What were you doing while the NHS was being destroyed? | Jacky Davis

The NHS is undermined, but not beyond saving. Here's what Labour and the public can do to make sure it is not scuppered for future generations

The NHS is in the headlines every day and the loud noise you can hear is the sound of the coalition's chickens coming home to roost. Last week Sir David Nicholson, the departing chief executive of the NHS, admitted to the Commons health select committee that privatisation and competition, the very core of the shakeup, were not proving a success. In fact the new regime has led to a quagmire in which improvements are blocked and only competition lawyers benefit from the new requirement to tender out all NHS services.

At the same time the National Audit Office has reported fears that the small number of corporations that are winning the tenders are becoming too big to fail. It also expressed concern about "the lack of transparency over profits, performance and tax paid with two of the corporations, Atos and G4S, having apparently "paid no tax at all". Scandals are already emerging, along with a sense that the government is outsourcing not only the work but its moral responsibility to provide appropriate public services.

Meanwhile, on the frontline, embattled NHS staff are trying to keep the service going while the infrastructure is cut away from under them. Since the coalition has come to power 20,000 nursing posts have been lost or left vacant, 8,000 beds cut and A&E performance is at an eight-year low. The latest response to this, the downgrading of many A&E departments and the creation of a two-tier service, will mean further uncertainty for staff and patients and does not address underlying problems. David Cameron has belatedly woken up to the fact that the service is in danger and has asked for weekly briefings, while the health secretary, Jeremy Hunt, has put private hospitals on standby to help in the predicted winter crisis.

It is not surprising that some consider the NHS beyond saving. But that is not the case. There are things which, if done quickly, will serve to slow down the vandalism the service is suffering.

Labour must make a convincing commitment to repeal the Health and Social Care Act and to restore the NHS as the preferred provider. While Ed Miliband has said as much, it is hard to find a campaigner who believes the promise, and only health spokesman Andy Burnham has stepped up and admitted that Labour went too far with the NHS market, building the bridge the coalition is now storming across. A firm message to the private sector that Labour intends to reverse the market would discourage them from getting too involved.

The next step is to restore the secretary of state's responsibility to provide a comprehensive health service, which was abolished by the act. The coalition insisted that changing the wording about the duty of the minister was vital while at the same time claiming that it would "in practice" make little difference. But the change was fundamental, breaking the legal link between the minister and healthcare provision and making it more difficult for parliament to hold the minister to account. Lord Owen has produced a bill that would restore the duty of the health secretary and Labour should publicly commit to passing this as soon as it gets back into power.

PFI has been a disaster for the NHS. The taxpayer is set to spend £60bn for £11bn worth of hospital building. Many hospitals are now running into serious financial difficulty because they were forced to turn to PFI for projects. As a result their future is in doubt. The debt should either be taken on centrally or other solutions sought, such as adjusting the tariff to cover the costs of PFI, sharing the burden fairly across the service.

Finally, bed losses (50% of hospital beds in the last 20 years) underlie many of the current problems and must be halted. On several occasions recently there have been no mental health beds available in the entire country, and in the summer a major London teaching hospital was forced to close its doors to emergencies. Labour should demand that there are no more acute or mental health bed closures until replacement services are available.

The demolition of the NHS will be an important issue at the next election. There is still plenty of the service left to defend but we need commitment from the opposition and continued pressure from the public. Otherwise our children will be asking us: what were you doing when they destroyed the NHS?

Jacky Davis is a consultant radiologist and author of NHS SOS


Jacky Davis

The GuardianTramp

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