NHS for Sale: Myths, Lies & Deception (7 page)

All the mainstream parties hurried to declare their support for the Stevens plan and claim some ownership of it. It remains to be seen whether any of them is prepared to agree the additional level of funding he is asking for, or whether any extra money that is planned will be provided soon enough to prevent an escalating crisis from 2015 onwards.

In the run-up to May 2015 and the months to follow, it’s all to play for. We have an NHS to win back – or lose. Which will it be?

For 20 years successive governments have pursued a policy [for the NHS] that the public hasn’t voted for and doesn’t want.

The Plot against the NHS,
Colin Leys and Stewart Player

For two decades politicians have introduced policies for the NHS that ran against the wishes of the vast majority of voters. These policies have been packaged up and sold to us as necessary ‘reforms’, a useful word suggesting improvements, although this has rarely been the case. They have justified their ‘reforms’ by a variety of myths about the NHS, which have become received wisdom for many people, including the media, and which are often no longer even questioned.

Before the 2010 election David Cameron promised no more top down reorganisations of the NHS and yet after the election his health secretary, Andrew Lansley, revealed to a bemused public the mother of all reorganisations, so big it could ‘be seen from space’. More myths were called for, explaining why the Health and Social Care Bill was necessary at a time when the NHS was rapidly improving with its highest popularity ratings ever. The HSC Act would give power and money to GPs to make the right decisions for their patients, patients would have more choice, the Act would reduce stifling NHS bureaucracy and red tape and would save money in the process. Choice would be improved and efficiency guaranteed by outsourcing NHS care to the carefully named ‘independent sector’ but this absolutely did not mean that
the service was being privatised. The biggest myth has been that the NHS is expensive and inefficient leading to the useful and inevitable conclusion that ‘it can’t go on like this’.

All these myths have proved to be false, but they have been repeated so often that they are still masquerading as incontrovertible truth even as the evidence accumulates that they are manifestly untrue. This part of the book takes the myths one by one and exposes them for what they are – convenient lies to conceal the continued attempts by an alliance of politicians and commercial interests to dismantle the NHS as a publicly funded, publicly provided and publicly accountable service.

Each of the chapters dealing with a myth is preceded by a short introduction and a summary of the case against for those who might be unfamiliar with the arguments.

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The higher figure of £10bn, which has been widely cited in the news media based on Department of Health Accounts, is not strictly comparable, since it includes ALL non-NHS spending, including the costs of hiring agency staff to fill vacancies, and services provided by local government.

We cannot afford not to reform the NHS. All I care about is that we avert the crisis and give the NHS the support it needs for the future.
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Andrew Lansley

The NHS wasn’t broke and it didn’t need fixing.

John Lister

When the coalition came to power in 2010 the NHS was doing well. Waiting times were falling and outcomes improving, and the service was at its most popular with the public since surveys began. International studies confirmed it as a very cost efficient, equitable and effective service.

Andrew Lansley and David Cameron cherry-picked statistics about clinical outcomes in order to misrepresent it as a failing service, which allowed them to justify their massive and disruptive reforms.

The coalition and their supporters, including right-wing think tanks, also claimed that reform was needed because the NHS was unaffordable.

Although the NHS has been shown to be highly cost effective there is significant wastage, but this is in areas to which politicians and think tanks are deliberately blind. The NHS market in England, set up by Labour and enthusiastically pursued by the Tories, wastes billions of pounds a year but
brings no benefits for patients. On the contrary it replaces collaboration with competition, fragments the patient pathway and diverts scarce financial and clinical resources away from frontline activities. At a time of financial pressure it is an ideological indulgence, but no major political party is proposing to fully abandon it.

The NHS needs to concentrate on improving clinical outcomes and patient experience but it needs stability and adequate finances to achieve this. The Health and Social Care Act gave it neither but has rather plunged it into organisational chaos and financial instability. Longer waiting times, rationed treatment and demoralised staff mean that it is the patients who are paying the price.

