‘Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community.’ Lottie Sellers, OULC member, assesses where Nye Bevan’s vision for the NHS stands 70 years on.
This July, our NHS and its accompanying social care system turn 70 years old. Personified as the average British citizen at the approximate time of its foundation in 1948, chances are they would have died around a year ago at the not-so-grand old age of 69. Today, thanks in no small part to their own provisions, they could expect to celebrate their 80th birthdays. However, health and social care are not humans, they are public services – and they are ailing.
Under our current government, spending on health and social care is at the lowest it has ever been since the modern system’s foundation. Annual spending increases on the NHS of just 1.4 percent are a poor relation to New Labour’s 5.8 percent, and the effects are clear. The last two winters have seen ‘humanitarian crises’, as the percentage of patients seen by A&E staff within 4 hours of arrival – this being the official standard set out in the 2009 NHS Constitution – dived to just 85 percent in both January 2017 and 2018. In fact, even outside the notoriously difficult winter months, the 95 percent standard was last achieved in July 2015. As our emergency care services are stretched to breaking point, further burdens are placed on the wider health service. For example, the cancellation of thousands of scheduled operations this winter, in an attempt to divert resources and staff to A&E, demonstrate the hand-to-mouth state our health service is being pushed into by the government. The NHS is being forced to scramble for survival in the short term rather than focusing on longer term plans.
The social care situation appears to be even more dire. Average local authority spending has fallen by around eight percent in real terms since 2009 as central government has slashed funding, leading to the inability of an estimated 400 000 people to access care and, in a study published by BMJ Open last year, a direct correlation to an estimated 120 000 excess deaths since 2010. Social care, unlike the NHS, is means-tested and in 90 percent of authorities, it is currently available only to those with ‘substantial’ or ‘critical’ needs. Yet part of the government’s action on this issue has simply been to call on families of those in need of social care to step up their actions and take on more duties. This is irresponsible, unfair, and deeply insulting. Moreover, it ignores their existing dedication at a time when many home care workers can expect to be allocated just 15 minutes per visit. Patients who would ideally be provided for through social care, are ending up on hospital wards, intensifying the pressure on the NHS. However, thanks in a large part to the coalition’s structural changes to health and social care, the two services, whilst overlapping majorly in their provisions, are currently treated as if they are entirely different beasts, a situation damaging and confusing to patients and employees alike. Considering our ageing and increasingly chronically ill population, the bleak situation outlined here is likely only to worsen as long our government blames demographic change as an excuse for problems, all the meanwhile propagating the austerity programme that is causing so many of them.
So where to go from here? IPSOS Mori polling has placed healthcare second only to Brexit as the most frequently mentioned issue facing Britain as of November 2017, having risen fairly steadily since 2010. It would be in no way hyperbolic to suggest that the NHS is the most important service our country has; and despite the stellar efforts of its wonderful staff, its principle of good quality care free for all has been jeopardised under Conservative governance. The simple fact is that every single Labour government has paid more into the NHS than any Tory government ever has, and the simpler fact is that our health and social care services need money to survive. The possibility of long term funding for the NHS, and the government’s pledge of cash injections for local authorities to help fund social care, may offer some relief, but as an NHS Improvement Manager interviewed for this article points out: “It’s still not clear exactly what extra, and with what conditions attached, the government will provide [this funding]. The devil is in the detail; this is by no means a done deal.” This stands in contrast to Labour’s history of investment, correlating with record levels of satisfaction under its last government. Currently, it has pledged £30 billion to the NHS, and £8 billion plus a National Care Service to ensure popular affordability and availability of social care if elected, not to mention the crucial reintegration of the two services to ensure the coherence that is currently somewhat lost. Of course, these policies are as of yet theoretical. Labour needs to be elected to fulfil them. But looking back over the last 70 years, it was a Labour government that created the NHS and social care system; it is Labour governments that have given them their healthiest years; and it is a future Labour government that will now provide the best treatment to ensure these valuable services can be wished as many more ‘Happy Birthdays’ as they deserve.