I am speaking at the same Royal Society of Medicine conference as Professor Stephen Hawking today. I make no pretence that I will offer anything as notable as he does, and am in any case sharing a panel discussion with at least four others and so have just four minutes at most to introduce my theme on how the NHS reached its current state. This is what I propose saying:
We have an NHS for three reasons.
The first is human compassion: I suggest that it is our natural pre-disposition to wish to relieve suffering in others.
Second, after World War 2 a unique confluence of sentiment, circumstance, political will and Keynesian economic thinking allowed a radical transformation of health care provision in the UK.
Third, people liked the outcome and are deeply reluctant to let it go.
That, however, has not stopped people trying to abolish what has worked so well. The result of their efforts is an NHS in crisis.
This crisis is not necessary: it is the result of the deliberate attack by neoliberal politics on the NHS. Neoliberal politics and the economics that underpins it assume three things.
Firstly, it says that all human beings are simply rational economic actors, reducing all decisions to an assessment of personal advantage.
Secondly, it says that only markets can in that case respond appropriately to the reality of human decision making because they alone allocate resources on a strictly competitive basis.
Thirdly, and consequentially, it argues that the size of the state must be shrunk because it has no role in supplying services that the market might deliver more efficiently in accordance with the spending wishes of consumers, including healthcare.
Neoliberals do, however, know three further things.
The first is that people don't want to give up the welfare state: they really rather like it.
Second, they won't as a result directly vote for neoliberal programmes.
And so, thirdly, neoliberalism has to be delivered by subterfuge. The irony of this — which implies that people don't rationally know what neoliberals think they rationally want — is apparently lost on those promoting the cause.
Austerity is part of that subterfuge. It shrinks the size of the state. It happens to also shrink the economy. And it cannot also theoretically and practically work. But so what? Shrinking the size of the state is what matters. And so NHS budgets are cut.
Breaking up national services into small, vulnerable, local services is also part of the subterfuge. Vulnerability is key to competition. Who cares about inefficiency, cost and not meeting need? The option to fail must be built in to the system: competition demands it. So we get NHS localisation and fragmentation.
And the myth of informed patient choice is the third obvious subterfuge when most patients clearly want expertise and guidance and not to be left on their own to decide their fate.
As a result I stress that the NHS is where it is because of political subterfuge that is designed to undermine its very existence.
This subterfuge is being delivered by politicians too frightened to admit to the reality of their programmes.
They are also too indifferent to society at large and to those who now suffer as a result to admit that their actions are driven by a political dogma that can only serve the interests of the tiny minority in society who can ever have sufficient resources to exercise anything approaching choice in a supposed health care market.
They may think that they have been subtle about this. But there can be no subtle response. The NHS is on the frontline of political warfare and the casualty list — I use the term wisely - will grow unless neoliberalism is defeated.
That's why we're here.
And there is an alternative.
We restore the NHS by cancelling the 2012 Act.
And we pursue economic policies that are based on a true understanding that money is always available for public services if we want them and the resources exist to deliver them, which is true right now in the UK.
We can have the NHS we had.
We can have the NHS we need.
But we need to challenge the economics and politics that deny us that NHS.
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Not so bad in Wales. No small CCGs, only large Health Boards. No major purchaser – provider split, no internal market. However, the relative small size of Wales might mean that big private companies might try to seize the small part of NHS business that is subject to tendering.
Wales’s NHS is attacked by Conservative politicians who wish to score cheap and nasty pints. of course, it isn’t perfect. There are shortages and rationing eg by waiting lists.
The NHS is accountable to Welsh politicians, and they keep a close eye on it. Proposals for change are put out to consultation.
Further features of Wales:
– Community Health Councils still exist
– there are no prescription charges.
What’s not to like?
Much closer to the model I recommended
I was there both involved with my GP uncle and later on an Area Health Authority and some times trotting down to London to talk to civil servants. The paying for and funding and organisation of management may have changed in 1947 but the provision took a long time. Going into the early 1980’s by then many felt that the centralised grip of the NHS plus central control of funding meant that out in the sticks changes that might have taken place long before if local authorities and other local groups had been doing the deciding were not happening. In particular the gathering speed of new research and techniques were leaving much of Britain outside the teaching hospitals well behind. I recall vividly the frustration of many consultants at seeing patients die who might have lived. I also recall the stark choice of having to pay for new procedures because the NHS did not do them because London had decided that the mortality rates were acceptable.
Well said.
