The NHS is not a question. But the British media wants to make sure it is.

The answer to making the NHS work is more money spent properly. That's it.

Previously: Columnist brain (non-fatal but chronic)
Why no one should be a columnist and if they must there should be term limits.

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The NHS was founded 75 years ago today. In a weird framing, most of the coverage of that milestone talks about it being the NHS’ 75th birthday. The NHS is a state institution. It is not a pensioner enjoying a nice slice of cake and a cup of tea. The “birthday” idea coupled with bizarre events like the church service in the NHS’ honour — another opportunity for Rishi Sunak to skip PMQs — add to the general feeling that debates around the health service are ludicrous.

This morning, the top headline on BBC Radio 4’s Today programme was a letter from health think tanks saying that the NHS must change or die. Unsurprisingly, the programme didn’t connect that statement to the billions of pounds stolen and wasted during the Covid pandemic nor did it spend much time on the fact that the NHS has been in accelerated managed decline since the Tory/Lib Dem coalition came into government in 2010.

The newspapers, radio phone-ins, and TV shows have dedicated lots of column inches and airtime to hyperventilating about whether “the NHS can survive”. The answer can be found in two paragraphs from the Kings Fund’s position on NHS funding, which explains bluntly:

Historically, NHS funding has faced a ‘boom and bust cycle’, with periods of under-investment followed by rapid growth in spending. In the decade following the global financial crisis in 2008, the health service faced the most prolonged spending squeeze in its history: between 2009/10 and 2018/19 health spending increased by an average of just 1.5% per year in real terms, compared to a long-term average increase of 3.6 per cent per year. These pressures were not unique to the UK, whose public spending on health care as a share of GDP is above the EU average, though lower than several comparable nations, including Germany, France, Denmark and the Netherlands.

This funding squeeze led to trade-offs between different areas of health expenditure; spending on buildings, equipment, investing in training more staff and prevention was deprioritised in order to pay for the day-to-day running of services such as staff and medicines. This was a false economy that stored up problems for the future. 

The money spent on the NHS has been poorly distributed and has reduced year-on-year since 2010. That’s a simple answer but it’s not the one the British media wants to give us. Instead, the principle of ‘‘free at the point of need” is being undermined in a rhetorical assault across the airwaves, online, and in print.

Anthropomorphic leather handbag, war crimes enabler, and former PM, Tony Blair is, to quote The Thick of It, all over the newspapers like a pissing puppy and — surprise, surprise, surprise — he’s banging the drum for more private sector involvement in the NHS. What else would you expect from the man whose government went all in with Public Private Partnerships that continue to see the state pay vast amounts to private companies decades after they built hospitals that started falling apart within months of their construction?

Under the headline Tony Blair urges expanded role for private sector as NHS turns 75, The Guardian reports:

The NHS must undergo radical change or it will continue to decline and lose public support, Tony Blair has argued on the service’s 75th anniversary.

It must embrace a revolution in technology to reshape its relationship with patients and make much more use of private healthcare providers to cut waiting times, the former Labour prime minister says.

The prevalence of chronic health conditions, long waiting times, the NHS’s stretched workforce and tight public finances in the years ahead mean the service must transform how it operates, he said.

“The NHS now requires fundamental reform or, eventually, support for it will diminish. As in the 1990s, the NHS must either change or decline,” he writes in the foreword to a new report from his Tony Blair Institute thinktank, which sets out ideas for safeguarding the NHS’s future. 

Every part of Blair’s premise — and the bought and paid-for conclusions of that ziggurat to his ego, the Tony Blair Institute — is built on sand. The prevalence of chronic conditions, the long waiting times, the stretched workforce, and the tight public finances are all products of underfunding and short-termism. Of course, Blair — a man who never saw a bit of privatisation he didn’t like — thinks the solution is vague handwaving towards ‘technology’ (in this case a synonym for ‘magic’) and selling off chunks of the NHS to “private healthcare providers”.

Elsewhere in the paper, The Guardian’s editorial says:

Doctors’ strikes this month will cause disruption, but the public recognise them as a distress signal and a majority support them. The workforce plan announced last week is years overdue, and the £2.4bn attached to it cannot make up for years of cuts. This year’s 1.2% increase in NHS England’s budget is less than a third of the roughly 4% annually that is widely accepted as necessary to keep pace with demographic and technological changes in countries like ours.

