Published in Tribune 30 March 2007

Suresh Pushpananthan argues that the NHS, once Labour’s electoral trump card, has become the Party’s Achilles’ heel.

In 1997 Labour inherited a sick NHS. After ten years, shouldn’t it be time to take it off the critical list? A recent poll by Ipsos MORI suggests that the public still think there is a long way to go. There is a general perception that the health service remains in a state of crisis. Reports that the NHS is flush with cash are drowned out by the cacophony of complaints about poor facilities, incompetent managers and cuts in services. Polling shows that hospital patients are overwhelmingly satisfied with their treatment – but voters who haven’t used hospitals are unreasonably dissatisfied. How did the government get into this predicament?

On one level, it seems unfair. When Labour came to power, ministers were told the NHS was underfunded. So they doubled its budget. They were told patients were waiting too long for elective operations. So they slashed waiting times. In England, very long waits for in-patient procedures have been eliminated; the longest queues have fallen from eighteen to under six months.

Ministers were told heart disease, cancer services and treatment in A&E departments were substandard. So they made these a priority, invested heavily and used the crude, but powerful tool of targets to improve care. Ministers were told the NHS needed more clinical staff – there are now 25,000 more doctors and 80,000 more nurses than in 1997. They were also told that staff were underpaid – today medical and nursing salaries in the UK compare well with those of almost every country in the world bar the US.

So why all the negative headlines when the very real accomplishments above cannot be disputed? It seems we are witnessing a real fall in confidence about the NHS, with people feeling it is getting worse rather than better. But when you look at patient experience, it is slowly improving. Polling shows that patients using the NHS are consistently happier than the public at large.

So what should Labour have done better over the past decade? The Government has been the architect of some of its own woes. At least some of the current financial strains could have been avoided if budgetary discipline had been imposed earlier. The need to change the shape of care and reduce hospital costs could and should have been pushed through when the extra money was flowing in, not just at the point where it was about to be turned off.

There were large pay hikes for hospital doctors, GPs and other staff. It was ambitious, not to say foolhardy, to try to transform the pay of more than one million staff simultaneously. The new GP contract, which has some beneficial features, was offered on extravagantly generous terms. The NHS has paid out a fortune, and at the same time achieved the seemingly impossible by infuriating the staff in the process.

Another serious charge is of hasty and sometimes inconsistent reform. Labour dismantled then resurrected a market the party inherited. It invented new primary care groups, remade them into primary care trusts, then merged them again into half the number. It demolished regional health authorities, put in 28 strategic health authorities, and then merged them back down to the ten original regions. The Government is moving towards a market in healthcare at breakneck speed, and yet huge issues about how that market will be regulated remain unresolved.

Failure to secure value for money is what the Tories will attempt to pummel us with at the next general election. Ever since the Government opened the spending taps, ministers have felt vulnerable to the charge that they are securing poor value for taxpayer’s money.

There is further trouble on the horizon with the reconfiguration of hospital services. The political impact of these reforms has the potential to dwarf all the difficulties to date. Previous governments have chickened out of necessary hospital closures, aware of the widespread criticism they are likely to provoke. Closures may be the right thing in some circumstances – but perhaps not now, when they will be portrayed as ‘cuts’ to meet Labour’s deficits. The next general election is likely being planned for May 2009. This leaves little time to ensure that major changes, such as downgrading of accident and emergency departments, are completed before the countdown to election begins. What is more, from April 2008 the period of big investment – more than 7 per cent per year every year in real terms since 2000 – will cease. That means the unattractive appearance of a service struggling to meet demand, without the excuse of being chronically underfunded.

Given staff disillusion and public distrust, the question now is whether there is time for the tough decisions to be made and for change to be embedded, before all is swallowed up in the political whirlwind of a general election.

Some of the negative polls, which seem to suggest that the public trust the Tories with the NHS more than Labour, reflect a reluctance to credit an increasingly unpopular administration with anything. But as Gordon Brown is smart enough to realise, there is no future for a government that blames the public for its unpopularity.

It is now ten years since Tony Blair told voters they had 24 hours to save the NHS. By the time of the next election, Labour must ensure that it is credited with the improvements that have undoubtedly happened in the NHS. Labour inherited a crippled NHS from the Conservatives. After ten years under Labour, the NHS is off the critical list, but it still requires a long period of rehabilitation.

The NHS over the past decade facts and figures

1997 2007
NHS budget £34Bn £92Bn
Waiting list 1,150,000 720,000
NHS total staff number 1,030,000 1,330,000
Number of qualified nurses & midwives 320,000 398,000
Number of health care assistants 138,000 225,000
Number of doctors in NHS 102,000 127,000
Number of managers 21,000 38,000
Newly qualified nurse salary £12,385 £19,166

(Source Dept of Health)

  • 71% of people say they have had a good experience of the NHS.
  • 25% of voters think that the NHS has improved since Labour came to power.
  • 30% think it has got worse.
  • 39% think Labour has made little difference

(Source:ICM).

Suresh Pushpananthan is a specialist registrar neurosurgeon, lecturer in neurosurgery and a member of the Central Council of the Socialist Health Association.

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