Ed Miliband has no need to “weaponise” the NHS. It’s a sidewinder missile all on its own, headed straight at Conservative Central Office, guided there by themselves. Any drone hovering over the NHS right now cannot fail to see where it is bursting at the seams.
Not surprisingly, the government is trying to silence the NHS by attempting to stop A&E departments declaring a major incident when they are full up, ambulances stacked at the door and unable to take more patients. David Cameron pretended that this was just a West Midlands instruction, but Labour produced an NHS England document in which hospitals were told, under the heading “Politics”, that they must get it “agreed with the on call director for NHS England out of hours” before making an announcement, after considering “excessive media coverage” and asking itself, “Is there a requirement to bolster or assure public confidence. Is there a risk of reputational damage?” The pressure on NHS staff and managers to zip their lip is intense.
As the election approaches, the climate of fear in the NHS means only the brave or powerful speak out about pressure-cooker conditions. I have just had the disorientating experience of cold-calling a range of NHS people – hospitals, walk-in centres, A&Es – and getting Pravda-like responses guided by their public relations departments: everything’s fine, no problem here.
Yet I get plentiful calls with off-the-record hair-raising evidence from those who dare not have their name printed. Those free to speak out are fire-proof leaders, such as Cliff Mann, head of the College of Emergency Medicine. And yesterday I talked to Maureen Baker, chair of the Royal College of General Practitioners, free to say how far GPs’ share of NHS funding has fallen as numbers of patients have risen over four years with the baby boom and soaring numbers of over-65s and frail over-80s. Gaping vacancies mean 8,000 more GPs are needed, but medical students shy away from 12-hour days and unlimited responsibility.
Trying to duck the crisis, in PMQs Cameron keeps blustering in sham shock that Ed Miliband said he’d “weaponise” the NHS. “Yes,” Miliband should have said, “of course – look what you’ve done to it”, before reeling off the damning statistics: almost £4bn wasted on a re-disorganisation whose full disintegrating effects are only beginning to be felt. More than 50,000 beds have been cut when need is rising – Germany has 8.27 beds per 1,000 people, while the UK now only has 2.95; a severe cut of 7% in social care has caused a rise in bed blocking as hospitals can’t let out old people with no care at home – that’s why A&Es are blocked with no beds to admit new patients.
No one is surprised. The NHS has never had so deep a squeeze on spending per capita: on average the NHS since 1948 has had 3.7% a year growth. In the Cameron years it has for the first time averaged 0.6%, the Nuffield Foundation says. NHS England says it needs another £8bn a year by 2020. Neither Labour nor the Tories say how that is to be found. The Kings Fund has found that public satisfaction with the NHS is rising, but suggests that is an expression of public support more than an analysis of how it is doing.
Today, another scandal breaks in the British Medical Journal – no surprise to those who followed the purpose of Andrew Lansley’s Health and Social Care Act 2012. Private hospitals are offering huge bribes to NHS doctors to refer their patients to them instead of to NHS hospitals. Labour introduced choice and used private providers to cut waiting lists, but the Lansley act made it compulsory for any service to be put out to tender, so no wonder inducements and backhanders are offered.
The BMJ reports several major private healthcare companies, including BMI Healthcare, Spire and the American giant HCA, have offered various incentives to consultants. One senior surgeon told the BMJ that he had been offered a package including facilities and secretarial support worth “a six-figure sum” by a hospital group only nine months ago. The journal’s editor, Dr Fiona Godlee, says these inducements are “a clear risk to patients of inappropriate referrals”.
This comes after previous evidence that putting GPs in charge of commissioning services has in some cases acted as an incentive for them to set up their own private services, or enter partnerships with private providers and refer their patients to their own profit-making businesses. Even in the US such conflicts of interest are banned. But under the act, the BMJ points out, doctors don’t even have to declare their interests, so patients never know if their doctor has a financial interest in the referrals they make.
So who really weaponised the NHS? The Tories turned it into an armament in their programme to diminish the welfare state, to outsource and privatise it wherever they could.
