The NHS underfunding is a choice. And people are dying. [video]

It’s really hard to capture and keep even the most interested and motivated persons attention long enough to explain how and why the NHS is being underfunded and the truly catastrophic impact of this.

This rather excellent video series does this perfectly. 

Share and RT, write to your MP. It’s your choice too; stand by and let the NHS die, or do something about it. 

It’s The Spin that Wins

The strike is back on and Jeremy is straight out in front with claims of committing ‘extra funds’ to the NHS. Unsurprisingly this is rubbish.

juniordoctorblog explains how the funding spin is constructed and how they are getting away with it.


 

NHS Funding: Who’s telling the truth?

The funding situation of the NHS can be a tricky thing to get your head around, so it’s no wonder the British media struggle to report it accurately. As such, we often hear statements from the Government and leading health economists that seem diametrically opposite to each other, leaving media reporters, and by extension the general public, confused and unsure of what to believe.

For example, George Osborne in his latest Spending Review can announce a “half trillion pound settlement, the biggest commitment to the NHS since it’s creation”[1]. Meanwhile, the chief economist of the King’s Fund, states the NHS is facing the “largest sustained fall in spending as a share of GDP”[2]. David Cameron can say he’s invested “£10bn more into the NHS” while the chief executive of the NHS is aiming for “£22bn in savings” [3].

Surely these widely varying statements aren’t compatible? So who’s telling the truth?

In fact, all of these statements are correct. No one is lying…technically. To understand how, we first need to explore the concept of healthcare inflation, and how it has affected the NHS budget over its 67-year history. Healthcare inflation describes the long running trend for healthcare needs and costs to rise above the rate of general inflation, and above the average rate of growth in the economy.

One of the most important drivers of increasing healthcare costs is an ageing population. This isn’t a new phenomenon; throughout the last hundred years we have been progressively living longer and longer [4]. We’re also spending a greater proportion of our lives in ill health [5], requiring greater medical care. Another cause of healthcare inflation is new technology – new medical discoveries, drugs and devices – and again, this is nothing new; research and innovation has always been a feature of medicine. So spending on healthcare has always had to increase to ‘keep up’ with these drivers. Before 2010, the annual NHS budget increased by 4% on average, in real terms, year on year since the NHS was created [6]. In 1948, 3.6% of GDP was spent on health, and by 2010 that had climbed to 7.8%[7].

Historically, successive governments have justified these increases because health is important to the British public: a fundamental right, a key part of our wellbeing, an economic necessity for our productivity, and the bedrock of a fair and just society. So actually, increasing expenditure on health is appropriate if we as a nation feel that health is a priority to our wellbeing, and we’re willing to devote a greater proportion of our economy towards it. Nor is this pattern unique to the UK; healthcare costs have increased over time in all developed countries regardless of the type of health system [8]. In fact, we spend less than most developed countries on healthcare [7], with better outcomes [9].

Returning to the present day, the NHS is clearly under pressure. But the Government would have you believe that these pressures exist despite robust investment in the NHS, and that’s where the real deception lies. Rather than being inevitable, the pressures are largely self-created as a result of funding decisions by the Government since 2010.

Yes, technically, there has been a funding increase, and yes, technically, the NHS is a ‘protected department’, ‘ring-fenced’ from cuts. But this increase has been negligible and far far below the demands of healthcare inflation. Over the last 5 years, the health budget grew by 0.8% per year [7], far short of the historical trend of 4%. Extrapolating this difference for a further 5 years works out as a 17% gap (£22bn per year) between needs and funding by 2020. So despite seeming like a ‘protected’ department, the NHS is actually having to make severe cuts, and that pressure is being felt by the overworked and under-appreciated staff of frontline services.

These realities are being hidden from the public, conned by effective spin to believe the NHS has been shielded from austerity. Osbourne’s recent boast of a “half trillion pound settlement” can simply be explained by multiplying by 5 a budget of over £100bn, for the 5 years of the parliament. “Biggest ever commitment to the NHS?” Yes, it is the largest absolute monetary spend, but then, every successive parliament has spent more on the NHS than the previous one [7], so this is meaningless. Cameron’s “£10bn investment” is a paltry sum when spread over 5 years. Yet for all these mistruths, the Prime Minister and his Chancellor are so skilled in PR and careful phrasing, they come out sounding like champions of the NHS, and it’s difficult for the media and the Opposition to challenge their over-simplified sound bites.

