After the election: the broken promises
Thursday 19th December 2019
Thursday 19th December 2019
- It might take voters who have returned Boris Johnson’s government for a 5-year time with an 80-seat majority a while to catch on – but the promises Johnson made on the NHS, which some clearly believed, are already being diluted and broken – or were simply inadequate in the first place.
- The Queen’s Speech makes this very clear. There is a big gesture of enshrining the promised extra money for the NHS in law: but this also means that there is no immediate prospect of increasing the funding above the level set out in the manifesto – despite all of the evidence that the NHS is now drastically under-funded and failing to deliver performance targets after almost a decade of austerity-driven real-terms cuts.
- NHS Providers, while grateful for any relaxation in the virtual freeze on funding, has pointed out that if NHS spending had increased in line with the previous average prior to 2010, the Department of Health and Social Care budget would by now be £35 billion higher than it is.
The Johnson government has now promised to increase spending by “£34 billion” over five years – but the government’s own figures show than taking inflation and cost pressures into account that will only be worth £20.5 billion in real terms.
In other words real NHS budgets in 2024 will still be miles short of the level needed to deal with today’s increased population, a substantially increased older population, and nine years of decline that have left trusts in debt to the tune of £14 billion.
That’s why hospitals are struggling to deliver A&E performance targets, waiting list targets, cancer treatment targets, and why tens of thousands face trolley waits and delays in ambulance transfers every month this winter – and for the foreseeable future. Similar delays and shortages will continue to impact on mental health services, GP services and community services.
Social care has again been kicked into the long grass, with vague proposals to seek a “cross party” consensus having failed to make any headway in the past 9 years, while the yawning gaps in services leave over a million vulnerable people without any care at all.
Staff shortages of course are another major factor, and ministers repeatedly tied themselves in knots trying to explain the promise of an “extra” 50,000 nurses. In fact it’s clear that the plan is for an increase over TEN years, not five. And it hinges on trying to retain over 18,000 nurses who are already working for the NHS: in other words only 32,000 “extra” nurses would be added. To make matters worse, while talking about extra “nurses”, it also relies on using thousands of less qualified nursing assistants to cover for qualified staff.
The promised restoration of the bursary turns out to be nothing of the sort: those applying for nursing course would get a £5,000 hand-out, but still have to pay the £9,000 per year tuition fees, which David Cameron’s government introduced.
The plan for extra nurses also relies heavily on further recruitment from overseas. It’s not clear if many of those who see Brexit as a way to reduce immigration were aware of the extent to which the entire NHS depends on migrant workers.
The Queen’s Speech states that “a new visa will ensure qualified doctors, nurses and health professionals have fast-track entry to the United Kingdom.” But recruitment from the EU has fallen massively since the Brexit vote, and the new £400 visa plus the immigration health surcharge, which ministers have recently pledged to increase to £625 per person, mean that after Brexit EU nationals will face a new £1000-plus up-front cost in coming here – in addition to paying the same taxes that we do: how this is supposed to attract extra recruits is a mystery, especially given the increased incidence of racism towards overseas staff.
The Conservative manifesto pledge to scrap some hospital car parking charges, for night shift workers and for some severely ill patients, also turns out to be deceptive. Whereas Wales and Scotland have abolished these charges which land unfairly regardless of ability to pay, they remain a major problem in England.
A large majority of people using hospital car parks – outpatients, visitors and day-shift staff – will still have to fork out hefty sums to park, while the continued centralisation of services and loss of local access in many areas, combined with poor or non-existent public transport, ensure that many have no choice but to travel by car.
Reduced to a mere heading in the Queen’s Speech, with no further explanation is the proposal for an “NHS Long Term Plan Bill” – to implement a 10-year plan that lacks adequate revenue or capital funding, a coherent workforce plan, or any details on how some of its ideas are to be translated into reality: it also embodies deeply worrying plans to strip away the last vestiges of local accountability and implement so-called “integrated care provider” contracts that carve the NHS up into 44 separate health services, with fears that this could open the way to larger-scale private sector involvement.
And it’s clear that only six of the promised “40 new hospitals” will even get beyond the drawing board before 2024, while 21 other trusts have been fobbed off with a share of £100m “seed funding” to draw up plans that the next government will have to finance, and over 100 trusts with hefty and rising backlog maintenance bills know they will get no help to repair and upgrade buildings or equipment unless the new government does an abrupt u-turn in the budget.
To sum up, if anyone really believed that Johnson’s “new” Conservative government, following nine years of Conservative governments, was going to pump big money into the NHS and tackle the problems that are increasingly in the headlines, they will have five miserable years to reflect on how wrong they were.
Health Campaigns Together, working closely with Keep Our NHS Public, warned of precisely these dangers in our campaign: and we will fight on at local and national level wherever and whenever we need to in our efforts to limit the damage, highlight the problems, and press for a change of course.
We still have a lot of NHS to defend against cutbacks and privatisation.
The fight won’t be over until we have won.
Editor, Health Campaigns Together