Part of the subterfuge has been to acclimatise people to the notion that the NHS as an inevitable failure. The constant stream of anti-NHS stories in the media and fake support (as opposed to weasel words) from politicians over the last 20 years or so have created the climate now where even many NHS staff appear to think the crisis in the NHS is an act of God, or just an inherent fact of life: ‘it’s the NHS isn’t it?’
When I point out to my NHS colleagues that the NHS is this way as a result of political choices made by this and previous governments i.e. it doesn’t have to be this way, they often express surprise. This is all the more incredible to me as I work in a hospital – which I have no reason to believe is in an unique situation – where the wheels are visibly coming off and seriously affecting the working lives of said staff as well as patient care.
I believe this attitude can also be partly put down to the (deliberately designed) lack of agency and the disempowerment people have come to accept as the norm in a society where there is constant change and yet nothing seems to go in the right direction or get better. People expect very little from government and politics, and would probably choke on their cornflakes if they woke up to news one day that showed the government really cared and was acting in their interest rather than putting the accustomed boot in.
Keep talking to them!
Moreover, in Wales, the junior doctor contract wasn’t changed, and, as far as I am aware, bursaries for student nurses are still in place.
Wales has this right
So much to say and so little time to say it.
I can hardly imagine that Professor Hawking will have the same impact!
I guarantee you he will
That’s simply more of your typical modesty again!
“And so NHS budgets are cut”
Have you got any evidence for that? – the overall budget is bigger than in 2010 in real terms. Perhaps you are thinking that the budget is less than you would like, but that surely is a different claim.
That is nonsense
That assumes static need and that is not the case
In that case your argument shows a complete lack of understanding
Are you claiming that the budget is less than in 2010 in real terms? Or less than 2010 when done on a per head basis in real terms?
Seriously – is that what you are claiming.
Apparently not – you are comparing it to ‘need’. So why the pretence of claiming there have been budget cuts. Why not be honest and admit that the budget has gone up and that the assertion ‘we can have the NHS we had’ is being delivered ( waiting lists the same as in 2007 for example ), it’s just that we are not getting the NHS that we now need because ‘need’ has gone up.
I am not getting a sense of consistency from you here.
The NHS has not funding it needs to meet demand
Bluntly, all you prove is your indifference by arguing otherwise, and your lack of empathy for those who suffer as a result, including NHS staff who have suffered badly
Healthcare spend as percent of GDP has been declining the UK since 2008 according to Worldbank figures.
http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?locations=GB
Clearly given the increase in demand we need to spend more not less.
Ignoring the ad hominem that I am not a very empathetic person, this still leaves hanging your claim that their have been budget cuts, your failure to support that claim, and your implied admission that there have been no budget cuts, just that funding is less than required to meet your needs.
Why would a Professor make a trip to the nation’s capital to make obviously outlandish claims that do not stand up to scrutiny?
In a healthcare system which is free to all the potential demand is unlimited while resources cannot grow sufficiently to keep up ( people, training etc, the unions not helping http://www.bmj.com/content/337/bmj.a748 ), and in the face of such constraints you can accept reality and ration on the basis of price, or you can have a queuing system.
Please note comments from Charles Adams who has referenced data whilst I have been otherwise engaged this afternoon
Please note the ratio is also of GDP slashed wholly unnecessarily by austerity
Now very politely stop wasting everyone’s time
No , still not getting it
I am aware that spending as a % of GDP is less than you would like, and less than in 2010 ( why is this the year for your baseline btw? ).
What I don’t get is why after several weeks of preparation would a Professor travel to London to make the explicit claim that “And so NHS budgets are cut” when Professor Charles Adams in his excellent link and many other sources tell you that it has not.
And why no rebuttal to the link I provided that resources are constrained because of the unions?
Because as Charles shows budgets have been cut
And as data shows, the NHS could and now cannot meet health demand meaning that the required budget (and no one is suggesting un-needed spending) has been cut
But you don’t care about that and want to play at pedantry
And I address real world economics – not pettiness
I stand by my claim
You will not get the right to reply
All true but the digmatic policies are already putting people’s lives at risk. The DoH puts out blatant lies. The tragedy is that the NHS could be an example for excellence globally; politically a tour de force.
I think it should be taken from the management of politicians. A dedicated N insurance based on income with access to other sources of income such as big business, local hospital friends’ subscriptions, lotteries, etc. could easily solve any financial problems. An expert commission could examine all aspects of the service.it would weed out the bureaucracy morphing into a managing body. Satellite committees would be answerable but largely autonomous. These bodies could be largely staffed by voluntary experts, retired medical and nursing staff.
