Mike Phipps reviews NHS Under Siege: The Fight to Save it in the age of Covid, by John Lister and Jacky Davis, published by Merlin.

A decade of austerity has left the NHS in a critical state. The Covid pandemic has deepened the crises of resources and morale, with staff already ground down by unrelenting pressure and falling real terms pay: the NHS currently has 110,000 vacant posts. The crisis of capacity is such that in 2020 the increased spending on private providers was up by over a quarter.

There are over six million people on the biggest ever waiting lists in England, with chronic waiting times in A&E, for mental health treatment and in assessing patients’ needs for social care. All this stands in surreal contrast to the government’s empty rhetoric to build 40 ‘new’ hospitals, or recruit 50,000 ‘new’ nurses, which turn out not to be new at all. Likewise, there is a gap between rhetoric and reality in the government’s proposals to expand digital systems – requiring more private sector expertise, yet threatening to isolate millions who are digitally excluded from the system.

A joint report by two parliamentary committees described the coronavirus pandemic as “one of the most important public health failings the United Kingdom has ever experienced.” Britain had some of the highest excess rates of death in the first wave, with nearly half of those deaths occurring in care homes. A combination of funding cuts, under-staffing and governmental refusal to prepare for the inevitable underpinned the crisis.

Johnson’s own refusal to take Covid seriously until he was struck down by it and the government’s blatant ignoring of WHO advice meant the NHS was quickly overwhelmed. Some £37 billion was wasted on putting the crucial task of ‘test and trace’ in the hands of inexperienced private bidders.

There was similarly huge wastage over PPE provision which failed to protect frontline staff. Basic rules of procurement were ignored, with many suppliers having connections to the Tory Party. PestFix, a pest control company, was awarded a £32m contract for surgical gowns, despite having listed assets of only £18,000. The company had to order the gowns from China: months later they had still not materialised, while other equipment they supplied proved defective.

Government self-interest and incompetence – even over simple messaging about facial coverings – stood in marked contrast to the self-sacrifice of frontline health workers who worked long hours in dangerous conditions to the detriment of their physical and mental wellbeing. Their reward was the insulting offer of a 1% pay rise and government-supported populist campaigns in the tabloid press for patients to be allowed face-to-face appointments with their GPs.

More money was wasted on Nightingale hospitals, which stood empty and unstaffed, while lack of testing and poor conditions in existing facilities meant that thousands of patients admitted with other conditions caught Covid in hospital. Over one–quarter of these would die within 28 days. The discharging of untested patients back to care homes ensured the rapid spread of the virus among the elderly and vulnerable.

This book also traces the history and rapid rise of privatisation in the NHS. In 2020-1, spending on private providers rocketed to over £12 billion. Despite the shockingly poor value of the contracts involved, this high level of reliance is likely to continue for several years. Mental health is one of the biggest areas of private sector growth, with nearly half of the £355 million NHS spending on child and adolescent mental health services going to private profiteers.

NHS Under Siege also contains a series of expert contributions. These include a powerful piece from Covid-19 Bereaved Families for Justice, who raise critical questions about the handling of the pandemic and its impact on the most vulnerable.

Another important chapter, by Roger Kline, looks at the culture of bullying and discrimination in the NHS: 24% of staff surveyed report they are subject to bullying, harassment or abuse from fellow workers or managers. Much of this culture comes from the top, from an obsession with targets, with under-investment creating intolerable pressures, and privatisation fuelling dysfunctionality.

It’s important to emphasise that the government’s running down of the NHS has met a level of resistance unmatched in any other public service. Plans to privatise older people’s services in Cambridgeshire collapsed after a public campaign of opposition. In London, broad campaigns prevented the closure of Lewisham, Charing Cross and Ealing hospitals. Unlike in an earlier era, the lead in these movements has been taken not by trade unions, but by a growing army of self-taught NHS campaigners, who have found a way through labyrinthine processes and little-publicised reorganisations to expose to a wider public the full impact of creeping service reduction and privatisation.

The bringing together of a range of different campaigns under a new umbrella this year, SOSNHS, has helped raise the profile of this campaigning. The alliance is demanding an emergency £20 billion injection of funding, above-inflation pay increases for staff and for investment to be directed at public, not private provision. If Labour is serious about providing genuine opposition to the Tories, it needs to throw its weight behind these demands and immerse itself in campaigning for them.

Mike Phipps’ new book Don’t Stop Thinking About Tomorrow: The Labour Party after Jeremy Corbyn (OR Books, 2022) can be ordered here.