"Crisis, what crisis?"
If you are suspicious about a managed news agenda, then the ‘looming funding crisis’ in the NHS which popped up all over the news this week should be making people twitchy. At first glance, and somewhat optimistically, much of this financial chatter has been explicit concerns about how current models of NHS funding are making the service unsustainable. However, far from invoking broad ranging critiques of ideologically determined spending priorities creating a cash starved service which is being relentlessly driven towards private for-profit providers, most of the chatter has been about how tax increases are necessary to ensure the continuation of the NHS. For example, in the Guardian the arrival of Simon Stevens as chief executive of the NHS was run under a banner headline that ‘only an injection of cash can avert an NHS crisis’, accompanied by a story with concerns over sustainability of the NHS. Similarly, the independent announced a Labour Party review into funding strategies for the NHS. Relatedly, Frank Field stated the NHS as we know it will cease to exist without a one pence rise in national insurance contributions (NICs) (critics have argued the NHS ‘as we know it’ has already ceased to exist). Meanwhile, the Telegraph reports that health service leaders within the NHS were concerned that patients will need to pay for bed and board when in hospital, unless there was sufficient investment and reforms in the current NHS. These stories raise one or two points of political interest. First, they hint at a looming catastrophic crisis – one predicated on questions of financial sustainability. Second, these stories propose a very distinct and specific set of solutions to these problems. These solutions feed directly into the very framing of the crisis, where the problem and the solution collapse into an ideological singularity. . The solutions proffered focus attention on the sovereign health consumer, couched within a rhetoric of individual entitlement. The insistence on a rise in levels of NICs pushes the responsibility for raising NHS revenue onto the general public (the Great British taxpayer, to coin the vernacular), diverting attention away from very real spending decisions being made right now about what services are, and are not available, in the NHS. This appeal to increased NIC’s creates the current crisis in NHS funding as a fiscal rather than ideological matter. It asks the public to all pitch in with an extra penny to save the great British NHS, diverting our gaze from the for-profit carpetbaggers who are making off through the backdoor with the NHS family silver. Similarly, the news about so-called hotel hospital charges appeals to a rhetoric of individual unfairness. There is an implicit appeal that as individual taxpayers we’ve already paid for the NHS, why should we have to pay again at point of use? Tellingly, the Telegraph story is a report of a speech given by Rob Webster, the chief executive of the NHS Confederation. In this speech he also talked about a looming crisis in terms of rural areas with insufficient GP coverage, of over-stretched and under-resourced A&E departments, of bankrupt hospitals unable to pay bills and longer waiting times and increased cancellations. These stories all share a common thread in terms of a direct link to a lack of central funding and resources. But for the Telegraph, none of these more structurally located stories merited headline status, this was reserved for the news on individual charges. In terms of the rhetoric of crisis, The Telegraph quote Mr Webster as saying
“Once we get into a crisis you have to look at where we get resources to fund care – if the NHS can’t afford to fund what it needs to it may be that we start asking people to pay for their own transport, their own food or accommodation – these are unpalatable choices.”
These rhetorics offer a horrific future and function to create a crisis of entitlement where what people have paid for, what they have invested their taxes in, is being offered to them at a rate of negative equity. The assertion is that there is a widening gap between what they thought they were paying for and what they are likely to get. This crisis metaphor functions as a perfect storm to drive through reform, in a way that provides legitimacy for the financial framing of the debate. For example, on the 1st May, the Kings Fund implored the current government and NHS management not to ‘waste a good crisis’. They continue:
“Now more than ever political and NHS leaders need to see the impending crisis as an opportunity to think and act differently. They should resist the temptation to prop up outmoded services and instead embrace the transformations of care that are long overdue….”
This overhaul relates to Kings Fund proposals to implement an NHS transformation fund for “new services that are needed to bring about the transformation in how and where care is provided.” These ‘cash releasing plans’ would be “underpinned by credible and accurate modelling of demand and cost.” What this solution does not do, is roll back the tide of private provision. What is needed within these debates is the development of an alternative model for the NHS. One that rejects the market mechanisms and principles of competition. One that requires the collective social good of universal healthcare based on need to be explored for the ‘real’ benefits it will bring to the fabric of any progressive modern society. Courtesy of Ewen Speed at Cost of living