So, the NHS is in crisis. Again. And not any old crisis, either: this time it’s a ‘humanitarian crisis’.
At least that is the view of the British Red Cross, which took time out from highlighting the plight of Syrian refugees to draw attention to the ‘large numbers of vulnerable people facing a threat to their health, safety or wellbeing’ due to NHS staff shortages, a lack of equipment and, more broadly, a chronic funding shortfall. The UK government, clearly unhappy about the state of healthcare in the UK being equated with the death and destruction being visited upon Syrians, countered that the problems experienced by patients this winter are no worse than previous winters. Still, as one report points out, ‘the large number of hospitals declaring a red or black alert – their way of saying that they can’t cope, at least temporarily – is not normal’.
And yet, there is a grain of truth in the government’s brush-off. That is to say, the NHS is always seemingly in crisis. In the autumn, for example, it was revealed that hospitals in England had ran up a record deficit of £2.2 billion, which is some going given it recorded a funding surplus of £546million in 2012-13. Before that, there was a ‘crisis’ in accident and emergency wards over the shortage of emergency doctors. Before that there was the junior doctors dispute which, we were told, was set to plunge the NHS into ‘crisis’. And so on.
The perpetual re-emergence of the NHS’s crisis narrative testifies, in part, to deep-seated problems. This is a huge, monolithic organisation – the fifth largest employer in the world – which, thanks to the aim-setting nature of management, has routinised carelessness, manifest in the myriad tales of care-home abuse and patient maltreatment, in the pursuit of hitting targets; a huge, monolithic organisation that has expanded, hectoring and nannying, into the realm of individuals’ lifestyles, all in the name of public health; a huge, monolithic organisation that, with its expansion, makes ever greater claim on the public purse. And all this expansion, all this increasing of demand, is happening at a time when government spending on the NHS, although it is continuing to rise, is doing so at a declining rate.
Yet here’s the odd thing about the perpetual crisis in the NHS: no matter how severe the problems, no matter how poor the service provision, no matter how intolerable the current set-up, the much-publicised crisis never provokes an interrogation of the nature of the NHS. The NHS is always there to be saved, never criticised. Every time patients are left unseen on trolleys in a hospital corridor, or the ill and the injured are left untreated in an understaffed emergency room, the causes are always located outside the NHS, usually at Tory headquarters, where, according to lefty legend, Hayek-reading, privatisation-hungry Thatcherites are dreaming up ever-more convoluted ways to ‘destroy the NHS’. The NHS’s problems are always someone else’s fault. There is never anything wrong with the NHS itself.