by John Lister and Jacky Davis (eds.). The Merlin Press Limited, Dagenham, 2022 www.merlinpress.co.uk
Like Woody Guthrie’s guitar (a ‘machine for killing fascists’), ‘NHS Under Siege’ is intended not just to educate, but as a weapon to inform and strengthen the fight for the NHS and social justice. Edited by two veteran campaigners who also wrote the first two thirds of the book, and with a forward by the writer Michael Rosen, it has contributions from, trade unionists, academics, public and child health experts, health policy analysts and covid bereaved relatives. First of these out of the blocks is Michael Marmot reminding us that while the NHS must be defended against attack, there is also a need to focus on the conditions that make people sick in the first place – the social determinants of health and health equity.
Even before the pandemic, life expectancy increase had slowed dramatically, health inequalities were increasing and life expectancy for the poorest was getting worse. This was the direct result of fiscal policies that led to massive decreases in public expenditure and dramatic increases in child poverty. A major section of the book draws on the People’s Covid Inquiry, elegantly summarised by Jacky Davis, exposing lack of preparedness, sluggish response, failure to protect workers and vulnerable, preference for the private sector, cronyism and corruption, and lack of accountability for tens of thousands of covid deaths.
The adverse effects of austerity policies are explored in detail together with the ever present and misleading spin from government. For example, £34bn funding marking the 2018 NHS 70th birthday was in fact only £20bn in real terms and the decade ended with 9000 acute and general beds closed, 22% of mental health beds lost, a pre-covid waiting list increased from 2m to 4.5m, deliberate lying to the public about the prospect of 40 new hospitals, and unacknowledged needs related to a four million increase in population. The NHS now faces an existential crisis both from ten years of austerity that wiped out the growth of the previous decade and the huge challenge while ill-prepared and under resourced of dealing with the covid pandemic.
The authors argue that the ‘besieging forces’ (right wing politicians, private health care corporations, etc.) don’t want to replace the tax funded system, but to exploit it more fully by ensuring the greatest flow of profitable activity to private providers, while also maximising the numbers of patients who will opt to pay for elective treatment rather than face long delays. A core NHS would be maintained to treat emergencies, provide care for maternity, complex and chronic cases, train staff and foot the bill for the poor, sick and elderly. Ministers continue to gaslight the public about ‘spending more than ever before’ on health when the truth is quite the reverse. Each year since 2010, the health budget has grown less than the previous average increase in spending, bringing real terms cuts as resources lag behind rising costs.
Key expectations that there would be a ‘national upgrade in prevention and public health’ set out in the 2014 Five Year Forward View for NHS were not met, while service providers have been overwhelmed by a slew of undeliverable objectives, lacking the investment and workforce required to make them feasible. Policies, decisions and circumstances that have brought us to this situation, the actual and real term cuts in spending, the fragmentation, the privatisation, the so-called reforms, reorganisation and plans that have weakened the NHS and made it more dependent on the private sector, including the most recent reorganisation into Integrated Care Systems, are documented and deconstructed.
A devastating recent report from the parliamentary Health and Social Care Committee has characterised the current situation in the NHS as the ‘greatest workforce crisis in its history’, castigating government for an absence of credible strategy, with critical gaps in almost every area of care. Health policy analyst Roy Lilley concludes the book by pointing out that without a workforce plan the NHS will fail, leading to a poor service for poor people. While he also opines that ‘no one plans to fail, they simply fail to plan’, it is difficult to read this book and not conclude that government policy does indeed amount to planned failure.
The authors stress that the siege of the NHS has been opposed, and their intention is to arm and fuel the resistance. Defences could be strengthened now by new money, above inflation pay rises for staff, and all investment being channelled into reopening, rebuilding and expanding NHS capacity rather than squandering on private providers.
This book should be read by anyone interested in both defending and rebuilding the NHS and in addressing health inequity as a matter of social justice, packed as it is with facts and insight presented in an accessible and well referenced form. It should also be read by anyone with any pretension to wanting to examine critically the claim by the conservative government that it cares for and has been generous to the NHS. John Lister reminds readers of the long history of campaigners fighting to defend and improve services, going back to the 1970s. This book should help inspire new generations of activists as well as stimulate the development of novel strategy and tactics. The question is raised that If the mission of the NHS is to put the equity of health and wellbeing at the heart of all policy, how much more should this be true for the whole of society? Read the book and join the fight.
Co-chair Keep Our NHS Public