In 2011 the NHS satisfaction levels were at ‘a record high’ – 64% of people either ‘very or quite satisfied’.(1)
This has been the result of considerable investment in time, staff effort, loyalty and money; the NHS bill in 2010 was £110bn.
Now, although NHS income is supposedly held constant in real terms(2), there are efficiency savings to be made between 2011-14 of between £15-20bn and transfers of funding to local authorities within these funds, for social care and public health, at levels proposed beyond current expenditure. That is beyond the ‘minimum’ cut in NHS spend of 5% per annum.(3)
Agenda for Change tried to ensure fair pay and equity across grades, it also tried to achieve parity across the NHS in comparison to the private sector, but now the defined benefit pension is targeted as an extra 20% perk to salary. It must be remembered that benefits were eroded in the private sector due to a race to the bottom typical of neoliberal capitalism. Agenda for Change was decreed too expensive but should the NHS apologise for maintaining the welfare of its workforce?
The unfunded pension liability of the NHS in 2009/10 was £287bn. But this is due to cross-sector issues of an ageing NHS workforce and the increase in the ratio of pensioners :working adults and the declining birth rate. In 2009/10 the pension scheme had 1.4 million members, that’s 1.4 million broken promises if pensions in people’s employment contract have benefits unilaterally reduced.
In response management have started the QIPP program (Quality, Innovation, Productivity & Prevention), which has as its aim to do MORE with LESS. ‘More’ because demands and expectations of the NHS continue to rise; it services an ageing population, new expensive drugs and medical technologies come to market and public expectations continue to rise.
In addition the marketplace is being introduced to the NHS. The NHS is being privatised, firstly by Social Enterprise which slowly erodes worker’s rights and then by the Any Willing Provider (AWP) threat.
The AWP threat is clear, current capacity will be competed away meaning empty and closed hospitals as contracts switch, this is not the stability on which the NHS should thrive.
It also further transfers wealth from tax-payers to the wealthy capitalists who invest in this new healthcare provision.
Despite pre-election promises from all major political parties of no top-down reorganisation, we have GP consortia. GPs who struggle to do their valuable primary care(4) are being asked to take on administrative tasks for which they have no training and even less inclination.
The annual deficit is – £149bn (5)
Tax avoidance has been estimated at £133bn (6)
A Robin Hood tax on banks would raise £20bn
Or by these two simple measures we could save enough to more than double the investment in the Green Bank! (7)
We could rescind the efficiency savings & transfers, or cuts by any other name, and return to an NHS which is performing well. Let’s avoid a wielded axe and seek genuine improvements:
* Adjust Agenda for Change so that increments are dependent on health outcomes achieved in the local community.
* Reduce inspection regime: High proportion of NHS spend on servicing varied bureaucracy such as the new economic regulator, CQC, Health & Safety executive etc…
* Reduce number of PCTs (towards 1m populations?) and elect GPs on to the board to run them.
(1) As reported in the British Medical Journal.
(2) Real terms may be difficult to maintain given recent inflation data.
(3) £20bn/4 years [2011-2014]
(4)Data shows that the fewer patients per GP the less social inequality.
(6)Tax Justice Network figures
(7) That is without other measures such as eco-taxes on polluting business, tax increases on the wealthy, land taxes, gains from nationalising the money system…