NHS in a Critical Condition
The Health Secretary, Wes Streeting, has repeatedly declared that the NHS is broken, and immediately on taking office, announced a public consultation on the future of the NHS. This book provides valuable context to many of the core issues that the Health Secretary wants our views on. Dr Julia Grace Patterson gave up practising medicine to campaign against the ongoing privatisation of the NHS. She set up and has run EveryDoctor since the start of the pandemic, providing ordinary doctors with a way to speak up safely about their concerns and experience. Few others have the breadth of frontline sources to report on why the NHS is failing and what really needs to be done.
Right at the beginning of the book, Dr Patterson states that:
“Politicians have no mandate for what they are doing to the NHS and we must hold them to account.”
A good introduction is followed by just five very readable chapters that reveal the current broken state of the NHS.
This book is about more than just the NHS, as the author describes her personal sacrifices and experience of campaigning, to the extent of having to move to Ireland following threats and abuse on social media for her investigative work (p.22).
We read how MPs have shaped legislation to make it harder for them to be held to account and legitimate protests to be held. For example, she cites legislative restrictions on campaigns against the political direction of travel (p.123-4), referring to two Acts of Parliament: the Police, Crime and Sentencing Act (2022) and The Transparency of Lobbying, Non-Party campaigning and Trade Union Administration Act (2014) which effectively gags charities like the Royal Colleges of Medicine from campaigning for change (p.118). Throughout the book, there is a real feeling of anger and frustration at the barriers encountered.
Betrayal
The principles that are embedded in the NHS Constitution are summed up as
“…the NHS will provide equal care for all, based on a patient’s clinical need, and provided free at the point of delivery” (p.37)
and we are shown how politicians from both the main parties have allowed these to be eroded with no mandate from the public. Driven by the neo-liberal doctrine that saw our public services privatised, the NHS is being sold off bit by bit, the author contends, (p.51).
- 1980s saw the Thatcher government creating the Internal Market, forcing NHS facilities to compete with one another.
- 2000s saw the Blair Government using Private Finance Initiative (PFI) contracts to build and maintain hospitals creating debt and high maintenance costs that are a burden to many trusts today.
- 2010s saw the Cameron led coalition government introduce the Lansley reforms that established the commissioning groups that outsourced thousands of NHS services.
We are taken through campaigns run by EveryDoctor and the frustration with both Conservative and Labour MPs who would not directly answer questions put by their constituents, just parroting whatever their central party told them to say (p.77). It seems that MPs don’t think that they have any responsibility for 500 avoidable deaths every week (p.74). The author complains of …
“No functioning mechanism to hold politicians to account as they break up the NHS” (p.99)
Nothing has changed
We have seen how the recent general election, following publication of Critical, has not changed anything as within weeks of winning, those Labour MPs who were formerly health care professionals voted to keep the two-child benefit cap, and to restrict winter fuel payments, knowing the direct harm this would do to the vulnerable, and the resulting impact on the NHS.
Dr Patterson notes that there is a lack of public awareness of how far privatisation has progressed and the scale of the harm the lack of funding has caused. The media seems have abandoned any sense of duty in holding government to account, simply reporting the numbers, delivering sound bites and headlines, but offering little analysis to build public awareness of the underlying issues (p.111).
For example, equal care for all cannot be provided where some hospitals are burdened with Private Finance Initiative (PFI) debt and others not. The cost of New Royal London Hospital was £1.2 billion, with the trust having to pay £116m every year – 7.68% of its income (p104).
“In these trusts doctors are forced to work extra hours, all due to the debt government refuses to pay off” (p.106)
Other alarming revelations that stood out include:
- The Proportion of the NHS Budget spent on private providers. The Department of Health claims this to be 7% whilst the Centre for Health & Public Interest has it at 18% (p.110)
- Deaths due to delays in A&E – A study by Royal College of Emergency Medicine estimated that 4519 died in 2020-21 (p.117)
- The number of doctors (p.157) In 2020 there were 159,100 FTE (full-time equivalent) doctors working in the NHS and just 860 FTE doctors employed by independent health providers. This explodes the myth of capacity in the private sector being able to reduce waiting lists.
The fight for the NHS is a fight for democracy
The final chapter outlines what needs to be done to fix the NHS. At the top of the list is to “stop and reverse outsourcing” (p.184) and later “to deliver a positive, hopeful campaign of what will be the most effective course of action” (p.191), but what that action should be was left open.
The discussion at our book club became quite emotional as we heard first hand accounts backing up the narrative. There was frustration that there is nothing we can do, as outsourcing continues with global companies like Palantir running more services. Many such as James Meek, Noam Chomsky, and Michael Hudson have explained how the neo-liberal plan of selling off our public services has enriched a few leaving us with poorer more expensive services. Tim Jackson has shown how the drive for economic growth is destroying our planet, and Ian Dunt has explained how companies and oligarchs control the media and fund the main political parties to serve their interests. With this in mind then surely the action needed becomes clearer…
First convince the public that we need a new plan. Campaign groups like EveryDoctor and trade unions such as the BMA are largely working in their own sector. If they could work with other campaigns and unions across the public sector creating platforms in each community, for public service workers and users to share their concerns and ideas, more of us will hear first hand how privatisation has failed and why a new plan is needed.
Elect a parliament committed to producing a new plan. The platforms will help identify those with ideas and energy to find a solution. One possible way forward is open primary elections, which would allow the public to select who they think is best able to develop these ideas in parliament.
If campaigns like EveryDoctor can work with others across the public sector, bring people together, build awareness and support, find brilliant candidates to campaign for and elect, then there is a way to create a parliament, even with the current electoral system, to do what is needed. Then there is hope that we can save the NHS, our other public services, and our planet too.
Extraordinary times give rise to extraordinary ideas. The NHS was one such idea.
Many thanks to the Kingswood and Wotton Socialist Book Club for sharing this brilliant book.
Critical: Why the NHS is being betrayed and how we can fight for it, By Dr. Julia Grace Patterson Published 22 June 2023 by HarperCollins. 224 pages
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