I was glad to see the Prime Minister discharged from
hospital on Easter Sunday – no more so than for any other patient who has
recovered from Covid19, but glad nonetheless.
His personal relief and emotion were clear when he spoke of his illness
and treatment at St. Thomas’. After
thanking the medical team that had treated him, singling out nurses Jenny from
New Zealand and Luis from Portugal for special praise, he went on to say, ‘Our
NHS is the beating heart of our country, the best of our country, unconquerable
and powered by love.’
They were powerful words from a powerful man and good to
hear but they made me suspicious and I wondered how closely matched his words
were to his previous positions.
Most recently, of course, he’s wanted to be seen to be a champion
of the NHS, promising it £350million per week once he’d won the Brexit
referendum, funding it to the tune of an extra £34billion, pledging to build
forty new hospitals and recruit 50,000 nurses, and happily being filmed and
photographed with medics on hospital wards as he campaigned for votes in the
run-up to last December’s election. He’d
probably rather we forgot his dismissal of photographs of a four year old lying
on the floor of an overcrowded hospital.
There are, of course, problems with every one of Boris’
commitments. £350million wasn’t accurate;
£34billion equates to £20.5billion in real terms, adjusted for inflation – the
same amount announced by Theresa May in the summer of 2018 – and represents a
2.9% increase according to analysis by the Institute for Fiscal Studies
compared to average rises of 3.7% since the NHS was established; forty new
hospitals turned out to be funding for six hospitals to upgrade existing
buildings; and 50,000 nurses will actually be 31,000 new recruits.
The bigger question though is whether, if they are realised,
Boris’ plans will make up for his party’s previous neglect of the NHS. 2.9% increased spending over the next few
years sounds good even if it is less than the historic average, but between
2009/10 and 2018/19, during the Tories’ years of austerity, budgets rose by just
1.4% each year on average. UK health
spending per person is now the second lowest in the G7 – way behind France and
Germany. In 2018, when Theresa May
announced the increased funding for the NHS, the Health Foundation described it
as ‘simply not enough to address the fundamental challenges facing the NHS, or
fund essential improvements to services that are flagging’. Earlier this year, the National Audit Office
questioned the financial sustainability of the NHS and warned of an increasing
risk of harm to patients.
In the same period, the number of beds in NHS hospitals
& other facilities fell by 14,463 or 10% of the total. The numbers of acute & general medical
beds fell by 7,547 despite warnings that bed reductions were unwise given the
increased pressure caused by the ageing and growing population. In 2019, Chief Executive of the NHS, Simon
Stevens said the policy had gone too far and that hospital beds had become
‘overly pressurised’ as a result of years of closures.
By the end of last year, the number of people on hospital
waiting lists had risen to nearly five million and one in six people visiting
Accident and Emergency Departments in England waited more than four hours to be
seen – the highest proportion since 2004.
Essential parts of the NHS in England are experiencing the worst
performance against waiting times targets since they were set. According to the Health Foundation, ‘longer
waits are a symptom of more people needing treatment than the NHS has the
capacity to deliver. This reflects a
decade of much lower than average funding growth for the NHS and workforce
shortages’.
There are now around 40,000 nursing vacancies in the NHS. Arguably, the reasons for this include Boris’
Brexit. By December 2019, 8,800 nurses and
midwives from EU countries had left while the number joining the register from
the EU dropped dramatically. Additionally,
in 2017 the Conservative government cut funding for the nursing and midwifery
student bursary, resulting in students facing £9,000 per year tuition fees
instead of fully-funded degrees, a decline in the number of applicants, and
certain courses having to cease due to poor intake. In the same year, Boris himself voted against
scrapping the 1% cap on pay-rises for nurses.
At the end of last year, itv.com suggested that many point out the lack
of a long-term plan for increasing staffing levels. This probably shouldn’t come as a surprise
given the Tories failed to deliver on their 2015 pledge to recruit 5,000
doctors; the intervening period actually saw doctor numbers fall.
