Shadow secretary of state for health and social care Jonathan Ashworth tells Richard Angell and Conor Pope his plans to invest in and reform the NHS so that it can face the next 70 years
On 5 July 1948, at Park hospital in Davyhulme, Trafford, Labour health secretary Aneurin Bevan met a 13-year-old girl suffering from a serious liver condition. She was the first patient of the newly-created National Health Service, which was being rolled out that day. Almost all of the United Kingdom’s 3,000 hospitals were being taken under control of the new system, and by the day of the launch, 94 per cent of the population had registered with the NHS.
70 years on, and the NHS has become an institution, to the point where people see it as an integral component of modern British identity.
‘It’s what makes people proud to be British,’ shadow health secretary Jonathan Ashworth tells us when we meet him in his Westminster office. ‘We saw it celebrated in that marvellous, wonderful opening of the [London] Olympic Games in 2012’ – when the NHS logo was lit up in the middle of the opening ceremony at the Olympic Park, beamed out as a beacon to the world of what we are proud of in this country.
The television commentator for the event even quoted Bevan during the section: ‘No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.’ It could have felt propagandistic, but because of the genuine level of affection in Britain for the NHS as both an institution and a principle, it felt entirely normal.
Why is it that British people feel this, in a way that very few other countries appear to feel for their healthcare systems? It is partly the universalist aspect of it, explains Ashworth. ‘Everybody, every single one of your readers, has been touched by the NHS,’ he says, and that taps into a greater feeling of security. ‘It is the relief of burden, it’s the relief of anguish; that you know, when your child is ill, the NHS is there for you.’
It is partly that strength of feeling from the public that has sustained the NHS for so long, and why the Conservatives now cannot afford the electoral blow of being seen to be actively opposed to its core fundamentals despite, as Ashworth points out, having initially ‘voted against it 21 times’.
Yet, exactly 70 years after Bevan visited Park hospital, the mismanagement under the Tories over the last eight years leads us to ask: will it last another 70?
‘That is definitely the question,’ concedes Ashworth, forlornly. He notes that his opposite number, Jeremy Hunt, recently became the longest serving health secretary ever – to widespread bemusement, given the state of the health service. ‘The question isn’t the survival of Jeremy Hunt, the question is will the NHS itself survive?’
‘The NHS is in crisis on its 70th anniversary. It really is in peril. It will, again, fall to a Labour government to rebuild and restore an NHS there for every family when they need it. As it always has done throughout our history.’
He points to the not-so-distant past to prove his point. ‘It’s always been Labour government who have stepped in to save, to restore, and to rebuild the NHS. Of course, the most recent Labour government more than doubled the investment in the NHS,’ he says. ‘Tony Blair made the NHS, and rebuilding the NHS, one of his big, signature key priorities. We more than doubled the investment. We had some of the lowest waiting times and highest satisfaction ratings on record.’
The comparison between this far into the Tory government and the beginning of Labour’s third term is not particularly favourable for Hunt: ‘Eight years into a Labour government, we were well on the way to some of the lowest waiting times. Compare that to eight years of a Tory government. We’ve got waiting lists at four million … We’ve got two and a half million people waiting beyond four hours in an A&E. We’ve got 26,000 people waiting beyond two months for cancer treatment. Our mental health services have been absolutely cut back.’
And, despite what you may have read on the side of any buses, Brexit will exacerbate these problems. A key area is staffing, where the NHS currently runs on a model that is dependent on freedom of movement.
‘We already have a hundred thousand vacancies across the NHS. We’ve already got vacancies for 40,000 nurses and midwives, and 10,000 doctors. The [Institute of Fiscal Studies] predicts in the next coming decade an additional 179,000 more staff [will be needed] in the NHS.
‘We are absolutely reliant on EU staff in the NHS and the social care sector. Over a hundred thousand EU nationals work in the NHS. We desperately need them to stay. They are valued. They are a valued part of our society, as well. They should never be felt, or used as bargaining chips. They are people who are part of our community, contribute to our community.’
