The underfunding and marketisation of the NHS have been placed at the front and centre of our national debate as a result of the pandemic. After a decade of austerity, the health service was stretched to near breaking point. Despite talk of ringfencing, the proportion of NHS trusts with annual deficits rose from 5% of all trusts in 2010/11 to 46% in 2018/19.
Nor was the problem confined to a lack of funding. As Colin Leys wrote in Tribune last year, decades of market reform had left the health service ill-prepared for Covid-19. Introducing ‘competition’ into a non-market system simply led to higher management overheads, reduced capacity, and more stress for staff. The result, as one report pointed out as early as 2014, was that the NHS was highly vulnerable to a pandemic, if one were to hit.
When it did, those predictions were proven horrifyingly accurate. The UK entered the pandemic with less hospital capacity than most advanced economies; in the autumn of 2019, there was some concern about the NHS’ capacity to cope with flu season. In December 2020 and January 2021, hospitals were at around 90% occupancy, and some experts were warning that London hospitals would be overwhelmed if action wasn’t taken.
While lockdown eased some of the pressure, the NHS is still struggling. Its future is uncertain but, bowing to popular pressure and the reality of the pandemic, the government has now promised £3 billion of extra funding for the health service in 2021/22.
However, history teaches us that headline-grabbing spending announcements for some areas of the public sector often mask huge cuts to others. The ringfencing of the NHS budget over the last decade has not only disguised a lack of capacity within acute and primary care, it has masked dramatic cuts to other areas of the health and social care system – particularly those catering to the needs of some of the most marginalised groups in society.
Local government, which provides public health and adult and children’s social care services, has seen the deepest cuts in the public sector. Central government grants fell by nearly 40% between 2009/10 and 2018/19, reducing local government spending power by 18%. Before 2018, not one English council fell into bankruptcy; by 2021, twelve councils were in rescue talks with the government.
The Conservatives were able to get away with this squeeze because services like adult and children’s social care are used by a comparatively small population of marginalised people. Most people associate local authority spending with things like bin collection and parks maintenance, but adult social care is a critical resource for the severely disabled, and children’s social care services are aimed at some of the most vulnerable and neglected children and young people in our society.
As I wrote for Tribune last year, both have seen substantial cuts that have put service users in jeopardy. Cuts to public health services, meanwhile, have been a false efficiency. Taking funding away from measures designed to prevent people from becoming ill in the first place has increased the strain on the wider health system.
Disabled adults and children have been severely affected by both the strain that has been placed on the NHS in recent years, and cuts to local authority-provided services. But as Ellen Clifford told me on this week’s episode of ‘A World to Win’, cuts to social care services are just one element of the government’s wider war on disabled people.
Successive Conservative governments have been accused of repeatedly and grossly undermining the human rights of disabled people. Disabled people have been forced to go through humiliating rituals designed by outsourcing companies charged with clawing back as much money from those individuals as humanly possible.
These processes ultimately led to horrifying cases of abuse and neglect. Errol Graham, a disabled man with severe mental health problems, starved to death after his benefits were cut because he had failed to attend a DWP mandated fit-for-work test. He was discovered by bailiffs, who came to evict him only to find his body in his flat with the gas and electricity cut off.
Errol Graham is just one case among many: the BMA found that austerity had led to 120,000 excess deaths between 2010 and 2017. The researchers found that cuts to social care services provided by local authorities, which saw the harshest cuts in the whole public sector, were more closely linked to avoidable deaths than cuts to health spending.
After suffering from a decade of cuts and human rights abuses, disabled people are now dying in huge numbers as a result of Covid-19. The government has been accused of breaching disabled people’s rights 17 times during the pandemic, including breaches of the Equality Act, the European Convention on Human Rights (ECHR), and the UN Convention on the Rights of Persons with Disabilities (UNCRPD).
Right-wing commentators, desperate to see the end of lockdown to ‘save the economy’, have cynically argued that the restrictions are affecting people’s mental health, while failing to mention that mental health services are utterly inadequate in the UK due to understaffing and underfunding. Yet many people with severe mental health problems also have disabilities that make them much more vulnerable to Covid-19.
One thing missing from the national debate on all of these issues—from the NHS to social care to the pandemic—is the voice of disabled people. Despite making up nearly 20% of the working-age population, disabled people rarely feature in the media, are underrepresented in politics, and are often excluded from activist spaces.
Where we do hear from a disabled person, their contribution is often limited to narrow questions about ‘access’ and ‘inclusion’, and they are excluded from wider conversations about politics and the economy. There is a reason one of the most well-known slogans of the disabled movement is ‘nothing about us without us’.
The callousness with which the Conservatives have treated people with disabilities is matched only by their cruelty towards migrants and refugees, who form the backbone of the health and social care system. This is no coincidence. Tony Benn once said that the way the government treats refugees is instructive, because it ‘shows how they would treat all of us if they thought they could get away with it’: I imagine he would say the same of the state’s treatment of disabled people.