“Charity is a cold grey loveless thing. If a rich man wants to help the poor, he should pay his taxes gladly, not dole out money at a whim”…Clement Attlee
We love our NHS
The NHS is the ‘jewel in our crown’, our ‘national treasure’…. we love our NHS. In fact, we love it so much we’re pained to see it’s staff struggling to cope with the Covid19 outbreak.
Our hearts go out to the families who have lost their loved ones from this terrible illness, and to the NHS staff battling to save them, who sometimes have to make the most difficult decisions about treatment pathways laid down by NICE guidelines.
Understandably, talking about the NHS brings out our strongest emotions. Knowing that NHS staff and Social Care workers are not being provided with adequate Personal Protective Equipment (PPE) in too many settings – hospitals, GP surgeries, Residential homes, ambulance crews, community nursing/caring, it brings out a natural response: we want to help.
Hence, there has been an explosion of fundraising activity on social media platforms. The biggest has been organised by NHS Charities Together:
As someone who has been a proactive campaigner in support of #OurNHS for three years, I fully understand the desire to help.
However…. Stop It! Our NHS Is Not A Charity
Be warned, you may find what you’re about to read controversial. I ask for your patience in reading all the way to the end. I might challenge your perceptions, but bear with me, I hope by the end you will have seen why I felt it was important to write this blog.
I’m going to set the historical context first. Then I’ll demonstrate how the context has impacted our NHS and why it’s in the position of needing help and support today. Next I will put forward the macroeconomic context, and finally I intend to show that Public Money should be the winner in a Fundraiser v Public Money for our NHS argument.
The NHS – brief historical context
NHS: the Early Years
In post war Britain 1948, the Labour government launched our National Health Service
A publicly owned, publicly run, and publicly delivered comprehensive *National* health service free at the point of need for all.
Birth to death….from the cradle to the grave. Eyes, ears, nose, mouth, mind, limbs, internal organs, disease, infection…. Midwifery, District Nursing, Consultations, Tests, Treatments, Hospital stays, and Prescriptions were free.
Aneurin Bevan, Health minister at the time said:
Many governments have come and gone, making changes such as implementing prescription charges, centralizing and decentralizing the ambulance service, and in 1998 devolution had some impact….
“The UK’s four systems were created very similar at the high water mark of British political unity. They were all ‘national health service’ (NHS) systems, with the government directly owning hospitals, contracting with primary care General Practitioners (GP) and employing most other staff in a system centrally financed out of general taxation and provided for free at the point of service.”
Corporatisation and Markets
The internal competitive market and Foundation Trusts (run as businesses) were introduced early to mid 2000s.
But…. every Secretary of State for Health of whichever political party in government had the responsibility to provide comprehensive healthcare for it’s citizens…. until the Health and Social Care Act 2012* passed into law.
NHS Death Knoll – The Lansley Act
Professor Allyson Pollock (March 2013):
“The UK NHS was created by national consensus in order to ensure that every citizen was guaranteed health care. Underpinning these arrangements was the secretary of state’s core duty to provide or secure a comprehensive health service, a duty repealed by the first clause of the Health and Social Care Act*.”
This was passed at a time when the country was still reeling from the 2008/9 global financial crash and the coalition government had imposed severe austerity measures on public services. But more on that a bit later.
- The Act opened up all our NHS services to the external market except for acute emergency and obstetrics.
- It opened the flood gates for private sector provision of health and social care services
- The Act also gave birth to four quangos: NHS England, NHS Scotland, NHS Wales, and NHS Northern Ireland each responsible for the provision of health and social care. Although still called NHS it was no longer a National Health Service
NHSE – The US model of healthcare comes to England
The appointment as head of NHS England was given to Simon Stevens, worked for the USA giant United Health Insurance company, where he was president of their global health division, and CEO of Medicare.
His job as NHSE head was to oversee implementation of the complete reorganization of our health and social care service in England, by splitting England up into 44 regional health economies – ‘footprints’.
The aim was to establish AccountableNB Care Organisations (an American model) which we now call IntegratedNB Care Systems/Organisations.
These ICS/ICOs are contracted out to a body (which can be a private business or a combination of local authority and private partnerships) who are responsible for the provision of health and social care across their ‘footprint’ within a fixed budget. They are run like a business, so must balance the books or make a profit… they cannot go into deficit.
NBAccountable in a financial sense, ie accounting Integrated in an admin sense ‘back room stuff’
Government Austerity and NHSE Combine for Maximum Impact
- Under Austerity, we saw swathing cuts in budgets to our public services from 2010 onwards
- NHS trusts told to make ‘efficiency’ savings, savings targets set and if not achieved, financial penalties imposed. A Trust could even be put in to Special Measures for being in ‘debt’
- Staffing levels were cut, wards and small hospitals closed, bed numbers dropped.
- Businesses have taken over services such as diagnostics, Mental Health, phlebotomy, radiology, cleaning, catering, ophthalmology, and so on.
In the private sector, the leanest service they can give the more profit they make. Our health service and social care system began to feel the strain.
“Sustainability” became the mantra of Government and NHS England chiefs.
