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What does the general election mean for the NHS?

NHS Olympics imageWith the general election just weeks away, it is worth considering what the stakes are for the NHS.

Although the record of the last Labour government is controversial in some respects, such as introducing PFI, and bringing rapacious private contractors like Carillion, and ISS into the NHS, both of whom the GMB trade union have been engaged in disputes with, the overall impact was enormously positive.

When Labour came to power in 1997, the Conservatives had run NHS spending down to breaking point: health spending was at around 5% of GDP, and the conditions had been created by the Tories for an expansion of insurance based private sector.

Labour saved the NHS by increasing NHS spending by 6% each and every year. Labour built 149 new hospitals, and recruited 80000 more nurses, 38000 more doctors, and 4500 more NHS dentists. Health spending rose to be around 10% of GDP by 2010. Indeed, the expansion of the NHS when Tony Blair was prime minister was the most effective and sustained period of growth in the NHS since the 1940s. The spirit of ’45 indeed.

Under Labour, virtually no-one waited 13 weeks for treatment, Specialist appointments were guaranteed within 2 weeks of referral, and a doctor’s appointment was guaranteed in 2 days. Interestingly, pre-election promises to stick within the spending plans of John Major’s retiring Conservative administration were quietly abandoned  in the NHS, when the full scale of the Conservative’s poisoned legacy in the health service became appreciated. Labour prioritised patient care.

What is more, Labour helped local councils provide decent services for social care, with a 43% real terms increase since 1997.

In contrast, since 2010, the Liberal Democrats and Conservatives have yet again created an almost existential crisis for the health service. Despite promising “no top down reorganisation of the NHS”, the government has spent £3 billion breaking up the NHS, and outsourcing to private health companies.

The full scale of the threat to the NHS has yet to become apparent to most people, as the Conservative’s reforms have not yet fully worked themselves through, but already the impact on patient care has been dramatic, and now 1 in 4 patients wait a week or more to see their GP. Over a million people have waited longer than 4 hours in A&E over the last year. Over half a million people are on waiting lists for treatment.

What is more,  coalition has made massive cuts of £3,5 billion to social care budgets. Almost 250000 fewer older people are receiving services than in 2010.

The Labour Party has made clear commitments, that will be implemented when Ed Miliband is prime minister.

  • Labour will recruit 20000 more nurses, and 8000 more GPs, funded by a tax on houses worth more than £2 million.
  • Labour will guarantee a GP appointment within 48 hours, and on the same day if medically needed
  • Labour will repeal the Lib-Dem & Conservative Health and Social Care Act, to stop further privatisation of the NHS. The NHS will be the preferred service provider.
  • Labour will give Mental Health greater priority.
  • Labour will gurantee that patients will wait no more than one week for vital cancer tests by 2020.

There will undoubtedly continue to be problems. The legacy of PFI debt needs to be addressed, the cost of which is unsustainable. There is certainly a case to be made that given the scale of the NHS crisis in 1997, and in the context of a robustly successful economy, the decision to turn to complex instruments for private finance was within the proportionate and reasonable range of policy options for a centre-left government, bringing as it did some perceived advantages of not requiring controversial rises in public sector borrowing. There is a distinct difference between Labour introducing PFI in the context of using private borrowing to expand and improve public services, with the Tory policy of privatising to disrupt and curtail public services. Indeed, the argument of using private money for capital projects as a mechanism to avoid increasing the PSBR is not indefensible.

However, even in that context, the illusions of greater efficiency and administrative competence from private companies were always naive, and even if private sector funding for capital projects might be justified, long term service contracts with the private sector have been both costly and ill advised: bringing as they do inevitable cost cutting in pursuit of profit, and reduction in public service.

Margaret Thatcher made great political capital out of her adopted persona as a housewife seeking to balance the household budget. Similarly, many voters today are familiar with the idea of seeking to restructure household debt, consolidating loans and, seeking to remortgage at a lower interest rate. By analogy, the unsustainable cost of PFI debt does require bold action,to restructure, and reduce overly high interest payments that are not in the public interest. This is an argument that the left and the trade unions will need to advance during the period of the next Labour government.

One Comment

  1. Robert says:

    Yep Progress and the Unions what a farce that will be.

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