By James Lazou, researcher on health for Unite the Union for Open Democracy
A Commonwealth Fund survey found the UK health system topped the poll on just about every criteria – so why are the Tories wrecking it?
After all the negative headlines over the last few years you would be forgiven for thinking that the NHS [National Health Service] was a mediocre, failing, bureaucratic service destined to collapse. That is the message that Health Secretary, Jeremy Hunt, would like you to believe. Since becoming Secretary of State for Health, Jeremy Hunt has seen it as his primary role to talk down the NHS and undermine the staff that run it in order to justify hospital closure legislation, draconian cuts to staff pay, and the rapid privatisation of large swathes of our health service (70% of contracts going to the private sector at the last count). It was also the message used to justify the biggest top down reorganisation of the NHS in its history – [Prime Minister] David Cameron’s Health and Social Care Act 2012. That is why it was so galling when the Prime Minister told the House of Commons in PMQs this week that the NHS under his Government was the best in the world.
David Cameron is misleading us. The Commonwealth Fund did release an international study in June saying that the NHS was top out of 11 major industrialised countries. But the report looks at survey data from 2011-13. This data pre-dates Cameron’s chaotic and unnecessary reorganisation, given the Health and Social Care Act 2012 only fully came into force in April 2013.
In fact the report contradicts many of Cameron and Hunt’s claims about the NHS, while reinforcing what campaigners were saying at the time.
The report shows that the NHS was not only better than the obvious examples such as the US health system, where even after Obama Care nearly 30 million people are still not covered, but actually it rated better than those countries with a better record of social security and welfare provision, such as Sweden, Norway, France, Germany and Holland.
The United Kingdom ranked first overall, scoring highest on most quality, access, and efficiency measures reviewed. Patients in the United Kingdom were the least likely to report having cost-related access concerns (4%). Care was better integrated than in other countries through widespread and effective use of health information technology (HIT), high scores on the chronic care management indicators, as well as its performance on system aspects of preventive care delivery. Overall, the U.K. outperforms all countries on each of the seven chronic care management indicators.
The UK also provided some of the best results for patient centred care, access and communication within the health service with for example the highest rates of follow-up visits with a doctor or other health care professional made upon leaving the hospital (87%). The UK had the highest ratings for timely information for patients and patient feedback systems. It also had the highest numbers who said that doctors always tell them about their options for care and ask their opinions, discuss goals and encourage them to ask questions, and give clear instructions about symptoms to watch for and when to seek treatment.
The report concluded that “it is a common mistake to associate universal or near-universal coverage with long waiting times for specialized care”, pointing out that the U.K. ranks highly on all measures of timeliness, with short waiting times for basic medical care and non-emergency access to services after hours. The U.K. also had improved waiting times to see a specialist.
The UK scored first on efficiency, where the report examined total national expenditures on health as a percent of gross domestic product (GDP). It came top on the percentage spent on health administration and insurance. Lastly the U.K. scored highest on overall equity, with small differences between lower- and higher-income adults on most measures. The one area where the UK fell down in the Commonwealth Fund report was on people living healthy lives.
The conclusion of all this must be that the NHS and its health workers are doing a good job. Not only have they been delivering the best outcomes on a lower budget, but they have been doing so in a society with some of the worst health problems than any other country in the list.
This was the situation before the Coalition had a chance to implement their “reforms”. The question is will the service score so highly next time?
The NHS has been losing money in real terms under Cameron – with funding expected to go back down to around 6% of GDP by 2021 which is lower than most similar countries. The wasteful reorganisation estimated to have cost between £1.6bn and £3bn caused by the Government’s Health and Social Care Act is leading to increasing chaos with rising waiting times, overcrowding in A&E and failure to meet targets such as those for cancer treatment. Huge swathes of the NHS have been contracted out to private providers following the Act coming into force in April 2013.
Some of these private providers are quickly showing their true colours. The scandals are mounting. Serco has been falsifying data in Cornwall. BMI has been providing poor quality care in Surrey. There have been patient safety fears and unnecessary deaths at the CLINICENTA service in Hertfordshire. Virgin has been putting patients at risk by using undertrained staff in Croydon. Given the increasing involvement of these private sector providers and the Government’s pride at “giving away control of the NHS” its questionable whether the NHS will still be top by the time of the next study.
Despite everything this Government throws at them, health workers areworking harder than ever to protect and treat the patients and service users they care for. This is a heroic achievement and something that all of society should value. The best way to do that is to pay them fairly.
Unfortunately that is the opposite of what the Government is doing. NHS staff have been subjected to a barrage of public criticism. Jeremy Hunt has accused NHS staff of mediocrity, coasting, and cruelty. His latest salvo has been to ignore the evidence of the independent NHS Pay Review Body that makes recommendations on NHS pay and imposing a further two years of pay caps and freezes on staff, particularly in England. After four years of the Coalition Government NHS staff have lost 15% of their real terms basic pay, as well as numerous other attacks on their terms and conditions, with thousands of NHS staff being pushed below the living wage rate of £7.65 (or £8.80 in London). Staff surveys show that morale is in decline, a culture of fear, with stress, restructuring, the falling value of take home pay and attacks on terms and conditions all cited as key reasons for this.
The Pay Review Body itself states that if the government failed to deliver the expected 1 per cent pay rise for staff, “patients would be impacted through declining staff morale and engagement” and it will become unsustainably hard to recruit and retain staff. There are already over 20,000 unfilled nursing vacancies in England.
This policy seems to be deliberate. There is clearly money available in the system with the Department of Health is returning over £2bn in under-spend to the Treasury to plug the gap in public finances.
The Government seems to be stoking an NHS crisis in order to undermine the NHS and the concept of free health care. Dr Paul Charlson, Vice Chair of Conservative Health, made this strategy explicit when writing about charging for NHS treatment – saying charging was “a good idea in principle… [BUT] It would be political suicide for a party to introduce this. They could only really do it if there was a feeling in the country that health services were falling apart.”
That is why Unite and other health unions are saying enough is enough. We all must work together to defend our NHS. Unite is challenging this Government vicious pay policy,working with local communities and national NHS campaigners to fight privatisation. We must make sure we continue to have a NHS for future generations.
To find out more about Unite’s campaigns on the NHS visit:
