IT’S NOW less than a year to the general election in which we have the first chance to get rid of the coalition government led by the nasty party that has made Britain so much nastier since 2010.

This right-wing government of millionaires has taken a brutal toll of public services, welfare rights and benefit payments, targeting the poorest and most vulnerable.

Its attitude to healthcare and the NHS has followed similar lines. The biggest-ever funding squeeze on the NHS has seen funding flatline since 2010 while pressures and demands increase costs by up to 4 per cent each year. The squeeze is set to continue to 2021 — a full decade of frozen funding leaving a potential cash gap of £50 billion.

So far the brunt of this has fallen on NHS staff, whose pay has been frozen or kept below inflation year after year, slashing the value of NHS pay by upwards of 10 per cent since 2010. 

Health unions have now started to reflect the anger of their members — promising a fight on pay. But even before this, hard-bitten management consultants such as McKinsey were warning ministers that a further prolonged period of effective pay cuts could not be sustained without damaging recruitment and staffing in vital services.

Already waiting lists are back to record levels, cancer patients and others are once again facing the kind of delays that 10 years of investment in the NHS under Labour effectively wiped out — until the Tories came back.

Desperate NHS trust managers are wheeling out cynical plans to “reconfigure” (ie cut) hospital services, knowing that there is no cash available to invest in alternative services in the community. 

Mental health budgets are being squeezed to leave desperate shortages of community-based services and hospital beds for those needing more intensive treatment and support. 

GPs are complaining that they can’t cope with the growing workload while spending on primary care has been squeezed downwards.

But in the midst of this massive cash famine, countless millions are being squandered on the costly and wasteful Health and Social Care Act, which splits and fragments services to create bite-size chunks for private sector and so-called third sector organisations to compete for. 

The NHS Confederation (trust bosses and commissioners) conference in Liverpool showed clearly who has been benefiting from the new legislation — exhibition stands from law firms and management consultants doled out lavish quantities of free champagne as they celebrated their new, expanding empire in what was a public service, publicly provided. 

McKinsey is apparently so busy they can no longer accept any more NHS contracts.

The Act is compelling many clinical commissioning groups (CCGs) throughout England to put a wide range of services out to competitive tender — at enormous cost. 

A survey by the Health Service Journal shows that fear of infringing the legislation and incurring legal action is the main factor behind almost a third of the CCGs that have opened up tenders. 

So far only one, the largest CCG in England, the North, East and West Devon CCG, has been bold enough to announce that it will reshape its community health services without opening up to competition. 

This CCG decided that to ensure “a more seamless service” its contracts are to go to NHS trusts and the Royal Devon & Exeter Foundation Trust. Other CCGs appear willing to fragment local services in order to comply with timid legal advice. 

Yet the NHS regulator Monitor’s guidance on Section 75 of the Act explains that CCGs can avoid tendering services if they can show this would not be in the best interests of patients. 

It never could be in the best interests of patients to waste money that could be spent on front-line care on legal advice and dense contracts drawn up by overpaid management consultants, much of which in the end is unenforceable.

Only today one of the three private sector-led bidders on a shortlist of four has dropped its bid for a share of the £800 million contract to commission older people’s services in Cambridgeshire and Peterborough — the day after public consultation ended. 

A company like this could just as easily up sticks and walk away part way through a contract — as Serco has done recently on its contract
to manage Braintree Hospital — leaving the public sector to pick up the pieces. 

Other private contractors are trying to screw down staff pay and conditions to create a margin of profit, or reducing numbers of better qualified staff — regardless of the impact on quality of care.

The competitive market in healthcare has for many years been a costly failure, delivering no benefits to patients, but undermining existing health services and healthcare providers. 

The Tories, promoting this at the same time as throttling the life out of the NHS through frozen budgets, now want ministers to keep quiet about health — they know they’re vulnerable to a determined campaign on this.

Sadly up to now there has been as little sign of vim or vigour from Labour on the NHS as there has been political savvy advising the hapless Ed Miliband to prevent him making an idiot of himself clutching a copy of the Sun or wrestling with an unaccustomed bacon sandwich.

But in recent weeks there have been limited signs that at least some elements in Labour’s leadership are waking up to the need to toughen up the line and offer a more radical and convincing alternative to the Tories on the NHS. 

Some timid anti-market rhetoric has crept in, alongside repeated vague pledges to repeal the Health & Social Care Act.

But without a much stronger critique of the Tories’ marketisation of the NHS and a clear commitment not to go back down the dire path mapped out by Tony Blair and Alan Milburn, of welcoming private, profit-seeking companies into the NHS “family,” Labour’s message will remain unconvincing.

Only a full-blooded break from the market system can stop the haemorrhage of vital NHS budgets into the coffers of lawyers, accountants, management consultants and private companies, and redirect it to expand patient care.

As long as Eds Balls and Miliband remain locked into acceptance of George Osborne’s plans for freezing NHS spending to 2021 rather than committing to make wealthy scroungers pay their tax — and collecting the £120 billion unpaid taxes each year — Labour will need to warn of similar “tough choices” and brace itself to implement unpopular cuts and closures.

If it continues to sit silent on the issue of NHS pay and tacitly accepts the Tory lie that any pay rise for NHS staff must come at the expense of patient care, Labour will fail to convince a million health workers that they represent a real alternative.

Rather than shilly-shally around with weasel words that avoid any clear commitment, Labour’s leadership should come out loud and proud as the party that will — once again — rescue the NHS and public services from the Tories.

They should sign up for the new short emergency Bill to restore the NHS that is being drawn up by Allyson Pollock and colleagues to complete work started in Lord Owen’s previous short Bill. 

The health unions could help in this by endorsing the Bill and helping to campaign for its adoption as a commitment to be implemented immediately after the next election.

If health unions go out now into local communities and the wider Labour and trade union movement campaigning for support to this short bill and for a break from the spending freeze on NHS spending and health workers’ pay, they could help to build an unstoppable pressure on Labour’s leaders to up their game — and give the electorate something to vote for.

From this weekend’s People’s Assembly demonstration let’s have a growing campaign for an NHS publicly provided and properly funded to meet the rising needs of the population. 

If Labour is bold, the money could be there without increasing taxes on working people. And, as the Unison slogan insists: “We’re worth it.”

John Lister is director of London Health Emergency