I explain the funding issues in The Joy of Tax
I believe we need to remove the NHS market
We need to restore NHS strategic health authorities
Thank you for such clarity, underpinned by expertise. Would that politicians might learn to be so direct.
Interesting to compare this case with education and with libraries. Much common ground, though some differences: e.g. public libraries (free and staffed) are still required by statute but successive governments have chosen to ignore the law; both sectors less monolithic than the NHS; all three sectors render public services free at the point of use, which is an idea current politicians seem quite unable to cope with so try to introduce artificial ways of making the services into revenue-generating ones and the users into “customers” (previously known as patients, pupils and readers (or just users)).
Thanks
‘And so, thirdly, neoliberalism has to be delivered by subterfuge. The irony of this — which implies that people don’t rationally know what neoliberals think they rationally want — is apparently lost on those promoting the cause.’
SPOT ON.
The Austerity Con is being delivered by an unholy alliance of ideologues & spivs. The spivs know Neoliberalism is bogus economics, but don’t care, as they will profit: the ideologues desperately hope it is true but don’t care about the consequences if not.
The conundrum for them now, as the cat’s well and trully out of the bag, is to either abandon it & stay in power, or carry on & be turfed out. Last time, plan B (B for Blair) worked. Surely not this time.
Population growth 2010 to 2016 =4.603%
Inflation (various measures) = between 16.25% & 23.15%
Budgets therefore need to have increased by between 21.6% and 28.9% to standstill
Factor in a aging population; those above 65 years old = 7.53%
Have NHS budgets kept up with this minimum requirement?
No
Very good to hear that both Hawking and yourself are making the case for the NHS. According to the data it is being starved of resource (spending declined from 9.8% to 9.1% of GDP between 2009 and 2014). This is a crime committed by the governing elite on their own people. The Naylor report plan to sell the land under our hospitals is another crime.
@Charles Adams
Why have you chosen 2010 as the baseline for your comparison ( given the massive expansion of public expenditure in the previous 2 years ), and not say 2003-2004 as some sort of mid-point of the last Labour government era?
Just asking, with you being from a scientific background.
Do you always propose uaing random data to test a particular hypothesis?
If the name you’ve made up (smoking a large one) is indicative of your intellect, it’s no surprise you’re losing the argument
We might as well call the neoliberal elite for what they are, robber barons. The rich pickings of the NHS are being gifted to them by their Tory mates. Brexit will make the process easier and faster.
Glad that you are adding your weight to the NHS lack of funding debate Richard. I have personally been affected by this earlier in the year when I developed a condition requiring an operation. I asked the ‘waiting list office’ in February where I was on the list, ‘you are not on the list as it is more than 3 months long’ I was informed. So, this means I would remain in pretty dire discomfort with attendant infections to possibly sometime beyond June or July. Of course, I inquired about private options and had the procedure done by the exact same surgeon and location on a Sunday (as the operating theatres were not used for NHS work on that day) mid April. The hospital runs a private facility (clinic) in the hospital and they say that they plough the money back into the general funding. I have no idea if this is a good idea or any better than simply going to the best expert in the field elsewhere.
This cost me £5,600 which as it happens I could afford, although if I did not have the money I would have taken out a loan as the situation (AUR) was that bad. The surgeon kind of apologised for this necessity and thankfully I have come out at the other end fixed, but I should not have had to pay and I am fuming about that loss of money and wonder how I should add my effort to the debate as I have contributed to the NHS every single working day since September 1969. My sitting MP is a Tory who to be fair has made some effort on my behalf but what chance have I of influencing him in reality?
Little, I fear
Tory culture is inherently pro market
I admire your courage having an op on a Sunday. I hoped you checked there was enough ITU cover
You can do a lot more than nothing, Ian. You can join your nearest NHS campaign. If there isn’t one, you will need to start it yourself, after you have done some research. You will find excellent resources at the Health Campaigns Together site, a platform for the many campaigns across England which are fighting for the NHS. You can use the information at this link both to brief yourself and to inform your local MP and councillors. http://www.healthcampaignstogether.com/redzone.php
The councillors now have skin in the game because local authorities are to partner with their local NHS in the 44 Sustainability and Transformation Partnerships in England.
The NHS is also poised to sell off billions of pounds of publicly owned land and buildings in the next few months, as per the Naylor report – here are the questions you should be asking about it; http://www.healthcampaignstogether.com/pdf/Comments%20and%20Questions%20on%20Naylor.pdf
Thanks for that info, I will take action on that.