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Successive governments have lied repeatedly about the NHS and their lies have taken many forms. They have lied by omitting important facts, they have buried them deep in documents that most people won’t read or they have published them when they thought no one was listening (‘a good day to bury bad news’). Increasingly they hide inconvenient facts behind ‘commercial confidentiality’ or they have just stopped gathering data all together so that they can claim with justification that they don’t have the facts. Then there is spin. When confronted with other people’s facts that need to be denied the political spin machine goes into overdrive and civil servants, whose traditional role was to provide reliable information, are now expected to defend indefensible government policy on the NHS. Finally, when lies and damned lies fail, you can always follow Mark Twain’s advice and resort to statistics.

Big lies were called for when the Tories arrived in government and announced their grand top down reorganisation of the NHS. When the Labour government left power in 2010 patient satisfaction levels were the highest since surveys began. Waiting times for inpatients and outpatients had fallen and outcomes were rapidly improving after more money had been put into the NHS for front line care. As John Lister has succinctly pointed out – the NHS wasn’t broke and it didn’t need fixing.

Andrew Lansley therefore had to justify his expensive disruption of the service and in his efforts to do so the first casualty was truth. He shamelessly cherry-picked statistics to prove that the country’s health outcomes were among the poorest in Europe. The media uncritically regurgitated his accusations and obliged him with banner headlines that
the UK rate of heart attacks was double that in France and that cancer outcomes were abysmal. The public was suitably alarmed and softened up for the next step, his massive Health and Social Care Bill.

Eventually academics pointed out that Lansley had taken liberties with statistics in order to paint the NHS as a failing service that needed to be rescued by his ‘reforms’. John Appleby, chief economist at the King’s Fund, wrote an article in the
BMJ
¹
which questioned Lansley’s assertions. He demolished the data on heart attack rates, pointing out that not only was the rate falling faster in the UK than in any other European country but had been achieved with less money, with France spending 29 per cent more on health care than the UK. He also showed that the cancer survival data had been cherry-picked and that far from the UK being the ‘sick man of Europe’ there had been significant improvements in survival rates, with the UK set to have lower death rates than France within a short time. But few members of the public read the
BMJ
and Lansley’s purpose had been achieved – voters believed the NHS was failing them and his reforms were needed to rescue it.

Along with the specific lies about outcomes, the coalition has waged a more general campaign against the NHS. They declared the service to be ‘unsustainable’, which naturally led to the conclusion that ‘we can’t carry on like this’ and the TINA defence of Lansley’s proposed reforms – There is No Alternative. Having frightened the public with dire tales of poor outcomes the politicians didn’t really need to be more specific or evidence-based and if they did they cited the cost of the NHS. It was too expensive and inefficient and in times
of austerity we couldn’t continue to lavish so much money on a failing health service.

But a major international survey showed them to be liars about this too. The Commonwealth Fund is a private US foundation that reports on health systems, using its own data as well as that from other international organisations.
²
Its 2010 report, involving 20,000 patients in 11 developed nations, found that the NHS was one of the most cost-effective healthcare systems with excellent access to care. Only New Zealand, where 1 in 7 had missed out on care because of costs, was cheaper and only Switzerland, spending 35 per cent more, gave better access. Despite the fact that these findings were widely known – and it would have been highly negligent for the Department of Health not to know about them – the government pursued their policy of lying about and denigrating the NHS.

In 2014 the Commonwealth Fund reported again, with an even better result for the NHS. This time it was ranked highest overall, using as criteria quality of care, access to care, efficiency, equity and healthy lives. Bottom of the list on almost all counts was the US system, managing to spend twice as much as other countries while getting worse outcomes and much worse access.
³
Politicians like Hunt were quick to claim credit for the Fund’s findings this time, although the success of the NHS was certainly achieved in spite of rather than because of their political interference.

