Hustings speech made at St. Mary’s Community Centre, Eltham on 26th November 2019
Firstly let me thank the Keep Our NHS Public group for inviting me to speak at the hustings. It is my pleasure to be able to talk for a few minutes specifically about the NHS.
The government as a whole raises and spends £800bn per year, that’s everything you can think of from pensions to defence to roads to hospitals to schools to housing to energy subsidies. Of that £800bn, how much do you think is spent on health?
The answer is that in 2018 the government spent 16.5% of all spending – £155bn – on health. After adjusting for inflation, that’s proportionately 10 times as much as what was spend on health in 1950.
This raises the question of why we are so stretched when we are spending what looks like a truly enormous amount of money. I’d like talk about this for a moment, before coming onto what the Green Party proposes to do about it.
First, there’s an upper limit to how labour-efficient you can make the health service without compromising quality. You can’t do heart surgery with fewer surgeons, you can’t make more beds with fewer nurses, you can’t substitute human care with a robot.
It’s very hard to have more healthcare with fewer staff, the reality is that to do more healthcare you need more staff.
Second, the NHS competes in the market for employees with other professions and other industries. At some point, you’ve got to pay the going market rate for a professional. And you don’t, you’ll get very high turnover and you’ll struggle to attract new staff to work in health.
It is an unfortunate fact that a colleague of mine working in publishing is actually a qualified surgeon who quit the NHS owing to stress. I’m not the only one who knows someone who has had enough and I’m in no position to judge.
Third, our society is ageing and the fact that demand for health services spikes towards the end of life means we have increasing cost.
I saw an exhibit in the British Museum a couple of years ago where they lined up a life’s worth of tablets on a table by year of life and the pile-up of tablets at the end of the table was quite something.
It’s simple arithmetic to calculate that in a society where the proportion of older people is increasing, more resources will be needed simply to provide the same level of service.
The ageing society problem is worsened by the demographic fact of the baby boomer bulge, which means we are in the middle of a decades-long extra stretch on services. Baby boomers born in the 1940s and 1950s are reaching old age over the 2000s through the 2030s.
Fourth, we have increasing costs in the provision of new drugs and medical research.
Contrary to popular belief, this isn’t really because of rampant profiteering so much as changes in demand. Rather, we want our new drugs to be safer with fewer side effects, we want higher thresholds for drug effectiveness, we want new drugs to be available to as many people as possible, we want rare diseases not to be neglected. Achieving these outcomes takes extra money.
And finally, costs are increasing because of the general poor health of the population. Statistically speaking, at a population level the best predictor of bad health is poverty.
There is a deep connection between health and wealth. The poor live in draughtier houses, nearer to polluting roads and factories, they are less able to draw on resources to cope with illness or disability, it is difficult to afford quality ingredients or find the energy to cook properly, precariousness of employment causes mental illness, and – I could go on.
So, as you can see, there are many factors increasing costs in the NHS. What that means is that simply in order to stay still, funding for the NHS must rise more than inflation every year. This is how we end up in a situation where we spend ten times in real terms on health than we did in 1950.
And yet, that increase is spending hasn’t been steady. We peaked on health spending as a share of GDP in 2009 and it’s been steadily declining since. That is directly a result of the political choices of the Conservative party.
What does the Green Party propose to do differently?
Firstly, we will stop the bleeding. There is an urgent crisis in NHS staff recruitment and retention, which – I might add – Brexit has made worse. That is the major bottleneck for providing better services. The Green Party would provide £6bn a year extra funding immediately to the NHS and guarantee this additional funding until 2030 from general taxation, where we’ll have an emphasis on taxing wealth rather than incomes.
Secondly, we will repeal the Health and Social Care Act 2012 in its entirety. The NHS internal market has been a disaster and has only made private companies rich while making cost and quality problems worse.
Thirdly, perhaps most importantly, the Green Party will work to improve society holistically so that we can improve health specifically. We are too focused on treating the symptoms of poor health at an individual and medicinal level, we do not have enough focus on preventing health problems by addressing their social and environmental causes.
We will address the epidemics of loneliness and stress, we will tackle the poor quality of air in our cities, and we will increase access to natural spaces, we will end precarious employment.
If you want me to fight for you, I encourage you to vote Green in the upcoming election.