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Neath Port Talbot
What next for the NHS?
Jackie Grunsell, Lancashire GP and Socialist Party member
On Friday 8 May, health workers in England gave a collective groan of despair at the news the Tories had won the general election. It's not that many had illusions any of the establishment parties were offering a plan to dramatically improve health care, but the Tories' Health and Social Care Act 2012 (HSCA) has been an absolute disaster for the National Health Service (NHS).
Over a year after its introduction a British Medical Association (BMA) survey of doctors revealed only 5% believed the Act had improved services for patients. Nearly three-quarters felt that competition, with increased use of private providers, has led to services becoming fragmented.
BMA Chair of Council, Dr Mark Porter, stated: "While everyone else in the NHS has been working to make it better for patients, the government, through its misguided legislation, has been doing the exact opposite. How can we ever achieve whole and seamless care when so many services have to be touted to private bidders? How will these services work together for the good of patients when they are constantly eyeing up each other's business? How can services improve when the law can impose competitive tendering but cannot be used to protect or prefer publicly-run services?"
The government's policies are not misguided but a deliberate attempt to undermine the NHS and create a private insurance based healthcare system similar to that in the USA. They have indicated they have every intention of continuing to implement the HSCA in the face of opposition from every major health workers' union and professional body.
In the run-up to the elections the Tories clearly felt the pressure over the NHS, making the pledge of increased funding of £8 billion by 2020. This is laughable when an estimated £30 billion is needed to plug the funding gap that already exists. No one knows where cuts will come from to deal with the current deficit.
The recent announcement of a £200 million cut in council funded public health services will also mean the NHS is left to pick up the pieces due to a lack of smoking and obesity prevention, school nurses and sexual health services, among others.
The Tories have also made the empty pledge of thousands more doctors. There are no details of how they plan to make this happen, to reverse the shortfall, particularly in general practice and the difficulty of recruiting and retaining people in the profession.
Health secretary Jeremy Hunt has admitted that in order to get the 5,000 extra GPs (General Practitioners, ie doctors) the government is promising, about half of all medical school graduates would have to choose that specialisation. But this year, the NHS struggled to fill existing GP training positions. And a British Medical Association survey of over 15,000 GPs last month found that a third of them intended to retire by 2020.
Meanwhile the GP magazine Pulse printed an article last week revealing that more than 160,000 patients across the UK were displaced as a result of their practices closing in the past two years.
Pulse also revealed a 500% jump in the number of practices seeking advice from NHS managers about closure or merging.
The BMA GPs Committee chair Dr Chaand Nagpaul believes the figures obtained by Pulse are the "tip of a much bigger iceberg".
He says: "There are many practices on the brink of collapse, while others may not be closing, but are significantly reducing the level of services they can offer. We have many practices running at half capacity and having to reduce the number of sessions." Practice closures are putting even more strain on those left nearby, who have to take on those patients en masse.
Prime Minister David Cameron's announcement that the government is committed to a seven-day NHS is yet another pipe dream on the basis of present health spending. In theory this is a great idea but with services stretched beyond breaking point for even five days now and further cuts to come, this is an impossibility.
Seven-day working in the NHS would require large numbers of new staff, the cost of this is nowhere near met by the £8 billion promised. If the government try to implement this plan, it will in all likelihood mean further closures of emergency and maternity services and closing more GP surgeries, due to having to provide cover with even fewer staff.
The continued privatisation of healthcare is set to continue apace with more and more service contracts coming up for tender over the government's term of office.
The lifting of the cap on hospitals treating and getting funding from private patients means that increasingly underfunded health trusts will turn to this as a source of income.
In this situation, combined with growing waiting lists to see and be treated by specialists, it's easy to see how more patients who can afford it, will start to go private or take out private insurance to cover certain conditions which are not well catered for in their area by the NHS.
And they will begin to take priority in a chronically cash-strapped, understaffed NHS, exacerbating the inequalities in health care that already exist and creating a service based on your ability to pay, not on need.
The news that NICE (the National Institute for Clinical Excellence) has abandoned its work to set standards for safe nurse to patient ratios in different hospital settings, means that cost will continue to be the driver for staff levels rather than patient safety.
Dr Peter Carter, chief executive of the Royal College of Nursing, said: "If staffing levels are not based on evidence there is a danger they will be based on cost."
Increasingly, the NHS is measured on how trusts perform financially rather than on the availability of care and how that care is delivered.
The profit motive that is seeping into the heart of care must be robustly challenged by the trade union movement and wider community.
What is the solution for the NHS?
The 2012 Health and Social Care Act (England) should be scrapped and privatisation of healthcare immediately stopped and reversed where it has already taken place.
Abolish Foundation Trusts and Clinical Commissioning Groups. Ending the cost and waste of a competitive market in the NHS would save money. Integrated health services are cheaper and provide better care for patients.