It is not just staff, though. As we are learning with all areas of trade and border, alignment with Europe on all sorts of regulation is now in doubt, and Ashworth says Labour wants to maintain the current relationship as far as possible.
‘I went to Brussels. I said that we would seek to align ourselves with the European medical agency. We want to stay in it, or at the very least align ourselves with them. Because you could have a situation where you have a major accident or attack, or some major trauma in the UK. Emergency medicines and equipment is delayed at the borders, we can’t import it in. Or you could have a situation where, because of delays in checking medicines at the borders, our chemists have got empty shelves. It’s going to have a huge impact on the NHS, Brexit, as well as the staffing issue.’
He is adamant that sorting out funding is the priority. ‘It’s clear that we need a long-term plan for significant extra investment in the NHS. We did it when we were last in government. We more than doubled the investment going into the NHS.’ That is why Labour is committed to raising investment by ‘£9bn extra a year’. The ‘Brexit dividend’, however, announced by May and Hunt last month, will do little to help: ‘It is not enough [money] to deliver the radical improvements in cancer outcomes and mental health outcomes we want.’
Also among the throng of pressures on the NHS is changing demographics. In the early years of the health service, ‘the challenges facing that NHS were completely different to today. In them days, life expectancy was so much less.
‘Children are no longer taken from us, generally, because of diphtheria or polio or [tuberculosis]. We are living with a society, or we’re living in a society where people live longer with these various complex needs, right? The NHS has to change to respond to that.’
That has led Ashworth to look, not just at rolling back the recent disastrous reforms, but at innovation too. ‘There’s lots of exciting opportunities coming down the track for the NHS – from artificial intelligence to bespoke nutrition to big data to the way the internet of things can help people manage their own healthcare in the future.
‘But at the moment capital budgets have been raided in the NHS for years. We’ve got a £5bn backlog of repairs … one of the things I’m looking for is a big investment in the infrastructure in the NHS and a big investment in equipment.’
Yet we will have to run before we can walk, and scrapping the 2012 Health and Social Care Act will have to come first. On this, there appears to be widespread unanimity. ‘As [former Labour health secretary] Alan Milburn said’, references Ashworth, ‘the Health and Social Care Act has created a sort of no man’s land of structures not fit for purpose.’
‘Ultimately, you’ve got to bite the bullet in getting rid of that [2012 Conservative health secretary] Andrew Lansley act. By doing that, we can also drive out privatisation of the NHS, because something like £9bn of contracts are now going to the private sector. You’ve got this crazy and offensive situation, where if Virgin Care doesn’t win a contract, they sue the NHS, and force the NHS to pay out over a million pounds.’
It has also led to an increase in health inequality. ‘A child in Blackburn, Lancashire, is five times more likely to be admitted to hospital for tooth decay, oral problems, than a child born in Jeremy Hunt’s constituency. A child born in the very poorest areas of the country right now, this minute, is less likely to get the immunisations they’re supposed to get as they grow up; is more likely to leave school obese; is more likely to have to turn to child and adolescent mental health services at some point in their life; if they are very, very, very poorly as a small child, is less likely to survive.’
This brings him to one of his big visions for the next 70 years of the NHS: essentially, investment in early years healthcare. ‘One of our big ambitions is [not just] to narrow these health inequalities, but to move to a society where we have the healthiest children in the world. It’s quite a big ambition, but I think you have to be ambitious for children. Because we know that if you invest in children’s health, that means healthier adults, which in turn means less pressures on the health services in the future.’
And once more, we are left reflecting on why the NHS – or ‘our NHS’, as so many of us think of it – is so important to us. ‘It is for me the greatest and most powerful engine of social justice our society has ever seen. It’s probably the greatest socialist achievement of any Labour government, and it’s certainly one of the causes that I think makes every Labour party member proud to be a Labour party member.’
Richard Angell is director of Progress. He tweets @RichardAngell
Conor Pope is deputy editor of Progress. He tweets @ConorPope
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