The free market ideologues in control of the Conservative Party seem hellbent on destruction. Last month, massive tax cuts for the rich funded by borrowing spooked the markets and forced the Bank of England to step in to prevent economic collapse. We now know that the Chancellor plans to reduce spending on public services by up to £18 billion a year, while refusing to augment the current budgets eroded by soaring inflation.
As economic policies impoverish large swathes of the population, there are hugely harmful consequences in the pipeline for the nation’s health. Lower wages won’t be able to match the rising costs of mortgage repayments and rent. Widespread fuel poverty will increase asthma and other respiratory diseases as a consequence of cold, damp housing. Food insecurity will mean worse nutrition for many. Stress from being on an economic knife-edge will increase the risk of heart disease, stroke, cancer, and depression, and reduce life expectancy. Increasing childhood poverty will cast long shadows, generating obesity, stress, and declining years spent in poor physical and mental health for the future.
All this will place more pressure on health and care services in both the short and long term. But the axed £18 billion, together with the consequences of £43 billion in unfunded tax cuts, will also further badly damage an NHS already on its knees—with the probability of major loss of services.
The NHS Needs Planning and Funding, Not Cuts
Even before the mini-budget, it was clear that the NHS was facing its biggest crisis ever—’the worst state in living memory’, according to the NHS Confederation. The Commons Health and Care Committee have referred to the Service having its ‘biggest ever workforce crisis’, and the NHS fell from first to fourth in the US Commonwealth Fund international rankings of rich countries last year, the reasons being delays in accessing care and treatment together with lack of investment.
The headlines are there for all to see: 6.8 million on waiting lists; 132,000 staff vacancies (an increase of 25 percent in three months); 165,000 vacancies in adult social care; GPs under huge pressure; Covid-19 once again resurgent with a 22 percent rise in hospital admissions; an influenza outbreak expected; emergency ambulance call outs hugely delayed; cancer referral and treatment targets continuing to be missed. Where is the anger over people dying because the NHS has been deliberately run down?
The insistence that government is giving the NHS more money than ever before is meaningless in the context of rising demand and rising inflation. The Nuffield Trust estimates that England’s NHS faced a three percent cut in its real-terms budget this year, with budgets over the next two years scheduled to grow at half the historic real-terms average. One of the first tasks of the 42 new Integrated Care Boards is to deliver £5.5 billion worth of spending cuts, while additional funding of £14 billion would be needed just to repair crumbling infrastructure and open up closed beds. 34 hospital buildings constructed with aerated concrete blocks are in danger of roof collapse but won’t be fixed before 2035; the new hospitals building programme has proved to be a fantasy.
Meanwhile, lack of social care support results in around one in eight hospital patients not being discharged. This in turn means sick patients cannot be sent from A&E to wards, or transferred from waiting ambulances into A&E, so crews are then not available for urgent calls. Ambulance service bosses reported that delays in just one year may have contributed to 160,000 patients coming to harm.
The Royal College of Emergency Medicine estimates around 4,500 patients died in 2020/21 because of overcrowding and delays in A&E departments. Evidence now points to 500 excess deaths per week from delayed access to emergency care. Despite the tragic situation detailed in the Ockenden report on Shrewsbury and Telford Maternity Services, recommendations on urgent funding and staffing have not been implemented, while units around the country are struggling to deliver safe services.
Amid this crisis, the Secretary of State for Health and Social Care, Therese Coffey, has said that her priorities will be ‘ambulances, backlog, care, and doctors and dentists’, and has pledged ‘to deliver for patients’ (what? Chaos, perhaps?).
The workforce issue should be an immediate priority—it is workforce shortages across the whole system that are the biggest barrier to bringing down waiting lists and providing care sustainably in the long term. Another striking omission is the bigger task of improving the nation’s health, not just its health services. Unfair differences in health between more and less deprived areas in England are vast, and growing. Rather than deal with this, one of Coffey’s first acts in role has been to cancel the publication of a report on health disparities.
The last government committed to ‘levelling up’ the country but failed to match the political slogan with the policy changes or investment needed to tackle social and economic drivers of health inequalities. The slow, steady rise in life expectancy stalled ten years ago. Simply put, Westminster has dismantled and defunded public health.
Even now, when the service is creaking and public satisfaction is falling, repeated polls show the vast majority of the population in favour of a comprehensive and publicly funded and delivered service. The free-marketeers have had the NHS in their sights for years, but have chosen to undermine it by stealth, recognising the political dangers inherent in an all-out onslaught. Some, however, are suggesting that the pending economic disaster they have created may present too good an opportunity to let go to waste, and that it could therefore spell the end of the NHS.
Any move in this direction should be understood for what it is: a vicious attack on the working class, amounting to what Engels called ‘social murder’. Even the whisper of it must ignite popular resistance. Along with fighting for pay rises, lower bills, and taxes on the rich, emergency funding for health and social care should be one of our core demands. The social wage is as risk as any other.