Reverse the pay freeze for NHS staff. Health workers are demoralised and undervalued. They need pay rises linked to inflation as a minimum. Better paid adequate numbers of nursing staff would reduce the need for costly agency workers, reduce sick leave and improve morale and patient care.
Invest in social care and community health services. The massive cuts in these services and privatisation have led to vulnerable people being left in the community without the support they need.
This means unnecessary hospital admissions and patients being kept there longer than necessary or being discharged unsafely only to bounce back in via A&E. Services are completely unable to cope with demand and need bringing back into public ownership with investment in well paid, properly trained staff.
Nationalise the pharmaceutical, medical supply industries and all private health providers. These companies are ripping off the NHS, charging over the odds for their products. Compensation to shareholders should be paid only on the basis of proven need.
For democratic control and accountability of health services. Plan health care on the basis of the population's needs, with care decisions made by democratically elected representatives of health workers, the community, as well as local and national government.
For united action to defend the NHS. Trade unions should take action supported by anti-cuts campaigns and service users. For health campaigners to link up with groups fighting other public sector cuts. Support the call for a 24-hour general strike against austerity.
For a socialist planned economy. End poverty, bad housing, unemployment, dangerous workplaces, pollution and inequality - the biggest killers and causes of ill health.
Privatisation an "unmitigated disaster"
When Circle, the private company infamous for its failure at Hinchingbrooke NHS hospital, took over the dermatology services at Queens Medical Centre (QMC) in Nottingham, workers and patients were right to fear the worst.
The privatisation of QMC resulted in the exodus of the majority of the consultant dermatologists putting the service in crisis, with cancer patients now having to travel elsewhere for treatment. Circle was forced to recruit locums (temporary consultants) costing as much as £300,000 a year!
An independent report into the unit's near collapse has branded it an "unmitigated disaster". It was a national centre of excellence when run by the NHS. So much for the spurious government claim that private companies can provide a better, more cost efficient service.
The report's findings fell short of according responsibility to the reckless handover of the department to a private company. However, there are numerous cases where privatisation has adversely affected people's lives and this government's push to further extend private involvement in public services must be stopped.
It is the responsibility of those who work in the NHS, as well as their fellow workers across the public services, to fight back against the dismantling of the NHS and free the service from Tory backed profiteering health companies.
Nottingham Socialist Party member
NHS in Wales: a crisis of underfunding
Cuts have gutted the NHS in Wales
Long-term underfunding is destroying the NHS in Wales. Funding for all public services is determined by the 'Barnett Formula', which robs Wales of around £300 million annually compared to England (estimated by Holtham Commission in 2009).
The Welsh Labour government decides where the money goes and has not 'ring-fenced' NHS spending (as in England and Scotland) leading to bigger relative cuts. Welsh Labour accepts and administers Tory cuts passively and as a result Welsh people have a derelict NHS and collapsing local government.
NHS funding in Wales fell by an average of 2.5% a year in real terms between 2010 and 2013. Despite the Welsh government coming up with extra money in 2013-14, it is projected that by 2016 the Welsh NHS budget will still be 3.6% lower compared to 2010. The Nuffield Trust estimates a funding gap that could be as much as £3.6 billion by 2025.
Labour's 'modernisation' of the NHS in Wales includes downgrading of maternity units, A&E departments and the loss of 2,000 hospital beds. This means reduced access to health care for many in Wales, especially for those without a car, the elderly, disabled people and some of the poorest communities with the furthest to travel.
The fightback has come from local community campaigns set up in the face of these cuts, while the leadership of Wales Trades Union Congress (TUC) and health unions turn a blind eye because of their unwavering loyalty to Welsh Labour.
In Rhyl, 2,000 people protested in February against downgrading of maternity services which would mean life threatening journeys for women and new born babies in distress. The campaign won a reprieve as a judicial review put a hold on these plans.
Similarly, hundreds of people from West Wales descended on the Senedd (Wales National Assembly, Cardiff) in April to protest about the downgrading of their local district general hospital.
One of the symptoms of neglect is the significant problem with recruitment and retention of staff. One-third of Welsh medical graduates choose not to work in Wales when qualified and the Welsh NHS has 400 junior doctor vacancies. There are also concerns about nursing staffing levels and skills mix in Welsh hospitals. This of course leads to more spending on agency staff which feeds rather than resolves the problem.
Neglect in funding is leading to neglect of people. The Andrews report unearthed failings in care provided to older people in Bridgend and Neath Port Talbot hospitals. Currently, Betsi Cadwaladr Health Board has been placed under 'special measures' with a shocking discovery of "institutional abuse" on a mental health ward.
Funding for the NHS in Wales should be determined by the needs of the population, not by shrinking budgets from a Tory government hell bent on attacking the working class and a Welsh Labour government with no backbone to fight!
Austerity in Wales is having a detrimental effect on the health of the population at a time when funding for health is dwindling. We must demand the Wales TUC and health unions lead on a fightback to protect the health of Wales and link this to a fightback involving the whole of the UK to reclaim the NHS.
27 May Reckless, lying cheats
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