This is a dangerous moment for our NHS. The latest figures announced today show 5.6 million people are waiting for NHS treatment. Nearly 1.2 million people in England have been waiting more than six months. This means people in pain and discomfort, struggling to go about their daily lives as they wait for cancer care, ear, nose and throat operations, hip replacements, mental health support, and many other operations.
The waiting list also pushes people towards painful choices about whether to go private, prodding us towards a two-tier system like the disastrous US model. In America, millions of people don’t get the care they need, and many are forced into bankruptcy. The system costs twice as much as ours for worse outcomes.
At the same time, the government’s ongoing project to privatise our NHS continues, with the Health and Care Bill in particular (which we’re calling the Corporate Takeover Bill) opening up new ground for the private sector.
In the last few days Boris Johnson has done his best to reframe the narrative on NHS waiting lists. He’s promised £36 billion over three years for health and social care, funded by an increase in National Insurance.
This announcement has overshadowed the discussion about what the NHS needs for the next six months, to get through the winter. The NHS Confederation and NHS Providers (representing NHS trusts) asked for £10 billion to cover ongoing Covid costs and tackle the backlog. Instead they’ve been given £5.6 billion, just over half of what’s required.
This is an insult, especially given that the government has already committed £10 billion to private hospitals in the context of the backlog. The government is stingy when it comes to our NHS, but generous with its private sector chums. Circle Health, Ramsay Health Care, and Spire Healthcare are among the firms expected to make around £200 million in profits from the latest deals.
The public’s top priority for the NHS is improving waiting times, and Johnson knows it. But with his new policy, Johnson has managed to reframe the conversation, turning the focus onto tax, instead of what these public services need. He’s created the opportunity for a hypothecated tax, which could encourage a two-tier system further down the road. And he’s completely failed—on purpose—to give the NHS what it actually needs to get back on its feet. It looks like he’s grasping the nettle, making difficult decisions. He’s actually continuing the project of undermining and privatising our NHS.
As Chomsky says, ‘That’s the standard technique of privatisation: defund, make sure things don’t work, people get angry, you hand it over to private capital.’ We need to understand waiting lists in this context.
The government wants to present this as a problem created by Covid. But even before the pandemic, waiting lists were far too high. In 2019, 4.6 million people were waiting for hospital treatment; people were waiting too long for GP appointments, for cancer treatments, and at A&Es.
That’s because the government has been deliberately underfunding our NHS for ten years, with ongoing cuts in real-terms funding. Between 2010 and 2020, government cuts meant we lost 22,000 hospital beds and 100 A&Es, and waiting lists doubled. The NHS doesn’t have the money it needs to maintain and refurbish hospitals and equipment – at least £10 billion in capital investment is required, and not forthcoming.
The UK has many fewer doctors, nurses and care workers per head than other countries – 90,000 more staff are needed. Doctor shortages in England have left the country’s health service staffing 25 years behind other European nations, according to the BMA. NHS staff have received a real-terms pay cut year after year and need better terms and conditions.
All of this meant that we went into the pandemic unprepared.
Hand in hand with these cuts there is the agenda to privatise and outsource. The 2012 Act removed the duty on the Secretary of State to provide comprehensive care and opened the door for private providers. The amount of NHS spending going to private sector providers has nearly doubled in the last ten years.
PPE supply chain management was itself privatised, causing huge problems. And in the moment of crisis, Johnson’s government turned automatically to private sector contracts with its chums, from PPE contracts to testing centres run by Deloitte to the failed contact tracing operation run by Serco and Sitel. (It’s instructive that while the government felt the need to announce a new tax to find £36 billion for health and social care over three years, £37 billion was offered for Test and Trace without blinking.)
At the same time, the government has been preparing a reorganisation of our NHS that gives the private sector a greater role. Less ‘bureaucracy’ actually means a tweaking of the Health and Social Care Act that enables contracts to be handed out with less accountability. The Secretary of State is being given more powers but still without the duty to provide comprehensive care. As it stands, private providers like Virgin Care and Centene would be allowed to sit on new decision making boards, making decisions about NHS spending and patient care (while patients themselves have no seat on the boards).
Waiting lists are a problem that isn’t going away, because this government wants to privatise our NHS and waiting lists help to achieve that. We mustn’t be deceived or side-tracked by Johnson’s reframing of the narrative. This government has been cutting and privatising our NHS for ten years and is continuing to do so.
So let’s call for what’s actually required. Funding of £10 billion revenue (not £5.6 billion) to get us through the next six months. At least £10 billion capital this year to urgently maintain and upgrade hospitals and vital equipment like ambulances and scanners. Funding to reopen the 22,000 beds closed since 2010. Funding to reopen the 100+ A&Es closed since 2010. Funding for staff – to increase the number of doctors, nurses and healthcare staff through training and encouraging staff to stay with better pay, terms, and conditions. An end to outsourcing staff and selling off hospital land. A real plan for publicly owned social care. And the reinstatement of our NHS in public hands.
With all of this, our NHS could once again be there for all of us, as intended, in our hour of need.