Rinse and Repeat: The sequel to the 5 Year Forward View

The NHS’ Long Term Plan was published by NHS England on 7 January 2019. It sets out the next 10 years of NHS healthcare in England. But it was the 5 Year Forward View published in 2014 that set the agenda. So here’s a quick reminder of what is being implemented – no matter what the PR says to the contrary – a reduced and diminished NHS. 

In 2014 NHS England published a Five Year Forward View (now extended  by the recently published 10 Year Plan) in which it states – undemocratically and presumably with the aid of a crystal ball – that the NHS in England will never have the money it needs ever again to provide services in the way it has done to date.  In this financial context the plan sets out an entirely new way of providing health services.

NHS England says the NHS must change: it is not fit for purpose in the 21st century and that an ageing population with complex needs is bringing it to its knees.The plan claims that the money projected for the NHS really is not enough to provide the kind of system we are used to. That is to say the local GP family practice, cottage or community hospitals, local District Generals with A&E – especially not A&E –  is very expensive.

Persistent de-funding of the NHS as a public service has lead to the haemorrhaging of staff whether that be through early retirement, leaving the country, career change or moving to the private sector. Not that the Five Year Plan mentions that. A smaller staff capacity means the NHS’ biggest cost is also reduced (staffing is the biggest cost to the NHS).

The business plan for the future of the NHS includes reduced funding. Its current fixed costs or those which will cost more in the future (PFI, commercial rents, IT, etc) are limiting the options for other ‘economies’, according to NHS England, so staff need to be got rid of, paid less or substituted with lower paid professionals or para-professionals.

Not having enough staff provides the perfect rationale for carrying out the reshaping of the system to fit the future funding restrictions. After all if there are 100 establishments with only the staff for 80 then the staff can be moved from the places which are planned for closure with the excuse that it is unfortunate, temporary pending recruitment or unavoidable. In the case of NHS service reductions and hospital closures it is usually patient safety that is quoted as the reason. And as a bonus!! Look!!! The NHS can sell off empty buildings to give it some cash to put in the pot!!!! Hurrah….

But all the time the actual re-shaping of services as described in the Five Year Plan and all its extensive supporting documents is being put into place. There is ‘no money’ but Super Hospitals are being built. There is ‘no money’ but £billions are spent on management consultants and the Big 4 to make the changes happen. Hospitals, GP surgeries and other health facilities are being emptied of their staff and services to be sold.

The NHS is being re-modelled on US lines – specialist superhospitals, multi speciality community providers – into 44 new commercial organisations which are being created to run these new systems. The Foundation Trusts themselves are already businesses – ‘independent legal entities’ (it’s 15 years since they were true public service bodies), competing in a market system for contracts, some in partnership with US health corporations to provide private healthcare.

The buildings the NHS used to own will be gone, demolished to build luxury flats in areas where land value is high. The possibility of finding sufficient numbers of sufficiently large spaces in towns and cities to recreate such an expansive and accessible health service as we have had for 70 years in the future looks increasingly remote.

Bear in mind that the response we are seeing to a supposed growing and ageing population is the shrinking of the NHS. Meanwhile hospitals can earn up to 49% of their income from non-NHS sources and a few are already doing that with gusto. Expanding the private capability whilst shrinking access to the public service. Private GP surgeries are being piloted in pharmacies. You can pay to have a telephone consultation with a GP on an app – ‘Uber’ style. The restrictions on the NHS creating market spaces for private profit.

This is all pushed into place by the false assertion that the government ‘cannot’ raise the money even to maintain the NHS at its current level. Look into my eyes ‘there is no money’. Rinse and repeat ‘there is no money’……. Meanwhile global health is an expanding market and McKinsey reckoned in 2010 that if the government would just allow the NHS to compete in private markets then it could become a £200bn a year business, twice what it costs now. As economic illiteracy/rentier money grabbing/obfuscation goes, it’s breathtaking. And as the loss of a brilliantly conceived public service, it’s heartbreaking.

This is why funding alone is not the answer. It’s why fighting individual service closures is (necessary, but) not the answer. At the same time the system which is being slotted into place has to be understood, challenged and halted.

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