One of your commentators (at 4.00pm) suggests you are excessively modest. I have to concede that I have never noticed this on my occasional visits to your blog but I would be interested to know how your fluent delivery this afternoon compared with Hawkings and how both contributions were received.
I think my talk went OK.
Hawking was stunning and he got a standing ovation.
There was no comparison.
From a psychological viewpoint (Attachment Theory and all that!) Neo-Liberalism is pathological and its effects consequently affect health which in turn puts greater pressure on the NHS and in turn the need for greater funding. Ipso Facto not voting for Neo-Liberal political parties like the current Conservative Party would reduce pressure for greater NHS funding:-
http://dissidentvoice.org/2011/04/the-awful-revolution-is-neoliberalism-a-public-health-risk/
Richard,
I am happy you intervened successfully, but, man, you left it so late.
Smokin Galargeone ,
I think you do not know what a budget is, and that makes your argument silly. A budget in my company was what we estimated would be needed to fund the next year or three on the basis of what would allow us to operate effectively as a firm. Any reduction would distress the firm and its customers and would indicate a failure to either have planned properly or to operate efficiently because we did not have enough money.
The NHS should never have the latter problem as the Treasury has access to all the money the NHS needs. Reducing the budget is therefore a political act, not a fiduciary decision. It is as Chomsky says: “….the standard technique of privatization: defund, make sure things don’t work, people get angry, you hand it over to private capital.”
I left what so late? Talk about the NHS? Or responding to a blog?
If the former, not true: I was the fourth most active opponent of the 2012 Act on social media, single handedly
If a blog comment: I was also in a conference. Give me a chance
Your comment on budgets is spot on: I should have made it instead of implying it
Oops. Didn’t mean to offend. It is just that yesterday was a really powerful intervention, and this had not happened in the past three years. Consequently I chafed at your blog community addressing issues you were raising that were (IMHO) not nearly as scary as the destruction of the NHS.
Once again, my apologies for upsetting you.
You didn’t upset me
I’m still not sure which issue you were addressing though
The biggest myth going about the NHS is that it is a wasteful monolith and its financial crisis can be solved by better managing its resources and spending less on beaurocratic managers.
This view is widespread amongst those I speak to about it.
The NHS is the fifth largest employer in the world, and as such, requires significant backroom staffing to keep the cogs turning.
It is also the most cost-effective healthcare system among developed nations as regularly shown by studies from e.g. the Kings Fund. This in itself surely demonstrates that the NHS spends money, overall, wisely by delivering the best bang for buck in terms of important clinical outcome measures?
I do not deny that some waste and inefficiencies exist within the NHS, but surely this will always the case with any large organisation? I work for a large pharmaceutical corporation and I am regularly astounded by instances of what appear to me to be very poorly thought out and wasteful spending.
As for whether eradicating waste, if even possible, could address the financial mess the NHS is in, the answer is a clear no. This would barely scrape the surface of addressing increased financial pressures that come with an ageing population (old people consume significantly more healthcare) and expensive innovative new technologies and drugs.
The only solution, if we want to keep the universal free at the point of need coverage many hold so dear and avoid quality of care quickly moving backwards, is significant cash injections. We spend a relatively low and declining proportion of our GDP on healthcare compared to other European countries, so should be willing to spend more.
It is impossible to deliver a gold standard service on a shoe string budget.
Agreed
May I also suggest that the medical profession may be insufficiently equipped with managers of the NHS who are also physicians or surgeons (or nurses). This is understandable given the length of training already required in their professions, but I also suspect the profession is too “hands off” management, or at least direct responsibility for management of the ‘whole’. There are powerful interest groups within medicine about which the public, I suspect, know little. Perhaps there should be a post-graduate or post-training avenue for physicians and surgeons who would actually wish to take on the role of managing the NHS as a prestigous career, and could be more directly involved in arbitrating the big decisions often between the big interests of the various disciplines and empires in medicine.
I am not sure if this is entirely credible, but I think it worth airing.
The key problem is the type of management as much as too much management which is a product of neoliberal thinking (NPM) and revels in command and control thinking and focusing on compliance and box-ticking – and not patient care.
This is embodied in HR regimes which are aligned with the execs and not with the staff.
