NHS at 75: Fund it properly or hold a referendum on its future

The NHS’s 75th anniversary is 5 July – and, while it’s an important moment to celebrate, we must use this opportunity to hold politicians to account.

Over the past four decades, politicians have made policy changes to the health service in England that have allowed increasing privatisation, the introduction of an internal marketplace, and the loading of enormous private finance initiative debt upon many NHS trusts. We are now in a situation where thousands of NHS services are outsourced to non-NHS providers. This has atomised the service, damaging the architecture of the system as a whole, disrupting important relationships between people and teams, and creating chaos and bureaucracy, which always accompanies the churn of short-term contracts. A system that was once whole is thousands of tiny fragments now, some publicly-owned, some run by non-profits and others by profit-making companies.

Our public healthcare system is fast collapsing and a two-tier healthcare system is being built in its place, excluding more and more people from the care they need. In England alone, more than 7.3 million people are now awaiting treatment, the longest waiting list in history. The number of missing staff members was 124,000 at the last count. This past winter the situation was so stark some patients received life-saving treatment on the floor of A&E waiting rooms, behind sheets held up by staff members in a desperate attempt to offer them dignity and privacy. The president of the Royal College of Emergency Medicine has said up to 500 people may have died every single week late last year because they could not access the urgent care they needed from the NHS.

But often, even as we see these figures climb, even as patients are failed in their most vulnerable moments, the situation is framed as a tragic happenstance. It might be blamed on an unexpected bout of Covid or flu, for example or even on NHS staff, who are scapegoated in various ways. It’s important to recognise that the state of the NHS was predicted and predictable, and the situation is worsening because politicians are failing to take necessary action to safeguard lives.

The situation is not new, because successive governments have been destroying the architecture of the system in incremental ways for a long time. But the lack of investment in the service and real-term pay cuts for staff since 2010 have exposed the resulting problems. As the funding has been pulled back over the past 13 years, the cracks have become visible, sometimes literally. In England, it would cost the NHS roughly £10bn to repair hospitals and equipment, and some of the backlog is putting patients and staff at risk. There have been dozens of recent examples of sewage leaks in wards, maternity units and A&E departments.

Of course, the pandemic has made everything worse. As resources were diverted to enable staff to cope with the worst public health emergency since the NHS began, many operations and clinic appointments were delayed or cancelled. This caused waiting lists to spiral; the situation deteriorated fast. As we watch all of this unfold there are reports that more and more people are turning to private healthcare and there are tragic examples of patients being failed.

The situation can feel hopeless but it’s important to remember it is reversible, should our politicians choose to take action.

They should pay the £10.2bn repair bill and also pay the NHS workforce properly. They should provide urgent, comprehensive and meaningful mental health support to staff who have endured more than can be reasonably expected throughout the pandemic and beyond. Those are the immediate priorities, which would make the service safer for patients. And in the longer term, our politicians need to focus on how to rebuild the system as a whole and reverse the fragmentation that has occurred over so many years.

Even as I type these words, I know they may seem fanciful because politicians have demonstrated they can – and will – do what they like with the NHS. They have never polled the public about their reforms; they have no mandate to load the NHS with debt or infiltrate the service with privatisation; but they’ve done all of it regardless. But here’s the crux. When any government takes power and takes on custodianship of the NHS, it does not take control of a gauzy and non-specific service, free to fund (or underfund) in any way it chooses. It takes on a public healthcare system governed by a constitution whose seven core principles include a duty to provide comprehensive care, free to all, on the basis of clinical need.

The NHS, in many instances, no longer provides comprehensive care to patients. Some of those who desperately need it are unable to access help. Senior politicians have even spoken publicly about introducing different ways to charge NHS patients. The government is failing to adhere to the NHS constitution; in light of this, it has two options. It can drastically change its current policy and invest heavily in restoring the NHS. Or it can hold a public referendum on whether the NHS constitution should be abolished altogether. The public has been consistent in its support for the NHS’s principles for the past 75 years. I think we can safely predict what the outcome of that referendum would be.

As we approach the NHS’s 75th anniversary, let’s take this opportunity to hold the government to account. Politicians often seize upon moments like these to profess support for the service but milestone events simply serve as convenient PR opportunities to boost their own image. It’s up to us to use this important moment to ask politicians a key question instead: will you immediately change what you are doing or will you hold a public referendum? If not, on its current trajectory, the NHS will not survive another 75 years.

Julia Patterson’s new book, “Critical”, is out on Harper Collins on 22 June