NHS Privatisation and Underfunding
Updated: Jul 26, 2020
There’s no magic money tree they tell us, so the crumbling buildings, sewage leaks and machinery failures are something we just have to live with. There’s money for privatisation, for handing out hundreds of millions of pounds for non-existent PPE, to companies that have no track record of making it before. There’s money to give to in-experienced Tory donors to make ventilators, while ignoring the companies who actually make ventilators offers of help. There’s money to buy out of date PPE, and to buy pre-packed sets that have only one or two useful items in and need to be taken apart to get to the useful bits. But there’s no money to have new equipment, only poorly maintained second hand machines that fail as often as not.
Even before the coronavirus pandemic the NHS was short of 100,000 workers, 40,000 of them nurses and 10,000 doctors. The decision to scrap nursing bursaries means that many potential nurses cannot afford to train. There is no way to replace those who retire or otherwise leave the profession without encouraging immigration, something our racist right-wing government would rather avoid. The annual ‘Winter Crisis’ in provision had become a year round catastrophe as dedicated staff ran themselves ragged to care for patients.
The NHS needs £6.5 billion for repairs and maintenance right now. What it is getting is less than half of that to prepare for the second wave of corona that we’re expecting in the autumn. Decades of neo-liberalism, and in particular the last 10 years of ideologically driven austerity cuts, have hit the NHS particularly hard. It began with the Thatcher governments bringing in privatisation of non-clinical departments and setting the precedent for 'New Labour' to privatise clinical areas and create the disastrous Private Finance Initiative (PFI) scheme. This has saddled many hospital trusts with debts that will not be repaid during the lifetime of the buildings that they financed.
Despite the propaganda that the private sector is more efficient and cost effective than anything run publicly, privatisation of the NHS is deeply unpopular with the majority of the population. Unfortunately this just means that it happens by stealth. By the time we know it’s happening it’s happened, or is so far advanced that there seems to be no way to prevent it. The standard formula for grinding down resistance is to defund services, so that patients can no longer access what they need, demoralise staff by downgrading their pay and working conditions and then claim that privatisation is the only way to save any service provision. This method helps to explain why, excluding general practice, 18% of the NHS budget goes to the private sector.
Aside from the moral issue of whether for profit health provision is ever an acceptable model, privatisation also makes impossible demands of staff by ignoring the unprofitable but inalienable human element. If an out-sourced domestic worker is expected to clean a certain number of rooms in a set amount of time, they have to hope that the rooms aren’t being used by other, generally senior, members of staff. The largely disconnected way in which most hospital departments work makes it difficult to discuss hospital-wide concerns and organise concerted resistance when individual services are threatened.
As well as privatisation there are the worrying levels of under-funding, with the Red Cross and St John’s Ambulance service supplementing NHS ambulance provision being a visible example. This trend is worrying as it helps to normalise the idea that public provision of healthcare is dispensable and that a mixture of charitable and private providers can take the place of the NHS. The fact that this type of system has failed before, and was replaced by the NHS is generally glossed over. The success of the recent fundraising campaigns for NHS charities demonstrates that there is a huge wealth of public affection for the health service. But the demand that needs to be made is for a full return to public ownership and proper funding through taxation rather than allowing the establishment of this new normal.
So we return to the departments, with the dripping sewage pipes, the leaky steam generators and the ever present threat of privatisation not to meekly contemplate our fate but to prepare to fight it.