There’s a presenter on LBC called Nick Abbot. As usual, Abbot did his usual ‘review of the year’ at the end of 2022, asking for contributions for an A-Z for notable persons or events from 2022. Abbot was compiling a book which he had provisionally called ‘What have we done to deserve this?’ As well as a well known English saying, it was an iconic track by the Pet Shop Boys and the iconic late Dusty Springfield.
People have been latterly querying how the NHS come to be in such a parlous state after 12 years of Tory rule. In a nutshell, there’s a spurious argument that the economy, including the NHS, has been thrown off course through a number of externalities, such as the Russia-Ukraine conflict or the coronavirus pandemic. The answer is actually much more boring. The ‘rot’ began well into the Cameron coalition government which began in 2010. And the rest is history.
I’m old enough to remember when David Cameron in opposition promised ‘no more top-down reorganisations’. For the 2010 general election, he indeed went to Battersea Power Station to launch his manifesto for government. I remember it well. A major thrust to his party’s campaign was that Labour had ‘bankrupted’ the economy, and made a massive song and dance about ‘the debt’. Osborne and Cameron came to power in 2010, and consistently downplayed that Gordon Brown had been highly commended for his handling of the global economic crash for the UK jurisdiction – and that it was a global crash. What followed was a period of austerity – you can call it ‘austerity 1.0’ if you wish, but to be honest it never ended.
Cameron’s coalition with the LibDems then introduced the infamous Health and Social Care Act (2012). It’s been consistently denied by both Labour and the Conservatives that the NHS has never been privatised. They were able to get away with this because for many in the public privatisation is an offer of shares to the public – known in corporate law as an ‘initial public offering’. There is no Big Bang with NHS privatisation however – it is simply transfer of resources from the public sector to the private sector. The process of 2012 cost millions; there was never any risk register published. It was based on an ideological flaw that increased competition in private markets could drive up quality. The legislation never contained any clause on patient safety, despite the well researched Mid Staffs crisis. Safe staffing was put on the map, but not in the legislation. And social care under its longest health secretary in history experienced devastating cuts, despite Cameron strangely launching a ‘Dementia Challenge’ with little resourcing for care.
The crisis in social care was known about in 2015. This is why Andy Burnham for the 2015 general election campaigned on full integration of health and social care – but it was more than that. Burnham proposed a full approach for ‘whole person care’, where inequalities in social care, mental health, and physical health or failures in parity of esteem could be tackled. The inability of acute trusts to discharge into social care, ‘delayed transfers of care’, was already known to be a problem even then. It is of course never off the headlines today. Dorrell, as a former head of the NHS Confederation, and predecessor to Matthew Taylor, this week told Matthew Wright, popular LBC presenter, that he blamed lack of care of social care as a major problem today. Dorrell is not only a former Secretary of State for health, but he has now swopped allegiances from Tory to LibDem. He’s not wrong.
Politics is about political decisions. The billions spent on the ‘democratic choice’ of Brexit has not seen much benefit to the NHS or social care. Like fruit pickers, Brexit has left major holes in the workforce. Wage slips for junior doctors and nurses has not kept up with the cost of living. The glaring failure of privatised markets, for example in utilities, has seen unconscionable profits being hived off to private equity funds in foreign countries, poor services, poor choice and poor investment. While London suffers with ageing water pipes prone to burst, the NHS copes with outdated bleeps, buildings and fax machines – and most potently it shows an inability to invest in people, thereby relying on expensive agency staff. For two decades, the NHS and social care have resisted in having a workforce plan – despite its critical importance in patient safety – and even now it is being slow to be implemented.
The point about a system where we have a social approach. to each other is that we pool risk together. Patients with rare diseases don’t suffer as they live in the wrong postcode. People aren’t bankrupted just because they happen to develop a life limiting illness such as correctly diagnosed dementia. This system was supposed to minimise ‘bad luck’. Ask yourself why the cost of a letter to somewhere local is the same as the cost to somewhere far away. The NHS is a much cherished national institution. The Tories have been able to play on ignorance that many of us sooner or later will need social care. They also prey on the myth that social care’s function is simply to stop NHS ambulances queuing. It is not. It is supposed to enable and protect individuals and carers such that they are able to live flourishing, fulfilling lives.
You may believe in the Tory mantra that ‘there’ no money left’, which Cameron and Osborne used to ridicule Labour. But consider all the money spent on war (which you didn’t vote for), PPE scandals or ‘test nd trace’. While some people bought yachts off Greece, others barely had a polythene apron in caring for sick patients.
We are all now suffering to do with the choices of some. We were offered a national care service in 2019, but it was rejected. Now, for the first time in recent English history, there is a realistic chance for the destruction of the NHS.
The SHWS 