It recognises the key point — the NHS is grossly underfunded — but gives the false and self-serving statements from Blair and his think tank lots of space. The NHS is being strangled but even the papers that still kid on that they are ‘of the left’ accept arguments that suggest that it’s standing on its own windpipe.

In The Telegraph, the execrable Gordon Rayner has the cheek to imagine what Aneurin Bevan might think about the current treatment of the NHS:

… Bevan did not hold back when he met the first National Health Service patient, 13-year-old Sylvia Beckingham, on the day the NHS was launched in 1948. The creation of the NHS was “the most civilised step any country has ever taken”, the health minister told the little girl being treated for a kidney problem.

Today the NHS celebrates the 75th anniversary of that encounter, which happened at what is now Trafford General Hospital, near Manchester. It marked the formal opening of the first healthcare system in the Western world to offer free medical care to the entire population.

What, though, would Bevan have made of what the NHS has become? As bloated as many of its patients, it gobbles up an ever-increasing share of the nation’s wealth, is allergic to reform and has become such a gargantuan bureaucracy that it risks collapsing under its own weight…

… Whether the NHS survives long enough to celebrate its next big anniversary will depend on political will. As Bevan said: “It will last as long as there are folk left with the faith to fight for it.”

The cheek of a writer in a Tory fanzine like the Telegraph trying to summon the ghost of Bevan to support his arguments is particularly obvious when you recall the Labour MP’s words from 1948 when he said:

So far as I am concerned [the Tory Party] are lower than vermin. They condemned millions of people to semi-starvation. I warn you, young men and women, do not listen to what they are saying, do not listen to the seductions of [Tory chairman] Lord Woolton. They have not changed, or if they have they are slightly worse… for what is Toryism except organised Spivvery?

One of the ‘modern’ Tory Party’s proponents of organised spivvery, Sajid Javid has received blanket coverage — including supine attention from BBC News — for his demand that there be a Royal Commission on the future of the NHS. The missing element from these reports is any substantive discussion of Javid’s connections to private health companies.

Two years ago, while Javid was Health Secretary, the Daily Mirror revealed he held shares in a Californian firm shilling AI ‘solutions’ for healthcare. He was one of twelve Tory MPs with oblique ties to private healthcare firms. Labour research revealed the links but it is hardly clean; Wes Streeting — the Shadow Health Secretary — who consistently argues for further ‘reform’ of the NHS, with a heavy emphasis on greater private sector involvement, took a large donation from a shell firm linked to a donor with major private healthcare interests. Other Labour MPs joined him in this wheeze.

The BBC’s Health Correspondent, Nick Triggle, a man with a disgraced children’s entertainer name, nods to Javid’s views in a piece headlined NHS 75: Happy birthday - but can it survive to 100? He writes:

The NHS turns 75 on Wednesday, but the landmark anniversary has been greeted with dire warnings it is unlikely to survive until its 100th birthday without drastic change. So what is the solution? From sin taxes to cutting back on medical treatment for the dying, experts have their say.

When the NHS was created the main focus was on short bouts of treatment for injury and infection, but now the challenge is completely different.

The ageing population means huge numbers of people are living with chronic health problems, such as heart disease, dementia and diabetes that require long-term care and for which there is no cure.

It is already estimated about £7 out of every £10 spent in the NHS goes on people with these conditions. On average, those over 65 have at least two.

The tone is common to a lot of the pieces about the NHS published to coincide with the anniversary: victim blaming and hand-wringing. The solution is funding at the correct level spent on the right things but that makes for less dramatic copy, so we get Triggle pondering “sin taxes” and more suffering for the dying. There may be cures for heart disease, dementia, and diabetes in the medium or long term, and it actually behoves the BBC’s Health Correspondent to question the motivations of “dire warnings” about the NHS’ future.

Many of those crying crocodile tears for the NHS resemble nothing so much as relatives hoping the death of a family member is sped up so they can get on with selling the family silver. The ‘question’ of the NHS’ future is only ‘complicated’ for those who want to ensure its managed decline is hastened. Writing “spend more money, waste less, and put it into the right things” doesn’t hit the word count, or produce conclusions that please donors and disaster capitalists.

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