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Volume 47 Number 1, January 21, 2017 ARCHIVE HOME JBCENTRE SUBSCRIBE

The Significance of the Battle for the Future of the NHS

What kind of health service do we want? What is the way forward?

Presentation by Tony O'Sullivan, Co-Chair of Keep Our NHS Public (KONP), as an
invited speaker at the London Political Forum on the Future of Society, October 29, 2016

A core duty of socialists is to fight to improve the condition of the people, the working class and the oppressed and vulnerable, and to fight for this in the here and now, not theoretically for the future. In this respect, the NHS is the major victory of the British people after the Second World War. It was said that the right of people to be decision-makers is on the agenda. The fight for democratic rights is not exclusive to socialism: anybody can fight for democratic rights. But fighting for the right of access to healthcare has become a fight for democratic rights.

The NHS symbolises much more. There is a point in time when something becomes a touchstone. To ignore racism for example, and the democratic right not to be subjected to racist abuse and attacks, is to step aside from a core part of the struggle. Likewise, not to face the issue that people are being disenfranchised from the right to access healthcare is to renege on a core part of the struggle as it affects working people. The attack on the NHS is part of a long-standing ideological assault on public services. The greatest equalisers between those who have and those who have not are the health service and education. You only need go to USA to see the starkest aspects of health problems. Health problems are the greatest single source of bankruptcies, destitution and death, for example. Defending the NHS is therefore on the front line against the forces of reaction, alongside the struggle against racism and war.

Today we are talking about the future of society and what kind of health service we want as part of that. There is a litany of demands, but there is something behind these demands, such as the need for the health service to be publicly funded. Some academic research has been done recently [i] into what is called the fiscal multiplier. This quantifies what the national economy gets in return from investment, whether that investment be in roads, energy, health, education, armaments, or anything else. The fiscal multiplier for defence spending is minus 9.8. Whatever society spends in armaments, the society as a whole loses nearly tenfold that expenditure. The payback on health is 4.3. The economy gets a fourfold payback for every unit investment in health. In a sense that is clear, because we would have a healthy society and a healthy workforce, even in a capitalist society. A main impetus for a school health service was when Britain was going to war in the Boer War. A lack of troops healthy enough to go to war led the government to set up a school health service. At that time it was illnesses such as TB. So, a healthy workforce, healthy children, healthy women, mothers; a healthy rest of society is clearly a huge investment as in education. Where there are educated, literate women as in Cuba or Nicaragua there is a plummeting of infant mortality and the health of society improves.

The quality of the service we should demand reflects the state of society and the stage of the economy that we are at; but we should also note that despite the blockade on Cuba it has got healthier parameters on all fronts - far above the US just a few miles across the sea. Britain is one of the largest economies. We should be demanding what we have had until recently: accessible, high quality healthcare.

One of the accusations when defending a hospital against closure is of "nimbyism": that you are against a closure in your own area, but, the argument goes, closures need to happen somewhere. Clinicians - nurses, therapists, doctors - always argue for change; we are the drivers of change. Not only do we not hold back if there is good evidence for change, we demand it ourselves. On the other hand, we demand evidence for change, evidence that should not be financially driven. That is not evidence for better clinical care, it is evidence for a cheaper service.

The context has to be right. When the government is pushing through the Sustainability and Transformation Plans (STPs) and talking about the integration of health and social care, the pressure is to put us onto the defensive. I have spent 25 years fighting for the integration of health and social care - for disabled children, for example. What the government is providing is a Trojan horse. It sounds great but is actually the driving force for imposing massive financial cuts, with a stick if you do not agree.

Tony O'Sullivan

We are demanding better quality high-tech equipment and cancer drugs, and whilst we need such equipment, care in the community for most people means that they need health workers with them. Ninety percent of health work is people looking after the vulnerable, which requires funding. They tried to close mental health institutions in the 1970s and to put people into the community. Care in the community is actually more expensive than hospital institutions. We do demand high quality community-based care, but not in place of hospitals. One of our points in the Save Lewisham Hospital Campaign was that we do want community-based care and we want a hospital at the centre of that community to make that community-based care safe!

