Volume 54 Number 26, October 20, 2024 | ARCHIVE | HOME | JBCENTRE | SUBSCRIBE |
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It is a mark of a humane society that it not only cares for the ill and vulnerable but that the well-being of all is guaranteed, that health care is part of the very fabric of society. However, the direction in which the NHS has been moving is towards a business orientated capital-centred public and private health system and away from a publicly-provided human-centred health care system. A consequence of this perspective is that the concerns of neither health staff nor the public at large who demand a caring health service have been listened to and paid attention to.
In appointing Lord Darzi in July "to establish the state of the nation's health service", the new Labour Health and Social Care Secretary Wes Streeting commented, "Anyone who works in or uses the NHS can see it is broken." This is to begin by de-humanising the situation. Where has Wes Streeting been for the past years of this millennium when campaign after people's campaign has demanded that the present and future of the NHS be safeguarded? There is no hint from Wes Streeting that it is the very direction that successive governments have been taking the NHS that has been intensifying the health care crisis, taking the NHS ever more in the direction of privatisation, increased burden on nurses and health care staff, lack of investment where it is needed to fulfil the just demands that the populace make on it, and refusal to acknowledge that health care is a right. Even less is there a recognition that a healthy population is the prerequisite to producing the material well-being of society. Rather, in the direction spelled out under New Labour, the watchword has been "investment with reform", which is now declared to mean "reform first, investment last" in the present. Nor has there been any recognition that in this pay-the-rich pro-business governance, there should be instead an obligation of the employers of a healthy (and educated) workforce to foot society's bill for the benefit of exploiting this workforce.
So that is the context in which West Streeting has suddenly woken up and commissioned Lord Darzi to "leave no stone unturned" and "to speak truth to power". Lord Darzi, a surgeon and former Labour health minister, was charged by the Health and Social Care Secretary to "conduct an immediate and independent investigation of the NHS" in England. On September 12, nine weeks later that report was published by the government [1]. It highlighted what everyone knew that the NHS was indeed in "serious trouble". On the same day of the release of the Darzi report, Keir Starmer addressed the press at a King's Fund event also claiming that the NHS is in a "critical condition" but that "there will be no extra money without reform" and that the government plans to announce its 10-year plan for the NHS in the New Year.
The Darzi Report
In his report, Darzi found "ballooning" waiting times and delays in A&E and cancer care, government "funding promises broken" and massive "shortfalls in capital spending" by government were among many issues he highlights. However, Darzi does not mention the huge profiteering from the private sector for NHS contracts enabled and continually pushed by previous governments including his own when he was a Health Minister. This included the Private Finance Initiative (PFI) putting a huge financial burden on the NHS rolled out by Tony Blair's government. Neither does he mention the increasing number of services no longer available to patients on the NHS as this privatisation comes at a cost to existing public services. Yet Darzi tries to claim, "Nothing that I have found draws into question the principles of a health service that is taxpayer funded, free at the point of use, and based on need not ability to pay."
Darzi then sets out what the government asked him to identify. The "major themes for the forthcoming 10-year health plan" to "turn the NHS around". In summary these include:
The "Three Big Shifts"
Wes Streeting on September 7 (presumably with knowledge of the report) had said that "three big shifts" were needed, summarised as: a move from hospital to community care; from analogue to digital; and from treating sickness to preventing it. Darzi also very helpfully outlines an almost identical agenda to that of Starmer and Streeting for his themes to "turn the NHS around".
What is striking about this review and points for a 10-year plan, is that whilst Darzi identifies the huge shortfall in investments in the NHS over many years, he does not call for this to be addressed. It can also be asked, what is the function of the report when the conclusions have already been decided by the new Labour government prior to it being released, particularly before any discussion has been undertaken with health workers, their unions and the communities they serve. Why not involve also the campaigning organisations which have tirelessly pointed out the need for a change of direction in the NHS?
Keep Our NHS Public (KONP) issued a statement on their website on the publication of the report [2]. The statement asked: "How will Streeting, Starmer and Reeves use Darzi for their policy direction?" It pointed out: "Streeting's three 'big shifts' are: from hospital to community care, from analogue to digital, from treating sickness to preventing it. These are soundbites echoing through the last 25 years and nothing new. What is needed is a restoration of commitment to the NHS wholly publicly run and funded to succeed."
"For Keep Our NHS Public, our three 'big shifts' are:
away from underfunding and to funding the NHS to succeed
away fromprivate outsourcing and to building back publicly provided NHS
services
away from fragmentation of services and to a reuniting of the national
NHS
And we add a fourth important parallel 'shift':
the establishment of a national service for care, support and independent
living"
That these are soundbites echoing through the last 25 years and nothing new is exactly what they are. The Darzi report does not address this need for a change of direction away from a business-orientated capital-centred public and private health system to a publicly provided human-centred health care system, where the decisions are taken by people in their communities, health workers and with a pro-social government that serves and invests in their interests.
Health workers and people in the communities should not become overwhelmed by this present situation but put their energy into discussing, planning and organising to resist cuts to their health services that the Labour government is continuing, or will try to impose. While, at the same time have the aim to establish their own decision-making power so that they can shape the type of health care service that is needed to meet the needs of all and what the NHS should be.
Notes
1. Independent investigation of the NHS in England - Lord Darzi's report on the
state of the National Health Service in England, Department of Health and
Social Care, September 12 2024
https://www.gov.uk/government/publications/independent-investigation-of-the-nhs-in-england
2. Darzi Report: will Government write the wrong prescription? KONP, September
12
https://keepournhspublic.com/darzi-report-will-government-write-wrong-prescription/