This week, emergency wards in England will be empty of junior doctors for the first time since the creation of the NHS. This is the sorry endgame to the dispute between the British Medical Association and health secretary Jeremy Hunt over the imposition of a new contract on junior doctors. Public opinion has (so far) remained firmly behind the junior doctors. In gambling that the British people would take the word of a politician over that of thousands of doctors when it comes to patient welfare, Hunt has taken a leaf straight out of the Labour party Handbook of Unnecessary Own Goals. But this is not just an opportunity for Labour to make short-term political capital. The underlying reasons for the strike reveal fundamental problems with the NHS which need to be addressed.
Making good on the Tory manifesto pledge ‘to deliver a seven day NHS’ is not the cause of the dispute, much as Jeremy Hunt would like us to believe otherwise. Delivering all NHS services to the same level throughout the week would require a reorganisation of every part of the health service – not just junior doctors who already put in substantial hours at weekends. It would also need funding far beyond any amounts that Hunt could currently pluck from the chancellor’s closed fist. Meanwhile, research pointing to higher death rates among patients admitted to hospital at the weekend indicates that it was the not the unavailability of junior staff on Saturdays and Sundays that was to blame, but the lack of consultants.
The real point of the new contract seems to be to grind even more out of a group of people who already work long hours in punishing conditions, all for a pitifully low hourly rate. This forms a consistent part of the government’s plan to eke the most out of the NHS, while handing out the minimum amount of resources necessary to keep it going.
Nevertheless in the short term, and at a very superficial level, this has been a reasonably successful strategy. Labour went into the 2015 election determined to ‘weaponise’ the issue of the NHS. Polls indicated that worries about the health service were of crucial importance for voters, and this was one of the few areas in which Labour was trusted a great deal more than the Tories. But we ignored the fact that around six months prior to the election patients had reported near-record levels of satisfaction with the health service. Labour’s hysterical rhetoric must have jarred with many voters whose personal experience of the health service had been positive.
A year later, the effects of underfunding are becoming clearer. Of 138 hospital trusts, only seven are not in deficit. Waiting times in Accident and Emergency have not hit targets since 2013, with the worst miss coming last February. The latest patient survey has shown a sharp fall in satisfaction. Labour is right that creeping privatisation, the fragmentation of care and pointless reorganisations are not helping the health service, but we should be honest enough to acknowledge that the deeper problem is that the population of Britain is changing, becoming both older and unhealthier – and therefore much more expensive to treat.
Ageing is to be celebrated – it is the triumph of science over illness. But the drugs to fight disease cost money, as does the care needed to look after the frail. The slashing of social care budgets has led to the excruciatingly perverse situation where healthy patients are forced to stay in expensive and inappropriate hospital beds because there is no one to look after them outside. Combining social care and health budgets (currently being trialled in Manchester) allows resources to be allocated more efficiently between the two areas but it does not increase the overall size of the pie. Money to pay for more social care is money removed from already cash-strapped hospitals.
An unhealthy population is obviously not a cause for celebration, but dealing with it involves carrying on the uncomfortable debate started by the introduction of the sugar tax about how far the government has the right to intervene in the lifestyle choices of its citizens.
There are some hard and possibly unpopular decisions to be made. NHS chief executive Simon Stevens recently called for a cross-party agreement on finding ‘a settled and durable new political consensus’ for the health service. This suggestion should be heeded. The temptation on all sides is to score points rather than acknowledge that without radical change, the NHS is slowly crawling towards a future as a third-rate service only used by those unable to afford private care, as it was in the 1990s. It will soon be time to save it – again.
The NHS is Labour’s proudest achievement. However, we should remember that the Beveridge report which led to its creation was written by a Liberal under a Conservative-led government – in other words it was the product of the kind of cross-party consensus Stevens is calling for now. This week too Heidi Alexander, with her proposals on the junior doctor contract, has shown it is possible to bring different parties together behind constructive proposals.
We should also remember that only the Labour party was trusted by the British people to fully implement Beveridge’s recommendations and in 1945 they rejected Winston Churchill the war victor to vote the transformational Attlee government into power.
The doctors’ strike has put the NHS at the front of the public’s mind and highlighted the inadequacy of the Tory strategy of providing only sticking-plaster amounts of funding. Labour should now have the courage to take the lead in working with other parties to find durable, radical solutions to the long-term problems facing the health service, and trust that only the party that created the NHS will be seen as capable of delivering the solutions to save it.
Christabel Cooper is a member of the Labour party and writes for Progress here
Progressive centre-ground Labour politics does not come for free.
Our work depends on you.