I entirely agree with that
The curse of measuring everything and valuing nothing
” it says that only markets can in that case respond appropriately to the reality of human decision making because they alone allocate resources on a strictly competitive basis.” — this argument has a convincing ring, but it turns out that it only works if all players in the market can command the same resources. Then players have to decide on what to spend/consume and one can argue that every player spends on what he wants most, so getting to a fair allocation. But, this argument does *not* work in an economy of rising inequality where a few players command more and more resources. — So, ironically for a neoliberalist, the argument in favour of letting markets allocate resources also, and necessarily, leads to an argument for more economic equality.
Precisely
In response to claims that funding has not dropped……. £42 BILLION will have been taken out of the NHS by 2020 by so called ‘efficiency savings’
see
https://en.wikipedia.org/wiki/Nicholson_challenge = £20 Billion
https://www.kingsfund.org.uk/blog/2016/01/nhs-focus-better-value-2016 = £22 Billion
[…] spent a whole day at an event talking about the NHS yesterday I think it appropriate to summarise what I learnt. What follows is not scientific. It cannot be […]
Dear Richard,
I live in the West of Scotland, but am from the far North. My twin brother and I developed serious heart problems, in fact exactly the same problems twenty years ago. Within a few miles of where I live is the Golden Jubilee Hospital, a centre of excellence in heart issues. I had very good treatment, there were subsequent difficulties but I knew I would never work again, after my mid 40s.
My twin, in the far North did not receive the same treatment at all as the nearest hospital to offer heart care was 130 miles away. He died 3 years ago. Essentially he lived in the wrong postcode area. Simply put down to budget cuts from successive administrations. I miss him greatly.
As I twin I genuinely feel for you
I saw my ‘other half’ this afternoon
And I have always sensed the injustice of another person not being the same way as me – from the time when one of us went to a grammar school and the other did not
Yours is worse though
Very good to hear your talk yesterday.
Repealing (as opposed to the pre-Corbyn NHS policy content in the latest Labour manifesto, which uses “repeal” to mean “amend”) the Health and Social Care Act is a necessary but insufficient step to reversing the Americanisation of our health service.
(One very good source I recommend on this: http://publicmatters.org.uk/2017/06/24/the-americanisation-of-the-nhs-happening-right-here-right-now/)
Implementing a version of the NHS (Reinstatement) Bill would begin to seriously address dealing with this. This was a commitment made by Labour last year under Diane Abbott at Labour conference but which has disappeared from official statements since Jonathan Ashworth took over the role.
Your talk was electric Richard, well done! We reached 20,000 today, please help us get more signatures. Thanks.
https://you.38degrees.org.uk/petitions/stop-the-plans-to-dismantle-our-nhs
Thanks for your contribution to the #TalkNHS event yesterday. It was so refreshing to have some plain speaking on the stage and your comments around think tanks were particularly welcome. They’ve been troubling our campaign for some time now. We’ve decided we’ve had enough of ‘independent’ think tanks so we’ve even started our own Think Paddling Pool.
This year 999 Call for the NHS decided that tackling the myths of neoliberal economics was key to the public understanding the need to restore the NHS to a pre-market model. We’ve started an ‘Austerity No More’ section which we’d like to include some links to your blog. Thanks again.
Steven Carne
You are welcome to use the material
Good luck with your work
Hi Richard congratulations on starting a much needed pragmatic debate one aspect I’d like to see given higher profile is workforce – I’ve been doing interviews with NHS CEOs and Chairs for our report on State of the State and without exception workforce is highlighted as their ‘stay awake’ issue – we need a rationale evaluation of the economic value of an engaged and appropriately funded workforce as central to the funding debate
I agree
Is your organisation willing to take part in pragmatic debate?
It’s the sheer scale of the cuts that have been made since 2010 that surprise me. They surprise me in that virtually no-one outside the NHS seems to care enough that it becomes a higher priority than, say, Big Ben’s bell being silenced or the sister of the future Queen getting married. The Daily Mail did run with a headline story earlier this year but it was silenced quickly with zero follow-up from the Mail’s usually good investigatory team.
Hunt and May have repeatedly said “no NHS cuts have been made” while their own government figures tell the truth. For example, Hunt’s recent announcement over mental health funding should be put in the context of inpatient mental health beds being cut by 21.7% since 2010 and 13.8% since 2015 (https://www.england.nhs.uk/statistics/statistical-work-areas/bed-availability-and-occupancy/bed-data-overnight/). It’s pointless having lots of new nursing staff in mental health if there’s no funded beds for patients to actually use.