Just as impressive as the top ranking was the fact that the NHS had achieved this while relatively under resourced. In the same year a report from the Office for National Statistics showed that the UK spent the least of the G7 countries (9.2 per cent of GDP) on health care, tying equal bottom with Italy.
⁴
An EU study reported that the UK was ranked 24th out
of 27 EU nations for doctors per capita, worse than Bulgaria and Estonia.
⁵
An OECD study showed that Britain had fewer hospital beds per person than almost any country in the western world (the second lowest of 23 European countries).
⁶
It was clear that the NHS was under resourced but still managing to achieve good results in a very cost-effective manner. The vested interests were not deterred and went on claiming that it was unsustainable and unaffordable, and the public began to believe them. Many in the media, led by the
Daily Mail,
were content to keep repeating government lies in their headlines, scaring patients and undermining NHS staff, who were trying to keep the service going under the relentless barrage of criticism.

In 2010 Cameron had appeared on pre-election posters promising that he would cut the deficit not the NHS, but this turned out to be another lie. The coalition government has subjected the NHS to financial hardship, described by its new CEO Simon Stevens as ‘the longest squeeze on NHS finances in our 65 year history’.
⁷
They have presided over an unprecedented slowdown in the growth of NHS funding, reversing the progress that had been made under the previous government. The so called ‘Nicholson challenge’
⁸
combined with other financial pressures such as PFI contracts are precipitating daily crises for patients and staff as waiting lists rise, treatment is rationed and A&E targets are missed.

A report by the King’s Fund in May 2014 warned that a financial crisis was now inevitable and that urgent action was needed to plug the funding gap. Increased spending on the NHS between 1997 and 2010 had pushed the NHS budget up from 5.2 per cent to 8 per cent of GDP but the King’s Fund
warned that this was heading back down again to 6 per cent by 2021 if nothing changed.
⁹
The Nuffield Trust followed suit a couple of months later, noting that it was becoming more and more difficult to find further ‘efficiency savings’, many of which had been at the expense of staff pay freezes and management cuts. They pointed out that the sums involved were not large – the overall trust deficit was just £100m for 2013-14. They also might have mentioned that while frontline care was clearly suffering under the financial squeeze the Treasury had clawed back a £2.2bn ‘underspend’ from the NHS in 2013, and £1.4bn the previous year.
¹⁰
It was notable that the government was quite prepared to see patients suffer while NHS money was returned to the treasury, and that while able to bail out bankers to the tune of billions the government chose not to do the same for the NHS for relatively trivial sums. It began to look to campaigners as though the government was deliberately running down the NHS, calling to mind Chomsky’s observation about how to privatise a public service: ‘That’s the standard technique of privatisation: defund, make sure things don’t work, people get angry, you hand it over to private capital.’
¹¹

There were many prepared to propose solutions to the NHS financial crisis. Simon Stevens, new CEO of NHS England, deplored the state of NHS finances in his NHS
Five Year Forward Review
and talked about saving money through the usual buzzword bingo of modernisation, embracing new models of care, and shifting work out of hospitals. Thinktanks, some captured by corporate interests, were ready with answers that typically involved up-front patient charges, which would require a radical overthrow of one of the
founding principles of the NHS.

The think tank Reform was keen to recommend charges for NHS services ranging from GP visits to ‘hotel charges’ for hospital inpatients.
¹²
Lord Warner, a member of the Advisory Council of Reform, co-wrote a
Guardian
article backing Reform’s recommendations, in which he attacked the NHS as unaffordable and ‘often poor value for money’ (having presumably failed to read the Commonwealth Fund report). The solution according to Warner (among other equally unsavoury non-evidence-backed recommendations) was a £10 per month NHS membership scheme.
¹³
Apparently it hadn’t occurred to him that while £120 per year was a trivial sum for a peer (rather less than half the £300 daily attendance rate at the House of Lords) it might well look like an unaffordable amount to many on low (or no) income relying on the NHS for their care.