An in-depth look at NHS, the state it is in and what we can do about it.
Most of us at some point in our lives will use Health and Social care services, be they NHS, Local Authority, or private sector. Many of us also will be only too aware of the major funding crisis that exists, threatening many of the basic services we have taken for granted in the past.
Add to this the numerous high profile scandals in the NHS (ie. MRSA, malnourishment of elderly patients, postcode lotteries that deny patients access to life-saving treatments, etc.), and the picture looks increasingly bleak. There are a number of factors which have contributed to this sorry state of affairs, from demographic changes to fundamental mismanagement. But pure and simple, the root of the problem is chronic underfunding and misguided policy making by politicians who have little understanding of the needs of people using, providing or requiring services.
Nice idea, shame about the funding
In the last 20 years there has been a major push by the legislative bodies to close large-scale institutions and replace these with more person-centred services on a local level. Indeed, many of us who work in social care will have witnessed a number of positive changes for groups such as people with learning disabilities who were once excluded and segregated from mainstream society.
The creation of monitoring bodies such as the Commission for Healthcare and Social Care Inspection respectively has also gone some way to improving quality assurance monitoring of some services. However, apparently progressive policies have been stifled in their modest ambitions by a basic lack of funding. People who are vulnerable or recuperating from illness require additional support to enable them to live the lives they choose; in their own homes and in their own communities.
Often, basic services do not exist, are chronically under-funded or are being cut back. Meanwhile in the NHS hospital wards are closed, operations cancelled and patients forced to wait or travel long distances for relatively routine treatments.
Attacking the workers
The response of many local authorities has been to 'outsource' much of their provision to private sector providers who often pay their workers at rates barely above the minimum wage. The very people who undertake such jobs precisely because they have a social conscience, (often working in particularly demanding and difficult conditions), make up some of the worst paid workers in the EU.
Similarly the NHS has seen fit to 're-tender' many catering and cleaning services to private contractors whose workers endure poor pay and inferior 'casual' conditions of service. The widespread deployment of Management and IT consultants, allegedly to improve efficiency and performance, has seen further valuable funds diverted away from frontline services.
The recent pensions debacle which prompted widespread strike action (and even led to the public service union Unison temporarily withholding its political levy to the Labour Party) is also a direct consequence of cynical government penny-pinching and corporate mismanagement. The temporary government concession to review proposals which would have resulted in the removal of protected pension rights and conditions appears to have appeased the union hierarchies. However, in the longer term, rank and file workers need to be mindful of the longer term plan.
Such moves all appear to be motivated by a wider government agenda to erode pay and conditions which public sector workers have had to fight long and hard to achieve.
The great continuing care con
Linked to the funding crisis in the Health and Social care sector, is the government's proven unwillingness to fulfil its funding obligations for those people who have health needs which are categorised under its own Continuing Care criteria.
Anyone who has suffered the heartache of watching a loved one suffer the effects of a degenerative condition such as Parkinson's Disease or Dementia, will be well aware that at the point that people become too ill to live at home (again, usually only because resources are not available), they will be admitted to a nursing or care home to be looked after.
In reality, it should be noted that most nursing/care homes cater for basic physical needs and little else, despite the best efforts of their overstretched and underpaid staff. Individuals entering nursing/care homes are financially assessed, and fees for such establishments can run into thousands. Anyone with assets exceeding £16,000 has to use these to finance their (social) care. As a consequence, many are forced to sell their homes. This only places the burden of further stress on relatives and the individuals themselves at a time of already undue pressure.
How ironic that many of the generation who were promised free care 'from the cradle to the grave' (if they paid their tax and National Insurance) and advised to save for the proverbial rainy day, have suffered so cruelly at the hands of the politicians.
Two BBC Panorama programmes in 2006 also highlighted that many individuals residing in nursing homes who clearly meet the government's criteria for health care (which should be free under Continuing Care legislation) are still having to fund their own care and support.
Although a minority of test cases have overturned Local Authority/Health Trust decisions, it is nothing short of scandalous that the most vulnerable members of society are treated so appallingly. Some reward for a lifetime of hard work and toil. Likewise, those people who often give up their jobs to look after their loved ones at home are denied basic financial, practical support and advice to help them cope with the massive sacrifice and demands that being an unpaid carer brings.
So, despite the widespread deployment of costly management consultants, league tables and performance frameworks in the NHS and Local Authorities, patients, unpaid carers, people receiving services and frontline staff have all borne the brunt of a lack of investment and the inability of local communities to have any real say in the type of services they receive.
As the National Health and other statutory services are increasingly cut back, the introduction of private healthcare has effectively created a 2-tier system based on a person's ability to pay.Meanwhile millions of taxpayers' money is invested in the occupation of Iraq and the new Trident programme. Chief Executives and MPs award themselves huge pay rises. An obscenely rich minority enjoys a lavish, sumptuous lifestyle, whilst in some of the most socially deprived parts of the country average life expectancy barely scrapes past 50.
People not profit: time to fight back
All the fancy rhetoric and silver-tongued spin of the politicians cannot hide reality forever. When a crisis in capitalism hits, the weak and vulnerable and those that support them are the first casualties. It is the task of health and social care professionals, patients and carers groups to organise and challenge the powers that be (including complicit union bosses) at every opportunity.
It is only by using our collective strength that we can strive for a more just and equal society where decent health and social care provision for all is a right, not a privilege for those who can afford it.
We need to work together to design and develop new systems, using all the knowledge and technology at our disposal, to provide people with the type of responsive person-centred care and treatment that they need and want. As with most other social and environmental issues, this will not be achieved without wholesale changes in society as a whole and, ultimately, the destruction of capitalism.
This article first appeared in Direct Action No. 38, Spring 2007, the magazine of the Solidarity Federation, British section of the International workers Association.