Dr Clive Peedell, co-leader of the National Health Action Party
The long term sustainability of the NHS is a political choice, so it’s a myth that the NHS is unaffordable. In fact, we can’t afford not to have the NHS.
There is strong evidence that spending on health and other public services like education promotes economic growth. A healthy and well educated population is economically much more productive. In addition, the tax funded nature of the NHS means that it a system that redistributes wealth, reducing wealth inequality, which also helps to address health inequality.
Unfortunately, decades of underinvestment and constant reorganisations have left the NHS in a precarious state. Paltry real terms increases in the NHS budget of less than 1% per year since 2010, coupled with a £20bn efficiency savings program, and huge cuts to local authority and social care budgets, has brought the NHS to its knees. With healthcare inflation running at 4% and an ageing, growing population, an additional funding gap of £30bn is predicted by 2021. In addition, a 30 year obsession with the market in the NHS has culminated in the Coalition Government’s 2012 Health and Social Care Act, which was another unwanted and unnecessary £3bn top down NHS reorganisation. It has effectively denationalised and abolished the NHS in England and created a complex and highly expensive bureaucracy, diverting NHS money away from frontline care to accountants, lawyers, shareholders of private companies and management consultants. The system has become fragmented and chaotic. No wonder Andrew Lansley used a cabinet veto to block the publication of the 2010 NHS risk register, a leaked version of which predicted the current chaos that the NHS is facing.
So what is to be done?
First and foremost the National Health Action Party believes that we must abandon the failed policy of fiscal austerity, which is responsible for increasing wealth inequality and having profoundly detrimental effect on the social determinates of health. Austerity not only drives up healthcare demand, but it also reduces the supply of healthcare services. This is precisely what the A+E crisis is showing us. Our A+E departments are a barometer for the wider problems facing the NHS: increasing demand from a sicker, aging population; too little investment in community services to keep people out of hospital and to receive them back into the community from hospital; closures and downgrading of A+E departments and DGHs all over the country; a lack of emergency care staff ; cuts to ambulance services; underfunding of General Practice with too few GPs (RCGP has stated 8,000 more GPs are needed).
We are a sovereign nation with our own currency and central bank, and abandoning austerity is a perfectly acceptable economic plan, backed by Nobel winning economists such as Paul Krugman, Joseph Stiglitz and Robert Shiller.
We would fill the £30bn NHS funding gap by raising tax by 1p, which will generate an additional £4.5bn per year. We would end PFI policy, and renegotiate and buy out existing contracts. New projects should be funded by the Government, which can borrow at very low interest rates. The problem of tax evasion and avoidance must be addressed and could generate £billions for the exchequer. Investment of this money into public services will in turn stimulate economic growth and reduce wealth inequality.
To make the NHS more efficient, we would abolish the failed purchaser-provider split NHS market (saving up to £4bn per year) by supporting the Pollock/Roderick NHS Re-instatement Bill, which would also serve to re-nationalise the NHS and prevent NHS services being outsourced to the private sector. We would dramatically reduce reliance on expensive management consultants which are costing the NHS £640million per year. We would also focus on strengthening and improving the purchasing power of the NHS, which should be a dominant buyer* in the healthcare market, but has often been too inefficient in the procurement processes. (*The NHS is much more of a monopsony than a monopoly). NHS prescription charges should also be abolished as in Scotland and Wales. There is good evidence that prescription charges are actually increase costs and they are effectively a tax on the working people with chronic medical problems.
The increased NHS funding and efficiencies that we propose must be used to prevent further closures of A+E facilities and DGHs unless a clear clinical case can be made. There needs to be investment in new staff, training, infrastructure and equipment, and funding of mental health services to achieve parity of esteem. Other key policies must focus on improving public health (with polices such as plain cigarette packaging, minimum alcohol pricing, and improved regulation of food industry), funding free personal social care for the elderly and disabled, and integrating NHS health provision and local authority social care.
Another key issue that is fundamentally important to improving the NHS is NHS leadership (especially clinical leadership). The NHS Leadership website states: “Effective clinical leadership is critical if we are to achieve an NHS that genuinely has the quality of care at its heart… With the economic challenges facing the NHS it is imperative that frontline clinicians have the leadership skills to drive through radical service reform”. But followership is essential to successful leadership and that can only be achieved with shared vision and trust. Since medical professionals overwhelmingly reject the failed market driven system they work in, there will never be effective NHS clinical leadership and successful NHS reform, until the failed market based policies of the last 25 years are abandoned. The increasing marketisation and privatisation of the NHS has also led to a revolving doors culture between politicians, civil servants and the private sector, which undermines trust and has excluded NHS professionals from the policy making process. Now more than ever, it is vital that the medical and nursing professions are brought back into the decision making process to put the NHS back on track and save it for our future generations.
You can find the full polices of the National Health Action Party on our website. Please also see our 13 point NHS Action plan