THE WELFARE State Network is planning a major conference next spring in defence of the NHS. Part of the preparation for this conference is seeking trade union support for a platform of policies which offer a way forward for the NHS, which can be demanded from the Labour government.
The latest issue of the WSN’s paper Action carries a centre-page spread setting out detailed proposals from John Lister of London Health Emergency. Here we carry a shorter version of his proposals, and urge readers to back the campaign.
THE GOVERNMENT’S allocation of an extra £300 million to the NHS to relieve the looming "winter crisis" is a recognition that more money really is the key to the problem.
But the new money, ministers insist, is strictly a one-off exercise: it will not be incorporated into next year’s budgets.
Worse, the government plans to get through the winter peak by reducing many Trusts to an emergency-only service. Of course in a growing number of hospitals this is already the case.
Health Secretary Dobson has set up yet another "hit squad" of bureaucrats to tour health Trusts telling them how to reduce their waiting lists. But the only way the Tories reduced waiting lists was by spending more money.
Wards must be reopened, and funded to ensure they give care all year round, in addition to "peak-time" provision in the winter months.
Running an acute ward costs around £350,000 a year. Opening two extra wards in each of 100 health authorities would cost around £70 million. 250,000 extra patients could be treated.
Waiting list operations cost an average of £1 ,500: with £450m extra spending on core budgets the entire waiting list could be cleared within five years.
Mental health beds for the most severely disturbed patients are under an almost impossible strain. One psychiatric ward at Guy’s Hospital recently recorded a bed occupancy rate of 230% – effectively three to a bed.
The Tory government last year admitted that there was a massive gap in the provision of 24-hour nursed accommodation to provide continuing care after the closure of the old Victorian asylums – and even costed out a plan to provide them, but, predictably did nothing to fund it.
Crowd control
With psychiatric nursing staff reduced to little more than crowd control on dangerous, overcrowded wards, and all but the most seriously disturbed patients being excluded from care, new money is urgently needed.
Much of the money saved from closing the old psychiatric hospitals has been squandered and diverted to other areas of care, any moves to fill this yawning gap must be funded by new government cash. Department of Health estimates showed that the required 5,000 extra places would cost £500 million in capital to establish, and £400m a year to run.
Services for the frail elderly also need urgent attention. Tory policies effectively privatised much of this care, with health authorities and Trusts closing geriatric beds, dumping the problem onto social services which in turn have become totally reliant on privately-run nursing homes.
For many pensioners requiring care there is the added misery of means tested charges, which are forcing an estimated 40,000 people a year to sell their houses or spend their life savings.
Social service budgets have also been cash-limited, and the growing problem of funding care in private homes is creating a huge backlog of patients awaiting discharge from hospital.
This year social service budgets are being slashed by over £200m, with more cuts come in 1998, while hospital bed closures have meant that every bed "blocked" by a patient who would be better cared for elsewhere causes huge knock-on problems.
The big nursing home chains have been amalgamating into ever-bigger corporations. Rather than allow these firms to profit from care of the frail elderly, the government should nationalise the nursing homes, and run them as a separate wing of the NHS, introducing basic minimum standards of staffing and care.
Even if the homes were bought at the full market price, for little more than £500m the government could take a huge stride forward in care for the elderly. A logical next step would be the elimination of means tested charges for nursing home care.
This would have a revenue cost, but could be set against the savings on bureaucracy and the consequent improvement in the efficiency of NHS hospitals.
NHS staff have been ground down by ever-increasing workload, successive waves of cuts, and wages declining in real terms. Rock-bottom morale has become a tool of management as cynical Trust bosses set out to close units by putting staff on short term contracts, then announcing that the services are "under review" – and then watching qualified staff leave for more secure jobs elsewhere.
The NHS has to recruit able and confident young people: it has to offer decent pay, conditions and job security. The new government should commit itself to a policy of ensuring a real-terms pay increase each year for health workers.
This, together with the injection of new resources into the NHS could revive morale and ensure recruitment and retention of staff .
The NHS should also invest in new hospitals. The Tory Private Finance Initiative brought all hospital development to a standstill for four years. Now the Labour government is attempting to make the failed Tory scheme work.
The long-term costs are potentially ruinous. Hospital wings costed at £40m are likely to wind up costing upwards of £425m as city speculators and contractors take their slice.
If Labour really wants to ensure value for money, it should scrap PFI and expand the kitty of NHS capital. Instead of regarding this investment in the infrastructure of our health care system as public sector borrowing, it should follow the practice elsewhere of counting it as a capital asset.
The full text, a model resolution, and details of other WSN activities, can be obtained by subscribing to the WSN (£5 individuals, £25 union branches).
Write to WSN, Camden People’s Centre, 183 Queen’s Crescent, London NW5 4DS. 0171-639-5068.