Westminster Abbey on Wednesday morning will be filled with NHS staff in their uniforms as the “national religion” gives thanks for its 75th birthday. Hymns adapt quite easily: Abide With Me might be the dirge-like tone for those in peril on the wards.
Prayers from the pews, among junior doctors and consultants about to strike and nurses who could strike no longer, will be full of mixed emotions. Managers, faced with a record staff exodus, will be praying to get through next winter.
The wail goes up that the NHS as we know it may not be here for its 100th birthday. These are its darkest hours: waiting lists were never so long, results are falling behind those of similar countries, and crumbling buildings have ancient IT systems thanks to drained capital budgets. Private practice is rising, as people who can’t wait dip into their savings to pay. Is this the way the NHS ends, not with a privatisation bang, but with the whimper of patients in pain reluctantly deserting it, causing a two-tier system?
I think not. The public remains passionately in support of the principles of the NHS, however glum about its current state. A Health Foundation poll shows three-quarters of voters believe a service free for everyone is “crucial”, so the famous dictum attributed to Aneurin Bevan holds good: “The NHS will last as long as there are folk left with faith to fight for it.” And there are.
Against all the odds, those founding principles survived the Thatcher revolution’s individualism, privatisation, anti-tax and anti-state arsenic injected into the national bloodstream. Though the creation of the NHS was opposed furiously by Winston Churchill’s Conservatives (and doctors), the Tory governments that have overseen the NHS for two-thirds of its life have, with gritted teeth, had to swear undying allegiance. Thatcher loathed it, but had to pledge that the NHS was “safe in our hands”. Cameron’s 2010 campaign sported vast posters promising, “I’ll cut the deficit, not the NHS”: under him, per capita spending fell further and for longer than ever before.
The question I ponder is why the universal egalitarian principle of the NHS, held in such high esteem by so many, rarely spills over into the other good things the state can provide for everyone. Why aren’t we more Scandinavian in our willingness to pay the taxes that would give us a public realm with better education, arts, leisure centres, parks, preserved heritage, great transport, fine public housing, a decent social security net and Sure Start centres for all families?
The mundane answer may be that everyone, of all ages and incomes, fears they might need an ambulance to A&E if they fall off a ladder or keel over with a heart attack, whereas only a certain number of people at any one time appreciate other public services. But Labour could tap into that Scandinavian sentiment, as it becomes ever clearer that the current plight of the NHS is due to profound social failures beyond its doors. The NHS is the last resort, the repository for the effects of neglect in everything else – from dirty air, to children in mould-ridden homes, to inadequate food. As research by Michael Marmot, professor of epidemiology at University College London, shows, healing the NHS requires healing the worst inequalities.
One reason why the NHS will survive (even if it takes years to recover) is this perfect political exhibition of the consequences of 13 years under Labour followed by 13 years under Tory prime ministers. For many years, Labour’s average annual spending increases from 1997 of about 6% gave the NHS its best ever results – and that led to the falling use of private healthcare. Look at it juxtaposed with the spending desert of the past 13 years, a Narnia of permanent winter where patients wait for care in hospital corridors. In years to come, that will stand as the example: you get what you pay for (except in the US). Labour has a history of leaving the NHS better, and the Tories of damaging it. NHS waiting lists now bake in economic failure, with too many people waiting, too sick to work. These historic facts are now so obvious that voters may take many years to trust the Tories again.
Wes Streeting, Labour’s shadow health secretary, looks on as the Tories’ workforce plan steals from his own much-trumpeted policy of doubling training places for doctors and nurses. He can now use elsewhere the £1.6bn a year he planned to raise from non-dom tax reliefs to spend on training. His reform priorities spelled out this week rightly shift resources out of acute care to community, GPs and prevention: it’s been tried before, and was advocated again by the NHS Assembly’s report last week. Has he the mettle to do as he says – and deny hospitals while beefing up GPs, social care and community health? How much Labour would spend on the NHS remains unknown for now, though Steve Barclay, the health secretary, gets away with promising £2.4bn over five years for his training plan, unable to say where it will come from. Rishi Sunak said ominously in his press conference, “By prioritising the NHS there will be other things that we can’t afford.” If rumoured benefit cuts are among those “other things”, they will ricochet back into added NHS pressure: social cuts always do.
Meanwhile, Conservative outriders hammer on against the NHS – Andrew Neil was the latest to berate its failings in the Daily Mail. Demanding “reform”, these opponents always leave that to the last paragraphs, never spelling out what they mean beyond vague but unspecified praise for European social insurance (which amounts to much the same as our national insurance, with more costly administration). They plant the thought that we should pay top-ups and extras, with no details, driven by an ideological and illogical impulse that says any form of payment is good.
Resoundingly, overwhelmingly, the public rejects all that, as will those NHS staff in Westminster Abbey singing hallelujahs tomorrow. As a member of the NHS Assembly, I’ll be hymning praises there too, like others thinking of births, deaths and family lives saved, all for free. Tory ministers will pretend to sing along, though they know that the terrible condition they have reduced the NHS to will be a prime killer of their electoral chances, possibly for years to come.
Polly Toynbee is a Guardian columnist