By 2016 Sustainability and Transformation Plans (STPs) were published. These were the plans which would transform our health service and social care into ICS/ICOs.
Some STP Boards held Public Consultations
As small gatherings of ‘the aware’ sat and listened to highly paid NHSE employees give glossy presentations, telling us that our NHS will not survive unless we make these changes, which would improve the service….. make it sustainable so it’s there for the future.
They asked for our views, which in practice were never going to make the slightest difference to their grand plans.
And Here We Are…..
2019 saw our fragmented, under-resourced, under-funded, and under-staffed system in a very poor state:
- 43,000 nurses and 10,000 GPs short
- Hospital targets abandoned because they consistently couldn’t be met
- Worn out staff working longer shifts than they were being paid for
- Cancelled appointments and operations a common occurrence
- Little to no mental health support
- 3 week waits to see a GP
- Apps being touted as the answer to everything
People were dying who shouldn’t have been……
“Like many junior doctors who have worked in overwhelmed and understaffed A&E departments, I’ve seen things happen as a result of the overstretched conditions that I believe should be classed as “never events”. Since 2016, nearly 5,500 patients have died in England alone as a direct result of having waited too long to be admitted to hospital. To put that in perspective, that’s nearly twice the number of people killed in terror attacks in the UK since 1970. We should be outraged”
Now in 2020, the pandemic has hit an already ‘in crisis’ health care service (exacerbated by a chronic problem in social care)
Our NHS…. Macroeconomic Context
It is political!
To all the naysayers who shout “Keep politics out of our NHS”………… you can’t.
Government has control of the public purse it’s role is to spend public money for public purpose and social benefit.
“If the job is to be done, the state must accept financial responsibility“
So what is the public purse and public money?
- The public purse is not a fund, and public money is not tax payers money
- The public purse is the Bank of England and public money is the creation of pounds sterling by keystrokes – entering numbers into banks’ reserve accounts so they in turn can credit the account of a person or company selling it’s goods or services to the Government – as instructed by the Treasury.
Having said this, I can hear you ask….. but where does the money come from? It must come from somewhere?
The key word is “creation”
The UK Government is the sole issuer of our sovereign fiat currency. Every time the Government (of whichever colour) spends, it creates pounds sterling out of thin air. If the government needs to purchase goods or services which are for sale in GBP, then it simply instructs the Bank of England to do so via the Treasury. The Chancellor of the Exchequer provides the Budget Statement ie ‘shopping list’ and this is administered by the Treasury’s Debt Management Office (DMO) and the Monetary Policy Committee (MPC) at the Bank of England.
There is no taxpayers money funding Government spending. The only constraints on spending are the availability of resources (goods, services, labour) and inflation caused by resource shortages.
Now ask yourself….. when the global financial markets collapsed in 2008 what shortage did this cause?
Government told us “There is no money! We have to tighten our belts… Austerity!”
Did anyone shout back “Hang on a cotton picking minute…….. you create money!”
[To be fair, some did. But the response they got (and still do, but from fewer people) was “Venezuela” and “Zimbabwe”….. which demonstrated how little they know about those countries’ economies.
The Truth: Our Government can NEVER run out of money
The Final Argument – Why we should not have to fundraise for the NHS
Current Shortages in our Health and Social Care Services
- Nurses, Doctors, Radiologists, Social Workers, Care-workers ie labour
- Equipment, especially PPE, Covid19 Tests, and Ventilators ie goods
- Diagnostics/Testing laboratories ie services
Labour – the workforce
500,000 volunteers have come forward to help our ‘NHS, there must be jobs that these volunteers are doing, and that is great. Practical help at a time of most need.
No shortage of people willing to work for no pay – although government could pay them via a Job Guarantee programme, and this could encourage more people into care-worker jobs.
However, the shortage of clinical staff and social workers needs addressing urgently through government investment in bursaries, decent wages, and free education, but will not help in the immediate crisis.
Through a combination of incompetence or deliberate policy, the government did not purchase goods listed above prior to the pandemic, despite being forewarned in the pandemic simulation report 2016. Government’s initial ’do nothing’ strategy exacerbated the situation as global demand for equipment and tests grew. By the time Matt Hancock and NHSE tried to get hold of, or refused to deal with certain suppliers of, what we needed, the goods aren’t there (although that’s debatable)
Volunteers across England are making PPE out of the goodness of their hearts and donated material. Practical help at a time of most need.
Although slow to start, government are negotiating contracts with laboratories. Money is being created to purchase these services.
There can never be a shortage of public money to purchase anything if it’s available for sale in our own currency………
There is not a shortage of money to attract, train and retain staff, only the shortage of will by the government to do it
There is not a shortage of money to purchase equipment, only the shortage of will by the government to do it, and at the right time
So why does the ‘NHS’ need money from charity when government can provide it with public money?
It doesn’t and shouldn’t!
If the government keeps getting away with not accepting financial responsibility, they will keep starving our NHS of money to pay for the facilities, staff, equipment, and resources it needs to exist !!
Please stop giving money to charity for the ‘NHS’
Demand from government that it carries out it’s duty to use public money as it was meant: for public purpose and social benefit.