The lesson here is that using absolute monetary terms to describe health spending is flawed, because the issue is complicated so much by healthcare inflation. Perhaps a more meaningful way of assessing relative spending priorities is to look at health spending as a proportion of GDP: as a nation, how much of our economy are we prepared to devote to our health? On this measure, the NHS has been falling consistently since 2010 [7], and it wasn’t that high in the first place compared to other countries. With an economy that looks set to grow over the next 5 years [10], and austere NHS spending plans already laid out, the health service looks set to lose out further. Hospital trusts are already running deficits [11] in attempts to maintain current standards of care, but it won’t be long before the impact is felt with longer waiting times and poorer quality of care.

Is this what the British people want? Did the electorate vote for this? In 2010, one of Cameron’s defining campaign slogans was “I’ll cut the deficit, not the NHS”[12]. Similar statements were made before the 2015 election. Given the highly persuasive Government spin, many simply aren’t aware of how the NHS is being starved. This systematic defunding of the health service would be democratically acceptable if, following honest debate, it truly reflected the views of British people. But that public debate never took place, and it’s one that our Government would rather avoid. In politics, it’s the spin that wins.

 

image

Image source: The Health Foundation

1. https://www.gov.uk/government/news/unprecedented-investment-in-the-nhs

2. http://www.kingsfund.org.uk/blog/2015/10/nhs-spending-squeezed-never

3. https://www.england.nhs.uk/2015/05/18/fit-for-future/

4. http://visual.ons.gov.uk/how-has-life-expectancy-changed-over-time/

5. https://publichealthmatters.blog.gov.uk/2015/09/15/the-burden-of-disease-and-what-it-means-in-england/

6. https://www.england.nhs.uk/wp-content/uploads/2013/07/nhs-belongs.pdf

7. http://www.health.org.uk/health-and-care-funding-nutshell

8. http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS

9. http://www.commonwealthfund.org/~/media/files/publications/fund-report/2014/jun/1755_davis_mirror_mirror_2014.pdf

10. http://cdn.budgetresponsibility.independent.gov.uk/EFO_November__2015.pdf

11. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/478860/Quarterly_report_on_the_performance_of_the_NHS_foundation_trusts_and_NHS_trusts_-_6_months_ended_30_September_2015_-_Overview_paper__2_.pdf

12. http://conservative-speeches.sayit.mysociety.org/speech/601556

 

contributed to JDB by DrWJ

How To Sell Off The NHS: A Users Guide

So you want to sell off the NHS? A 65-year old behemoth, part of a raft of reforms that radically improved the quality of life of working people for nearly a century? It won’t be easy, but with this handy step by step guide you too can privatise your health service.

Step One
Know your enemy. In 2010 a Kings Fund poll put NHS satisfaction at above 70% [1]- the highest ever recorded approval rating. The United Kingdom has low child mortality outcomes globally; 5 per 1000 live births, (compared with world number 1 – Iceland at 2 per 1000 and the U.S. At 8 per 1000), long average life expectancy (male); 79 (compared with world number 1 Iceland at 82 and the U.S. at 76) and for maternal mortality the UK has an estimated 8 deaths per 100,000 pregnancies (compared with 1 per 100,000 in Belarus and 28 per 100,000 in the US). As a system the UK was ranked the best in the world for health access, efficiency, effective, safe and coordinated care (Commonwealth fund, Mirror,Mirror 2014). However, it currently spends only 9.1% GDP on healthcare or US$3,598 per person, which is free at the point of service. [2] The US spends over twice as much (17.1% of GDP or US$9,146) and was ranked dead last in the same Commonwealth Fund study. [3]
So, to sum up, you’re faced with a well-liked, efficient, life saving machine. So you won’t be able to try a head-on approach, public opinion will need to be swayed first.

Step Two
Misinformation: the great thing about the NHS is most voters at any given election will not have a vast deal of deep experience of its services. To many people the NHS is for shoulder physiotherapy and antibiotics for a chest infection and maybe the odd stitched wound at A&E. This is to your advantage! Start early on by pervading a helpful message of ‘improvement’ and ‘efficiency’. Steer every news piece towards this same message, regardless of context. Be consistent with this message and quickly this will become the ‘norm’. You will need some national newspapers on side to keep this reinforced. Before you know it the NHS will be percieved as ‘failing’. But that won’t be enough!

