After five years of a government which pledged to protect the NHS, this election campaign makes it timely to assess its stewardship, since 2010, of England’s most precious institution. Our verdict, as doctors working in and for the NHS, is that history will judge that this administration’s record is characterised by broken promises, reductions in necessary funding, and destructive legislation, which leaves health services weaker, more fragmented, and less able to perform their vital role than at any time in the NHS’s history.
In short, the coalition has failed to keep its NHS pledges.
The 2012 Health and Social Care Act is already leading to the rapid and unwanted expansion of the role of commercial companies in the NHS. Lansley’s Act is denationalising healthcare because the abolition of the duty to provide an NHS throughout England abdicates government responsibility for universal services to ad hoc bodies (such as clinical commissioning groups) and competitive markets controlled by private-sector-dominated quangos.
In particular, the squeeze on services is hitting patients. People may be unaware that under the coalition, dozens of Accident & Emergency departments and maternity units have been closed or earmarked for closure or downgrading. In addition, 51 NHS walk-in centres have been closed or downgraded in this time, and more than 60 ambulance stations have shut and more than 100 general practices are at risk of closure.
The core infrastructure of the NHS is also being eroded with the closure of hospitals and thousands of NHS beds since 2010.
Mental health and primary care are faring no better – with both in disarray due to funding cuts and multiple reorganisations driven by ideology, not what works. Public health has been wrenched out of the NHS, where it held the ring for coordinated and equitable services for so long.
In September 2014, the Royal College of General Practitioners said that the wait to see a GP is a “national crisis”.
In England the waiting list to see a specialist stands at 3 million people, and in December 2014 NHS England estimated that nearly 250,000 more patients were waiting for treatment across England who are not on the official waiting list.
Throughout England, patients have been left queueing in ambulances and NHS trusts have resorted to erecting tents in hospital car parks to deal with unmet need.
A&E target waiting times have not been met for a year, and are at the worst levels for more than a decade; and elderly, vulnerable patients are marooned in hospital because our colleagues in social care have no money or staff to provide much-needed services at home.
Funding reductions for local authorities (in some places reductions as high as 40%) have undermined the viability of many local authority social care services across England. This has resulted in more patients arriving at A&E and more patients trapped in hospital as the necessary social care support needed to ensure their safe discharge is no longer there.
The NHS is withering away, and if things carry on as they are then in future people will be denied care they once had under the NHS and have to pay more for health services. Privatisation not only threatens coordinated services but also jeopardises training of our future healthcare providers and medical research, particularly that of public health.
Given the obvious pressures on the NHS over the last five years, and growing public concern that health services now facing a very uncertain future, we are left with little doubt that the current government’s policies have undermined and weakened the NHS.
The way forward is clear: abolish all the damaging sections of the Health and Social Care Act 2012 that fragment care and push the NHS towards a market-driven, “out-for-tender” mentality where care is provided by the lowest bidder. Reversing this costly and inefficient market bureaucracy alone will save significant sums. Above all, the secretary of state’s duty to provide an NHS throughout England must be reinstated, as in Scotland and Wales.
As medical and public health professionals our primary concern is for all patients.
We invite voters to consider carefully how the NHS has fared over the last five years, and to use their vote to ensure that the NHS in England is reinstated.