The grindstones of Brexit pound everything else into the ground. Boris Johnson claims day after day that if only parliament would “get it done”, the country would be free to focus again on the NHS, police and schools.
But when the searchlight eventually does fall again on public services, as it likely will in a general election, that may do Johnson and his party no favours. Take Brexit out of the immediate battleground and what’s left? Only the true state of the country and its services after nine long years of funding starvation perpetrated by Conservative governments. Airy promises of shedloads more money from a man not even Tories regard as trustworthy may carry less conviction than the evidence of everyone’s eyes in their own neighbourhoods. As ever, the NHS is the standard bearer for public perceptions of much else. Two particular NHS items stand out as political emblems of this Tory era: the record shortage of nurses, and a particularly bad case of privatisation.
Start with the shocking privatisation in 2013 of the NHS blood plasma supplier, on which thousands of patients depend. To protect the quality of the blood product, David Owen, as health secretary in 1975, took blood plasma collection into public ownership as Plasma Resources UK. But Jeremy Hunt, as health secretary, sold that off for £200m to a US private equity firm, Bain Capital, while Britain kept a 20% stake. Co-founded by Mitt Romney in 1984, Bain has over the years acquired such well known health products as Burger King, Dunkin Donuts, Dominos Pizza and much else. Protesters, David Owen among them, warned that the company had a predatory reputation for asset stripping, but Bain promised it would develop the company into a “life sciences champion” in Hertfordshire. Instead, it sold it on to a Chinese company in 2016 for £820m. Was there any protest from our government, losing its last remnant of control? Not a word. Instead, an irony, the US government is expressing concern at China taking over a vital US-owned health asset.
Privatisation threats were raised in the debate on the Queen’s speech on Thursday, as Labour’s shadow health secretary, Jonathan Ashworth, pointed to the doubling of NHS expenditure on private health providers since 2010, to £9bn. That’s still not a vast sum out of the NHS budget, but only because the extreme shortage of funds has made core NHS services less tempting for takeover by private companies than the 2012 Health and Social Care Act was designed for. Though NHS England wants its competition elements repealed, the act continues to let companies like Virgin Care sue the NHS when they are denied the chance to tender for profitable contracts. Exhibit number two in the Tories’ destruction of our health service: the NHS has just published its highest ever rate of vacant posts for nurses, at more than 43,000 missing roles. A survey by the Health Service Journal, working from its own FoI requests, finds 93% of NHS trusts are falling short, with nearly half lacking 10% of the nurses they need: that’s three times more than five years ago. Nurses are being substituted with untrained assistants.
Nurse training places fell victim to George Osborne’s first budget: a conveniently commissioned McKinsey report said there would be less need for nurses in future. Later came the 2017 abolition of bursaries for trainee nurses, which cut the number of subsequent applicants. That made training unaffordable for women with children, who are often healthcare assistants wanting to upgrade. The attrition of nurses leaving the profession has worsened, with one in five quitting as soon as they train, and 5,000 going back to other EU countries as a result of the Brexit vote. Particular specialisms have been hit hardest. Between 2010 and 2018 there was a 40% drop in learning disability nurses. The Royal College of Nursing points to voluminous research showing not just the fast-rising numbers of patients, but also the increasing complexity and severity of their conditions. Statistically, for every extra nurse who joins the wards, 157 new patients have been admitted over the last five years. The greater the pressure on them, the more prone nurses are to quitting. At the same time many trusts have been downgrading nurses to save money, re-evaluating them from a top pay band 7 to a band 6, doing the same work for a lot less pay, causing many to leave in anger. The health commentator Roy Lilley has been pointing to their loss of some £6,000. Prof Alison Leary of London South Bank University warns district nurses are nearing extinction. A nurse loses £10,000 in pay to take a three-year district nurse course: none will qualify in 2021. Both Lilley and Leary suggest that nurturing nurses, supporting them when they start and encouraging them in promotions, could stop their flight from the NHS.
Are these tales of privatisation, neglect and cost-cutting the kind of thing Johnson wishes we would all focus on intently once Brexit is “done”? (Not that it ever will be.) If he thinks close coverage of the state of public services is his winning ticket in an imminent election, he may be in for a shock.
Promising jam tomorrow will cut no mustard with voters who can see the nine-year plight of services they use today; Johnson’s vague offers are nothing like the money needed to repair them. He might prefer we returned to scrutinising his exceedingly bad Brexit deal.
• Polly Toynbee is a Guardian columnist