Step Three
Divide and conquer! It doesn’t matter what you campaigned on- once you’re elected you only have to apologise occasionally and you can do whatever you want! Push through some major reorganisation as early as you can- use words like ‘transform’, ‘power’ and ‘into the hands’. These will keep everyone in service on the back foot trying to respond. Make sure any change is extremely complex- this has two advantages; A) it makes it difficult for opposition campaigners to create ‘headline’ zingers against you and b) this is your opportunity to lay some legal horcruxes to build your platform!*

Step Four
Wash your hands early! If you want to sell off a national institution you have to make sure it’ll slide away easy. When no one is looking, make sure the government no longer has a legal duty to provide the NHS. But don’t stop there! Now is your chance to plan ahead!

Step Five
Open market! Everyone knows they get a better deal when one supermarket opens next to another one! Despite there being absolutely no evidence this applies in any way to healthcare provision! Use that knowledge to your advantage! Use words like ‘competition’ and ‘drive up performance’ – the more you can paint the NHS like a car the better- people like to sell their cars. Meanwhile once the law has changed,  open up the NHS to private contracts bit by bit. This will mean if anyone kicks up a fuss you can say ‘come on! It’s only 4%! It’s only 8%! Etc’. When the numbers start to get bigger use the relative percentages ‘It’s only increased by 15%!’. Useful phrases here are ‘can we please focus on the bigger picture?’. But then what about the staff on the inside?

Step Six
You do have a problem here: much of the NHS staff will see what’s happening, and people will listen to them if you don’t do something about it! Politicians are the least trusted individuals in the country, while doctors are the most; start early on with subtle denigration of the perception of all NHS staff. Take any news report about A&E or midwives or doctors or nurses and make sure someone high profile gets on a box and sticks it to them. Appoint a health secretary who will regularly inflame the situation- this will create distraction from the sell off! Frequently offer empty re-organisations that both fail to address and belittle any problems. Then get down to business.

Step Seven
The money! Cut it, and cut it hard. People use A&E and the GP the most- keep these areas stripped of cash and drive up demand by demanding people go at any time of day- encourage your health secretary to do exactly this! Once these areas go too far under they’ll sink by themselves- locum agency costs to cover staff gaps will cripple failing departments, and smaller GP closures will domino into bigger ones. Obviously don’t be seen to be thrifty- use words like ‘efficiency savings’ and ‘reform’, and above all ‘austerity! But do cut services away- the more gaps you can create the easier it will be for private companies to fill them! Put pressure on the very front services by cutting departments like a and e and maternity, and sell off the backend like microbiology and biochemistry, because no one really understands this stuff anyway.
Make sure you use this opportunity to crush the spirit of the staff- cut their pay, at least in as boring way as possible, e.g by pay freezes and under inflation changes. In the meantime try to award yourself a huge pay rise- this sell off is hard work you know! Doctors and nurses will leave, temporary agency staff will come, the service will worsen and the People will suffer! Now it’s time!

Step Eight
It’s showtime! If you’ve followed the above steps then this last will be a doddle. You’ve got a demoralised and depleted workforce, an unhappy electorate and you aren’t even spending very much on it all! You’ll need to do some hand-wringing, some lamenting, some explaining away. You will find these phrases useful; It’s ‘an ageing generation’, 21st century demand is too much, and ‘the burden to the taxpayer’. And then roll them in- hopefully by this time you should’ve got private companies into at least 20% of services.

Step Nine
Sit back and relax! All your hard work no doubt has been a lot of stress. And those long hours of drinking and smoking and missing the gym have really taken their toll. You deserve some time off! Don’t worry about the newspaper backlash- it’ll come eventually, and there won’t be a hint of apology as the same papers that supported you will hypocritically tear you down. And don’t worry about that chest pain you’ve been having! You’re insured right? Oh you lost your job? But what about the end game- the cushy seat on the board of the health companies? Oh, you’re politically toxic now and all those backroom offers disappeared? And you didn’t save anything?

Oh.

Goodbye.

Re-printed with kind permission @ juniordoctorblog.wordpress.com

*if you have to bridge an election with this still hanging over you just apologise for it! Say it was a big mistake. Then once you’re re-elected you don’t have to do anything about it!
[1] http://www.kingsfund.org.uk/projects/bsa-survey-2013
[2] http://data.worldbank.org/indicator/SH.DYN.MORT?order=wbapi_data_value_2013+wbapi_data_value+wbapi_data_value-last&sort=asc
[3] http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror