There is a dual attack on the NHS of underfunding and privatisation

The NHS is struggling to deliver safe and prompt care. But let’s be clear: it is not the NHS that is failing the population, it is this government that has failed the NHS. The evidence – and we should rely on fact, not on false narrative hostile to the NHS – tells a powerful story, and one of hope for campaigners. The NHS, when funded to succeed and not underfunded for ideological reasons to fail, has been and will be again amongst the very best health systems in the world.

Those who pursue an alternative form of health system, such as social insurance or otherwise privately based healthcare, preface their argument with misleading claims about the NHS being a funding ‘bottomless pit’, wasteful despite ‘record funding’, ‘record numbers’ of doctors, nurses etc. Under cover of this barrage of mistruths, the Government chooses to divert large-scale funding to the private sector and it is content to leave the NHS in a dangerous and lethal state of stress. Why are we not hearing outrage daily in the media about 500 people dying avoidable deaths every week, caused by delayed emergency treatment including 35,000 12-hour trolley waits per month; and about the tens of thousands amongst 6.4m patients waiting for 7.6m assessments and investigations dying from these delays?

There is a dual attack on the NHS of underfunding and privatisation and an organic link between the two. The ongoing refusal to adequately fund the NHS to allow it to function contrasts with the government decision to invest £10bn in the 4-year contract (2021-25) with private hospitals to treat NHS patients, the billions spent on largely private community investigation centres, the £480million contract with Palantir to run our NHS patient data platform and the conscious policy to involve the private sector on cream-skimming pipelines such as cataract surgery. On top of the well-known tens of £billions wasted on privately contracting useless PPE and the failed ‘Test and Trace’ scheme at the height of the pandemic.

There are areas of the NHS now where care is either unavailable (dentistry) or disrupted and dangerously close to being only provided by the private sector (ophthalmology – eye care). These situations are beyond ‘canaries in the mine’ – they are symptoms of a dangerous present. And the disgrace that is the privatised social care has to be the future we act on now to avoid for the NHS.

We need to talk about ophthalmology. This example of how the profit motive that is the private sector’s top priority distorts the health process should open all our eyes. In ophthalmology there is a process in train that is in danger of following the road of NHS dentistry where in many areas of the country it is already impossible to get any NHS care, where charges are for many unaffordable in the cost of living crisis. The Royal College of Ophthalmology is concerned that so many integrated care boards are now commissioning cataract surgery from private companies like SpaMedica that in some areas NHS-run general and emergency ophthalmology departments are in jeopardy. Many patients are being offered cataract surgery prematurely (dramatically jumping from 450,000 to 650,000 operations per year) and the commissioning costs are going through the roof. This is threatening vital funding for NHS care. Surgeons are being offered up to three times their NHS pay, taking them away from NHS work. Patients are literally going blind on NHS waiting lists that have not been touched by this private jamboree in cataract surgery. 8% of the total NHS waiting list is patients waiting for eye clinic appointments and this has not fallen. The harvesting of NHS funding by the private sector means that funding for key sight-saving care like glaucoma clinics and macular degeneration care is threatened. The president of the Royal College is worried that soon it will be hard to access eye care provided by the NHS which is ‘losing consultants, money and trainees to the private sector’.

Bear this in mind when Labour says it will provide an open door to the private sector and use it more efficiently than the Tories. There is no spare capacity in the private sector that does not further undermine the publicly provided NHS. There is only one pool of trained clinical staff: what staffing the sector attracts to serve private expansion is the NHS’s loss. It is important to say that the NHS is still functioning and in so many ways is functioning well. And staffing pressures exist in most other rich countries too. But we now have an embedded two-tier health system and many more who can afford private treatment are buying it.

The only way to end this is to invest heavily in building back NHS publicly provided capacity: reopening wards and theatres, upgrading equipment, making buildings safe and fit for purpose, investing in the workforce. The only way to stabilise the NHS staffing crisis is to restore staff pay, terms and conditions, and build back morale and trust and halt the haemorrhaging of staff leaving the service.

The wider context demands policies to address the social determinants of health inequity; a national rebuilding of Public Health that will put the safety of the population foremost; and a national care, support and independent living service based on publicly funded, publicly provided care.

To imply that the call for urgent NHS funding is the simplistic solution of ‘some on the Left’ is egregiously insulting to exhausted NHS staff, the millions on waiting lists and countless bereaved families. The campaigning call on the NHS must have two elements: the NHS needs urgent funding and it must be invested in publicly provided services, building back and restoring the people’s NHS.

Dr Tony O’Sullivan is co-chair of Keep Our NHS Public

Image credit: Garry Knight – Creative Commons

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