We’ve all seen, heard or read reports of hospital corridors full of trolleys with patients waiting to be treated or moved onto a ward. This isn’t a fictional TV series like ‘Casualty’ or ‘Holby City’. It is a stark reality, and a blight on a National Health Service that struggles to meet the demands placed upon it.
The underlying cause of the ‘trolley wait’ is a shortage of available hospital beds. So, how has this situation been allowed to develop? The Government tells us that the underlying cause is an ageing population occupying the majority of ‘general and acute’ beds and then being unable to be discharged on time because there are no post-hospital care arrangements available for them. This is certainly part of the problem, but by no means is it the whole story.
The problem of an ageing population alone cannot account for the fact that the ‘trolley wait’ is getting worse. In the financial year 2010/2011, about 100,000 patients waited up to 4 hours for a bed. In the financial year 2015/2016, that figure had increased to 475,000 1
The bald fact is that there has been a steep decline in the number of available beds for ALL patients in the period 2010 to 2017. In 2010, there were 144,455 beds: in 2017 there are 129,083.2
To read a personal view of the hospital bed crisis by Rachel Varnsverry click here
Why has this happened?
The NHS restructure in 2013 called for drastic cost-cutting and improvements in efficiency by Trusts and other major players, at the same time as introducing several new layers of management. No prizes for guessing that an enterprise’s response to a demand for ‘more efficiency’ results in a downsizing of operation. Add to the mix a raft of Locally Commissioned Services and their associated demands on the overall Health budget, and any hope for cost-cutting efficiency is gone.3
So, having set up the NHS for failure, how can the Government possibly have made things worse? One way to do this is to pluck arbitrary figures out of the air and demand strict adherence. This is especially true in the case of allowing for ‘spare’ capacity. Having overseen the unsustainable reduction in hospital beds available at hospitals, they proceeded to insist that only 85% of them should be occupied – a figure that has NEVER been achieved!. The main reason for this is that hospitals have to operate at increasingly high levels of occupancy, particularly during the winter months. In reality, many hospitals are frequently operating close to or above 100% occupancy during the day. 4
Plucking arbitrary figures out of the air came to the fore again in 2014 when David Cameron pledged to ‘ring-fence’ the NHS budget. The next year, having secured a win in the General Election, there came a Spending Review that announced a 20% cut in health spending that mysteriously ‘fell outside’ of the ‘ring-fenced’ budget. That 20% cut amounted to £22 billion to be found by ‘efficiency savings’. NHS England Chief Executive, Simon Stevens, said “£6.7 billion [of the required annual efficiency saving of £22 billion] will be delivered nationally through a range of measures that the NHS nationally, the Department of Health and wider Government will be able to take, and that leaves us £14.9 billion to secure locally”. At the time that statement was made, the source of the £14.9 billion efficiency saving was ‘unknown’. We are only now beginning to see how those savings will be achieved ‘locally’ with the ‘rationalisation’ (i.e. closure) of facilities like ‘local’ maternity and childcare facilities.5
So, a combination of funding cuts, and an ideology that is opposed to the NHS on principle, is responsible for a scandalous deficiency in a service that is the mainstay of our British way of life.
Under a Corbyn-led Labour Government, there are a variety of plans to improve and fund the NHS to the benefit of all the population: One of the 10 Pledges on his website state: 6
“We will end health service privatisation and bring services into a secure, publicly-provided NHS. We will integrate the NHS and social care for older and disabled people, funding dignity across the board and ensure parity for mental health services.”
This all sounds great – but the question is as always, what is the detail and how will it be funded?
Let’s start with the funding first. If you’ve looked into our piece on the economy, you’ll already know that Labour plan a series of National Investment Banks across the country.
One of the biggest drains on current NHS funding isn’t what you’ve been led to believe by the media – staff wages, too much paperwork, funding of care for foreign nationals – it’s something that was brought in by the John Major’s Government in 1992 and continued by last Labour Government, under Blair, and is to this day still having contracts signed off by this Government, increasing the debt and the drain on the NHS. These are the PFIs or Private Finance Initiatives, which gave short term boosts to the NHS, enabling new hospitals and new wards to be built, staffed and run, but a medium to long term unsustainable debt due to the repayments then due to private contractors for that initial investment. There are 100 hospitals with PFI. The original cost of these 100 institutions was around £11.5bn. In the end, they will cost the public purse nearly £80bn. The total UK PFI debt is over £300bn for projects worth only £55bn.
Just as an example, one of the largest NHS PFI scheme at St Bartholomew’s and the Royal London Hospital NHS Trust in London, could have been publicly financed for around £1bn; instead, it will end up costing £7bn by the time repayments are complete in 2049.
To put these figures simply Barts is paying over £2m a week in interest, which adds up to over £120m a year, before they see a single patient.
Labour will instigate a buyout of organisations from their PFI contracts using the new National Investment Bank and free up the debt and its crippling interest from the NHS budget.
With this debt now not on the NHS books, its budget can be utilised to implement Labour’s Pledges:
Re-Nationalising the NHS and bringing it back into public hands, making it a not-for-profit public service with the interests of the public at its heart, as was envisaged when it was first set up.
The importance of an integrated health and social care system will be reinstated, with parity for mental heath problems, where emphasis on the whole person is considered, their dignity and human rights respected and all patients treated with dignity.
The Health and Social Care Act ended the practice of having public health as a responsibility of the NHS – when the Act is repealed then this will be reinstated, meaning that prevention of illness and disease is as much a priority as treating it.
The cap on public sector pay has meant that our NHS staff have been working for what amounts to pay cuts, year on year, with cuts in staff and increase in work meaning that for the most part, they are working harder and longer for less. Staff morale is at rock bottom but NHS staff are committed to the welfare of their patients and this loyalty and hard work will be rewarded by a Labour Government and not punished as seems to currently be the case.
4 NHS-bed-occupancy-report-feb2017-England (1).pdf
5 20160880 NHS funding factsheet 03