The investment under the Labour government did actually allow the NHS to become a high-performing institution. It was the health workers themselves who were fighting for co-ordinated, multidisciplinary, inter-agency working. The government at a certain stage started to pour money into the health service. As is well-known of course, Tony Blair fatally undermined the future health service with PFI, by bringing in competition, and developing marketisation and privatisation. Now we have six years of austerity and are heading for four more years. We now have waiting lists rising, including for cancer, and Accident and Emergency problems. We now have public dissatisfaction growing, so that it will be increasingly difficult to say that this is the best healthcare system in the world. There is a case for saying that it still is, if taken as a whole, but it has been seriously undermined. The danger here is exemplified by a recent article in the press asserting that if you think the NHS is the best in the world, you are "living in cloud cuckoo land". The issue here is not just to say that the NHS is "the best in the world" - we do have to demand better cancer care, for example - but that it has this capability and potential.

Similarly, it is not an issue of conspiracy theories or searching out the worst motivation. We do not oppose integration simply because these are the words of Simon Stevens, CEO of NHS England. Rather, Simon Stevens is trying to deceive us with what he is demanding. What he is trying to integrate are two systems that have been deliberately made to fail - a health system that has been underfunded and a social care system that has been massively underfunded. What we should be demanding is social care as well as a health system that is free at the point of use, publicly accountable and publicly provided. That is what is wanted: a set of integrated services that make sense.

There is no other area that is more obvious than in disability, which is where my own professional life has been. Take a young person, such as I have worked with, who is 18, who has cerebral palsy with feeding difficulties, mobility problems, communication speech problems, and therefore education problems, and a high level of dependency on parents to care, to move, to look after, to bathe, to feed. That family has needs: that young person requires primary care, hospital care, possibly mental health care, education, social care and transport, everything wrapped around that family to look after them. We do want integration, but we want it to work for the family, not for hedge funds, for example. We need integration to look after people with long-term conditions - mental health problems, where mental health impacts on physical health, and physical ill health leading to mental health problems. We need integration with the community, so that we are able to relate to people of different ethnicity who have conditions related to their social and ethnic background - sickle-cell anaemia is an obvious example, but there are many others including diabetes and hypertension. That is the kind of vision we should be demanding. It includes integration between community and hospital, between acute and long-term illness, between physical and mental health, between health and social services and, in the case of children, education too.

What is the way forward? Two weeks ago, I was at Trafalgar Square to welcome the "Hands Off Huddersfield Royal Infirmary campaign" coming down to London by coach. They had been thrown into a situation like Lewisham, where one of two hospitals in the trust is a PFI hospital, Calderdale, and they are trying to close Huddersfield Royal Infirmary for financial reasons. This is in a town of 190,000 people, a major place that needs a hospital. The campaign got in touch with Keep Our NHS Public and Lewisham sent up speakers. They were energised by the Lewisham campaign, but we found that they had gone beyond that. They had a huge initiative: not just a campaign but ten satellite committees in towns and villages around Huddersfield. We in Lewisham had got 55,000 to sign a petition - they had got 154,000. They had contacted other campaigns. Four campaigns converged on London on the Monday lunchtime, besieged Downing Street and lobbied their MPs in parliament.

They see the need to be part of a wider fight immediately. Their Clinical Commissioning Groups have decided that the closure will go ahead. They are not giving in and the fight is on. They see the need to join up with everybody else. They contacted the Grantham and Chorley A&E campaigns and the Horton General in Banbury. And London campaigns: Ealing, Hammersmith & Charing Cross and St Helier's hospitals, all under immediate threat. Huddersfield has joined Health Campaigns Together, an umbrella organisation that has now had three conferences around the country and is calling a health demonstration - It's Our NHS - on March 4, 2017. Our clear aim is to win!

[i] Aaron Reeves, Sanjay Basu, Martin McKee, Christopher Meissner and David Stuckler, "Does investment in the health sector promote or inhibit economic growth?", Globalization and Health 9: 43, 2013,


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