Learning Disabilities is even worse with 51.7% of inpatient overnight beds cut since 2010. No-one seems to care about that though. Neither do they care that the community care required for out-of-hospital care for seriously ill people in this category has been cut, cut and cut again with contracts being awarded to cost-cutter private companies and matching race-to-the-bottom former NHS CICs. That people are suffering and not being national news is a scandal in itself.
The “great” British public will only care when it’s their little Johnny who can’t get an appointment or falls critically ill.
The biggest problem is that the opposition parties dare not attack it too hard for fear of being asked “well, how would you fund the £22bn needed to stop the STP cuts?”, especially given the Labour manifesto was even less generous to the NHS than the Tory one. Then there’s the Lib Dems with zero NHS credibility given that Norman Lamb oversaw much of the devastation to NHS mental health services in his time as Minister, cutting at rates that outstripped every other bit of the NHS by quite a way; he valued his job title as Minister more than his ethical stance that he’s suddenly found again as a backbencher, if he TRULY thought that way he’d have walked rather than accepted collective responsibility over that disaster.
Then you get the point that the NHS is genuinely stuck in the 1980s in some of its processes. Its finance departments still run on commercially discredited basis, some of the commercially focussed units (such as CSUs) cannot operate on P&L budgets because that’d show some extravagant overspending in some areas being funded by unbelievable underspending on others. Its HR functions are so understaffed that it’s a surprise that there have not been major scandals. Its IT functions are so immature that a small company’s IT Director would be sacked for the incompetence of not even being able to roll out a critical security patch within six months. Its estates functions are so underfunded that major problems are fixed with WD40 or duct tape because that’s all the money there is. Fixing these would not cost or save £billions (except the capital estate funding problem…) but no wonder detractors can always point to incompetences when talking about how inefficient the NHS is; fixing them is not on the table though because it would mean NHS management would have to move from over-promoted amateurs to actually professional executives.
So, how to fix it? I have no idea. Leaving it in the hands of people like Hunt will just see us move to a US-style healthcare that actually costs the state twice as much with half the benefit to patients.
Looks like I may be doing more on this
Perhaps someone could show me a single piece of evidence that the UK is moving or plans to move it to a US style system? I have read this nonsense for the entirety of my 35 year career in the NHS. Why is it nonsense? Because the US is as about as different from our system as it is possible to be. Because even Tory politicians know that the US is the most expensive, least effective system in the world (see Commonwealth Fund analysis). Because, surprise surprise, the millions of people who love the NHS include millions of Tory voters.
For all its flaws (including poor outcomes which may be as much about as culture as about service provision) the NHS is bloody marvellous. One of its greatest strengths, funding via taxation resulting in some of the lowest admin costs in the world, becomes a great weakness when neither of the 2 main political parties (hats off to the Lib Dems) will promise an increase in taxation to pay for it.
Also, some of your correspondents seem to be unaware that many managers in the NHS have a clinical background including consultants who lead clinical departments whilst continuing a full clinical workload – insulting them all as ‘over-promoted’ isn’t helpful.
Read what the Tory think tanks say
Read what ministers have written in the past
Be aware of the risk
Take your head out of the sand: this is about dogma, not arguments on effectiveness
[…] has been some discussion on the blog, on Twitter and elsewhere since Saturday’s debate at the Royal Society of Medicine on NHS England budgets (Wales, Scotland and Northern Ireland have their own health […]
Here is an example of the trend to use private contractors in the public sector at vastly more expense. This is about the NHS and is a report in the Daily Telegraph (somewhat surprisingly to me anyway, I thought they followed the Tory playbook, or maybe it is deliberate to make it look like a failing of public sector management, therefore it needs more private sector ‘help’?):
http://www.telegraph.co.uk/news/2017/08/19/managers-400000-year-failing-nhs-authorities/
Paul
I recommend you read Dexter Whitfield The New Health and Social Care economy, available as a pdf from this site http://www.european-services-strategy.org.uk.
Come back to me with any more questions after.
I accept what you say.
But does the Labour Party?
At previous general elections the shadow health spokespeople and chancellors are very reluctant to commit to additional spending and many Labour MP’s go along with new models of care, STPs, ACOs and all the other obfuscations for neo-liberalism.
The best criticism of the NHS is that it leads to the underfunding of healthcare as it relies on politicians for adequate funding who have been elected in the past and recently on the basis of cutting public spending and taxation.
How should the NHS respond if it cannot rely on politicians to defend it?
Does the Labour Party listen to you?
I gave no idea if Labour listen
I try anyway