In October 2016, the government ran a national pandemic flu
exercise, codenamed Exercise Cygnus. One
conclusion reached by then Chief Medical Officer, Sally Davies was that Britain
faced the threat of ‘inadequate ventilation’ in a future pandemic. She was referring to the need for ventilation
machines. According to the New
Statesman, the government’s planning for a future pandemic did not change,
despite that not one of the three plans published in 2011, 2012 and 2014
mentioned ventilators. The 2011
preparedness strategy referred to plans for increasing the capacity of critical
care services but according to the Sunday Times on 15 March, such planning was
non-existent. ‘Pre-existing pandemic
plans never went into the operational detail’, a Downing Street official is
quoted as saying. At about the same
time, then Health Secretary, Jeremy Hunt was preoccupied with the first strikes
by junior doctors in forty years, after he dismissed
their concerns for how his proposed working conditions would directly impact on
patient care and safety.
It’s not thanks to the Conservative Party that the NHS is
‘unconquerable’ but Boris himself can’t be held responsible for the failings of
his party in government from 2010; he himself only re-joined the House of
Commons in 2015 before joining Theresa May’s government in July 2016. Arguably, however, he was highly influential
throughout, yet very quiet when it came to his party’s policies on the NHS. Moreover, we know from the position he took
on the EU withdrawal deal – resigning from May’s government – that when
something really matters to Boris, he’s not afraid to stand up for it, even
against others in his own party. It
seems then that he approved of his party’s policies; either that or the NHS
just didn’t matter to him.
Historically, Johnson has not exactly been an effusive fan
of the NHS. In a 2004 column for The
Daily Telegraph, it was not for him unconquerable but ‘unimprovable’ and he has
long been a proponent of greater involvement by the private sector in health
services, defending Michael Howard’s plans to give NHS patients choice to be
referred for private treatment with a portion of the cost covered by the NHS,
for example. In a column for the
Spectator Magazine in 2005, he criticised his own party as cowardly for not
introducing charges for some health services and in a 2002 speech to the House
of Commons, he criticised the ‘monopolistic’ NHS, advocating provision by the
private sector. ‘We need to think about
new ways of getting private money into the NHS,’ he wrote in his book ‘Friends,
Voters, Countrymen’ in the same year.
It’s a theme he’s returned to regularly with almost ideological
fervour. Given these views, the fears of
some that they could lead to a two-tier health service and a diminished NHS could
be understandable.
On another issue – that of immigration – Boris told Sky News
in December that he would stop EU migrants treating Britain ‘as their own
country’. What, I wonder, did Luis from
Portugal make of that?! Now that he has
seen first-hand just what many immigrants contribute to the NHS and now that his
own life has been saved by them, perhaps the Prime Minister will rethink his
assertion that they have no right to think of this country as their home.
I hope Boris’ apparent conversion on the road to recovery
and his new sentiments for the NHS are genuine.
I hope too that he remembers them long after he shakes off the mantle of
poster-boy for recovery from this emergency.
You’ll forgive my scepticism though if I have some doubts.
Sources:
The Independent, 9 December 2019: https://www.independent.co.uk/
The Guardian, 9 February 2020: https://www.theguardian.com/co
The Guardian, 27 November 2019: https://www.theguardian.com/co
Euronews, 11 December 2019: https://www.euronews.com/2019/
itv.com, 19 December 2019: https://www.itv.com/news/2019-12-19/is-boris-johnson-s-nhs-pledge-as-generous-as-it-sounds/
Business Insider, 7 December 2019: https://www.businessinsider.co
Newshub, 13 April 2020: https://www.newshub.co.nz/home
New York Times, 10 December 2019: https://www.nytimes.com/2019/12/10/world/europe/nhs-election-boris-johnson.amp.html
Sky News, 26 November 2019: https://news.sky.com/story/gen
New Statesman, 16 March 2020: https://www.newstatesman.com/politics/health/2020/03/government-documents-show-no-planning-ventilators-event-pandemic
The Independent, 28 November 2019: https://www.independent.co.uk/
The Independent, 10 December 2019: https://www.independent.co.uk/
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