Pledge for the NHS - key facts for candidates and activists

Pledge for the NHS: key facts for candidates and activists

8 February 2024

The NHS has just lived through the worst 14 years of underfunding, understaffing and outsourcing in its history. It is not an exaggeration to say that our NHS might not survive another 5 years of the same.

As we approach the general election this year, you hold the power in your hands to save our NHS. We can do this by coming together and making collective demands from our politicians. As individuals, they can ignore us. But together, they will be forced to listen to us.

That is why We Own It has launched Pledge for the NHS.

Take just 2 minutes to send our letter to your local candidates now. Click HERE.

Pledge for the NHS is our election-year campaign to mobilise tens of thousands of people across the country to demand their local general election candidates back our NHS. 

By taking the Pledge for the NHS candidates will be promising that if elected they will demand that, irrespectively of the winning party, the new government:

  • Reinstate the Health Secretary’s legal duty to provide healthcare to all.
  • Invest £40 billion more per year in the NHS (combined revenue and capital spend) to catch up with equivalent European countries;
  • Bring services outsourced to for-profit companies back into the NHS as their contracts end;

We Own It will maintain a webpage HERE with responses from all candidates.

Key facts for candidates and activists:

Please find below key facts that show why these specific demands are crucial to saving our NHS. Candidates may find it useful for deciding on whether to take the pledge as well as for formulating their campaign messaging. Activists may find it useful for making the case to candidates that committing to the Pledge for the NHS demands can help save our NHS.

The Health Secretary's legal duty to provide

Until the passage of the Health and Social Care Act in 2012, the Health Secretary had a legal duty to provide health services, and put in place all the “reasonable requirements” for this, in England. That duty was repealed by the Act.

This duty allowed local populations or patients to sue the Health Secretary when they believed that the Health Secretary as been negligent in providing health services and caused some damage as a result 

(For example, four Staffordshire patients who had been on waiting lists for years were able to sue the Health Secretary in R. v Secretary of State for Social Services Ex p. Hincks, 1980 WL 619040 (1980). Although they lost, this duty was established as providing patients with the right to sue). 

The 2012 Act divided up the NHS in England into more than 200 individual health bodies (then called Clinical Commissioning Groups, now 42 Integrated Care Systems), and passed that duty on to them to “arrange” for the provision of healthcare services to the populations for which they have responsibility. 

Combined with Section 75 of the 2012 Act, which made it compulsory in most instances to tender out contracts for services, the change of the duty from “providing” to “arranging” has led to the growth of privatisation in the NHS. In the first year of the 2012 Act, one-third of NHS contracts went to private companies.

Reinstating the legal duty to “provide health services in England” to the Health Secretary, will enable the public to hold the government to account in court for failures.

Our NHS is being systematically underfunded

  • According to analysis by Health Foundation, between 2010 and 2019, healthcare spending per head in the UK lagged behind the European average by £40 billion per year. Compared to similar (in terms of GDP and population size) countries like France and Germany, we spent £40 and £73 billion less per year over that period respectively.
  • Furthermore, a British Medical Association’s analysis suggests that if NHS spending kept pace with its 4.1% average historical growth rate (1955-2010), the NHS would have received £322 billion more than it received between 2010 and 2022. 
  • Politicians talk about wanting to modernise the NHS, but the lack of adequate resources is undermining the NHS’s ability to advance a substantive modernisation and digitisation agenda, with NHS managers being forced to make cuts to IT and innovation budgets to ensure underfunding doesn’t hit patients directly.

Why privatisation is bad for patients and the NHS

Profit-seeking makes the NHS less efficient.

Figures on how much profit leaves the NHS from NHS contracts with private companies are difficult to access, because private contracts are by their nature opaque and in many cases, secret. This by itself provides an argument against privatisation.

But we have some indications of how much is leaving the NHS in the form of profits.

  • A Financial Times analysis of profits from PFI contracts between 2011 and 2016 (just one form of NHS privatisation) suggests at least £831 million had left the NHS in shareholder profits in that time.

Privatisation causes problems the public has to pay for.

Like in the case of profits, no overarching analysis exists for how much has been spent to fix problems created by NHS privatisation but we have illustrative examples:

  • Outsourced cleaning and infections. Academic analysis shows that NHS hospitals cleaned by in-house staff are cleaner and result in fewer hospital-acquired infections than those cleaned by private outsourcing companies. Estimates suggest that there are 300,000 cases of hospital-acquired infection in the NHS yearly, costing the NHS an extra £1 billion each year.
  • Private hospitals hand patients to NHS A&E. Another example, revealed by the Sunday Times, is the fact that over 550 people receiving treatment in private hospitals, who develop medical emergencies while there, are then transferred to NHS hospitals every month. This last issue has been cited by Oxford researchers when linking NHS outsourcing to 557 treatable deaths. 

Privatisation has driven down overall quality.

Our NHS was ranked number one among the healthcare systems of eleven developed economies compared in terms of efficiency, care quality and overall by a 2014 Commonwealth Fund study. The UK has fallen to fourth place in the 2021 edition of that same study. It is no accident that this decline has coincided with the growth of outsourcing caused by the 2012 Health and Care Act and the systematic underfunding of the NHS over the last 14 years.

Nothing can take the place of proper staffing and building NHS capacity

  • The NHS has played a world-leading role in new diagnostic and treatment technologies, in a way that a profit-oriented system simply cannot. We must defend this proud history of adapting and modernising to solve new problems for patients:
    • 1960s — advancements in hip replacement surgeries.
    • 1987 — the world-first heart, lung and liver transplant in 1987
    • 2021 — ran RECOVERY as “the world’s largest trial into treatments for COVID-19, with more than 40,000 participants across 185 trial sites in the UK”
  • Investing in modernisation cannot open the door to privatisation and, even more importantly, cannot take the place of proper investment in staff and capacity. This was made clear by a 2018 joint report by the Institute for Fiscal Studies and leading health policy experts. A 2022 analysis of the NHS workforce by The Health Foundation found that the service needed 103,000 more staff than it had in 2021/22 and projected that by 2024/25, that number will have risen to 179,000. 
Pledge for the NHS: key facts for candidates and activists

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