THE PEOPLE'S DAILY

Apr
2014
Wednesday 16th
posted by Morning Star in Features

Now's the time to pile on the pressure for Labour to go big on the health service, says JOHN LISTER


Join the dots, you can see the emerging picture - the NHS is being suffocated through prolonged and deliberate cash starvation.

What began under the banner of the Con-Dem coalition trying to address the deficits created by the banking crash has now emerged as a thought-out, long-term Tory plan to scale down public spending and permanently reduce the size of the state.

David Cameron's recent denial that this is what they are doing is all the proof we need that it is indeed their plan.

Everybody knows that the cash limits proposed by George Osborne between now and 2021 would be unsustainable for the NHS.

The King's Fund admits it, outgoing NHS chief executive Sir David Nicholson admits it, even the Tories' own Office of Budget Responsibility has produced graphs showing the widening gap between required spending and available resources.

Indeed OBR figures show that the share of national wealth (GDP) spent on the NHS, which grew in the 2000s, is set to decline from 6.5 per cent in 2012 to 6.2 per cent in 2015.

John Appleby of the King's Fund has warned it could fall to 6 per cent or less by 2021, wiping out all the extra investment under Labour.

The Nuffield Trust explained this situation in detail back in 2012, when it warned that the gap between demands on NHS services and the money available would grow to a massive £48 billion by 2021 if budgets remained frozen.

Since then we have seen things get even worse - more billions of "unspent" NHS money have been clawed back by the Treasury, and £1.5bn of the frozen, allegedly "ringfenced," NHS budget has been forcibly handed over to councils this year to prop up the even more parlous finances of social care, with even bigger sums to be deducted next year.

There's also a huge question mark over the future of NHS spending after the 2015 election - a year in which a further round of major cuts in public spending has been set in motion by Osborne, and many expect that as soon as the general election votes are counted the "ringfence" protecting the NHS against outright cuts would be scrapped if the Tories get back in.

But even in the best-case scenario Osborne's plans would see a 10-year freeze in health spending while costs and pressures increase each year.

So far almost all the "savings" that have been achieved towards the £20bn target by 2015 have come at the expense of long-suffering NHS staff, who have faced job losses, rising workloads and five years of pay freezes or below-inflation increases - with the threat of more to come.

It's clear that the only reason Osborne has got away with this squeeze on NHS funding for so long is because of the generosity of the increases in funds pumped into the NHS by Labour in the 10 years from 2000, which pushed up British health spending to near the European average and attempted to make up for some of the decades of under-investment that had gone before.

If Labour had not done that but adopted Osborne's freeze instead, NHS spending would now be some £30bn a year lower than it is now - and much of the system would already be in a state of collapse.

It's clear now that the increasingly desperate lack of cash is the driving force behind hospital cuts and closures and increasingly inadequate staffing levels in front-line services, resulting in poorer quality of care.

But it's also again the excuse for various right-wing "think tanks," now including the King's Fund, opening up artificial one-sided "debates" over "hard choices" and hugely controversial policies, such as the hoary old Tory favourite of charges to see a GP - rejected by an overwhelming majority of the electorate in a recent poll - or for a stay in hospital or Lord Warner's loopy idea of a £10-a-month fee to "subscribe" to the NHS.

Down the road of cuts there are only unpleasant choices and unacceptable compromises. So a change of policy is needed.

It's clear that will not come from the Tories, who are only too happy to see the NHS reduced to its knees, putting even more pressure on those who can afford it to take out private health insurance.

But another massive question mark hangs over Labour's policy on NHS funding.

Ed Balls appears determined to lock the party in to endorsing all of Osborne's spending limits, which would mean it could be a Labour government that presided over the crash dive of the NHS into a cash-driven crisis.

Anyone who spends any time in the real world knows that a promise to spend more to rescue the NHS would be overwhelmingly popular with the electorate, while clinging to policies that wreck our most popular public service could easily make a Labour government unelectable for many years.

It's a no-brainer - but at present it seems there is no brain being used in shaping Labour's policy, which is only gradually evolving away from the Blairite fixation on markets, competition and the private sector, partially promising to reverse the Health and Social Care Act, and lagging behind the best Labour councils and campaigners who have been battling to save local hospitals and services.

One thing Tony Blair - and Gordon Brown - got right in 2000 was the need to invest in the NHS to enhance its performance.

Even though they wasted some of that extra money, the extra staff and resources that were employed helped reduce waiting times and performance on many fronts.

Now's the time to pile on the pressure for Labour to go big on the NHS, denounce Osborne's cuts and make the bold promise to rescue our health service from the Tories, who once again have starved it of cash and undermined it through competition and privatisation.

As a gesture to show that they have got the message, Labour's leadership could take a decisive step and expel Lord Warner, whose very existence as a member, consorting as he does with his unsavoury right-wing friends in Reform, brings the party into disrepute.

Labour could go on to spell out a commitment to restore NHS funding in real terms to pre-coalition levels, rising not only with inflation but also in line with rising pressures and demands. With all the rhetoric about a recovering economy and bankers enjoying their bonuses, why should health - and other public services - not feel the benefit?

While we're at it, let's see a promise to pay for it by collecting the £120bn a year of taxes that go unpaid. Just a fraction of this could put our public services on the road to recovery.

It's decision time. Will Labour move forward with courage or dither and delay its way to ignominious failure and defeat?

 

John Lister is director of Health Emergency