scrapping the bureaucratic and costly nightmare imposed by the Health & Social Care Act, which requires over 200 clinical commissioning groups to put thousands of contracts out to competitive tender. 

Hundreds of millions more could be saved for the NHS by renegotiating £11bn-worth of over-priced and unaffordable PFI contracts, with a potential cost of £65bn, to fair value. 

The Euro elections showed timid Labour desperately lacks any radical appeal to draw in the votes it needs to defeat the Tories. 

But Labour councils and candidates that joined local campaigns to save threatened hospitals and defend the NHS, especially in London, showed in the local elections what an electoral asset the NHS can be. It’s time to be bold.

Finally, a big-up for the young Cross Country train manager who recognised me on a journey from Coventry last month, and declared himself a fan of this column. Great feedback!

 

John Lister is director of Health Emergency.

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