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The NHS has always been deeply political – pretending otherwise is exactly what got us in this mess

We do need a debate rooted in evidence, not fantasy. But we cannot do that without acknowledging how the last decade of Tory rule has affected healthcare

Dolin Bhagawati
Tuesday 05 November 2019 15:11 GMT
Matt Hancock insists the NHS is not for sale after government held secret trade meetings with US

Writing in The Times, Chris Hopson, chief executive of NHS Providers, acknowledged on Monday that the NHS will always be a key election topic due to its enduring popularity with the British public. So far, so good. His decision to call on politicians not to turn the service into a political football ahead of the general election next month, however, misses the mark.

In light of the current election discourse, where statistics are wilfully manipulated, resulting in a level of debate that would shame a pupil starting secondary school let alone those debating the future of the country, Hopson’s frustration in requesting the de-politicisation of the NHS issue is understandable. In reality, however, politics and the NHS have a strong relationship that simply cannot be disentangled. In order to achieve an appropriate level of discourse, we must recognise that.

Under a consecutive variety of governments, NHS staff have witnessed their industriousness reduced to policy announcements. Declarations and promises of investing an incomprehensible amount of money in the sector have led to the government’s NHS policy being dictated by fashionable soundbites. However, analysis of headline-grabbing figures by the Health Service Journal has shown that the big figures rarely reach the front line. Only 3 per cent of the 2.7bn promised since 2017 has made it to frontline. On the basis of such evidence, the drudgery of similarly meaningless numbers ought to be viewed as more nonsensical PR, rather than implementable policy.

The quote “health statistics represent people with the tears wiped off”, attributed to the epidemiologist Sir Austin Bradford Hill, should be kept in mind when hearing our prospective MPs discuss our vaunted health service.

The currently politicised health debate focuses on funding and privatisation – a consequence of allowing a political discussion to be driven by think tanks such as the IEA, which attempt to frame an NHS conversation as a funding question only and therefore a choice between a publicly-funded NHS or an insurance-based model.

To do so, however, goes against the instincts of a political class that chases soundbites and popularity over substance and morality while failing to understand how the NHS functions, as demonstrated on Monday by the health secretary, Matt Hancock in his column for The Sun, in which he suggests that the root of the NHS's issues lie with Labour's "scaremongering".

Health is a point of intersection and reflection of all societal ills. As health inequality expert Sir Michael Marmot states – a health crisis is a social crisis. Policy changes from other political areas impact enormously on the NHS and its reverberations are felt in numerous ways. Two pertinent examples which are yet to make their presence known in the election debate to date are immigration and tax, two explicitly political issues.

Immigration and health have been framed as the former causing undue pressure on the NHS, despite repeated debunking. However, the signature immigration policy of the last decade, the hostile environment, a political policy resulting from poor evidence, continues to prevent the NHS addressing its crippling staff shortage, while the policy’s insistence on chasing charges for migrants has proven to cost more than it has recovered.

The current number of staff vacancies in the NHS is about equal to the population of Oxford yet, as reported this week, the Home Office continues to prevent measures to recruit staff from outside the EU. The NHS has throughout its existence thrived on immigrant labour. Currently, 13.1 per cent of NHS staff are of a non-British nationality, demonstrating that without immigrant labour, the NHS dies. As a result, the longer the government continues to reject the link between immigration and health-related policies, the longer my patients have to wait in pain to see me in clinic (due to staff shortage) while other patients recover from operations on wards with unsafe staffing levels.

Simultaneously, a timebomb put in motion under former chancellor George Osborne in 2016 meant rising numbers of consultants and other senior staff were facing unexpected tax bills linked to the value of their pensions. Doctors continue to be advised not to work extra hours in order to avoid tax demands totalling nearly £100,000. This lack of extra work has led to increased delays in scans being reported and nearly 70 per cent of experienced surgeons have considered leaving their NHS jobs early due to these potentially crippling bills.

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Suggesting that the NHS can be divorced from politics falls short of the mark and risks glossing over issues such as revelatory meetings between British officials and US trade officials, as exposed on Channel 4’s Dispatches last month, which Labour claimed as proof of privatisation. The Tories’ defence, on the other hand, predictably explained the issue away as a distraction tactic from Brexit. Lost in this was the heart of the matter – that the talks featured in the documentary could result in the drug budget for the NHS increasing by £30bn.

As Mr Hopson writes, we do need an NHS debate rooted in evidence, not fantasy. But we cannot do that without acknowledging the political aspects of healthcare. The structures currently in place, like segregated ministerial departments, encourage the thinking that depoliticisation of an institution as crucial as the NHS is possible. It is not.

When it comes to the effect of the NHS on the upcoming election, where statistics still continue to be deliberately warped and manipulated, voters may have to approach the situation by paraphrasing Ronald Reagan’s argument from one of his presidential debate. One party has been in charge of the NHS for the last nine years, do we feel it is better or worse than nine years ago? If the answer is better, then it’s clear where our choice lies. If we feel that the course the NHS has been on is an incorrect one, then we must choose an alternative.

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