The NHS has been sabotaged – why are we so reluctant to point it out?

Nobody sees a poster saying, ‘vote for the destruction of the health service’ and thinks ‘by Jove, what a good idea!’ It works gradually, over years and decades

“Intolerable and unsustainable.” Those are the words that Professor Phil Banfield, chair of the British Medicine association, has used to describe the situation with the NHS. It is a full-blown crisis, with as many as 500 people a week dying unnecessarily because of overcrowding and delays at Accident and Emergency departments.

This isn’t just a wintertime glitch. This has been going on for years. Deep fractures in the resilience of the National Health Service were uncovered by the Covid-19 pandemic. The government was caught flat-footed, having systematically underfunded the NHS, leaving it fragile and brittle. Its emergency response served to funnel money into the pockets of donors and cronies, and left the structure of the health service unfixed.

In a sane country – and even in many insane ones – people dying on trolleys in hospital corridors while donors to the ruling party walk off with millions of pounds would bring down the government.

However, certain sections of the press and the party of opposition are strangely muted here. Not entirely absent – the reporting is there, the crisis is getting coverage – but without the white hot furious outrage that the British press is famous for. The opposition’s criticisms are undermined by its lack of an alternative plan and its pathological inability to state the clearest and most important truth: you cannot fix this without spending money. A lot of money. It’s going to be expensive in the short term and even more expensive in the long term. There’s no getting around it.

For all the talk of “magic money trees”, there remain some fundamental truths at the bottom of everything. If you want hospitals, you have to buy them, you have to pay to keep them running, and you have to pay to staff them. This is not “magical thinking” as some oh-so-sensible critics would have it. This is the kind of basic, nuts and bolts common sense that’s obvious to everyone. All the clever schemes and efficiency savings and reorganisations in the world cannot get you round the fact that the work is the work and it costs what it costs. You cannot get blood from a stone.

The excuses come thick and fast. They tell us that the NHS isn’t fit for purpose, that it’s fundamentally weak and that’s why it’s failing. With all due respect, that’s total garbage. That’s like people carrying sledgehammers covered in brick dust telling you that the structural analysis they just did of your house reveals that all the walls have holes in them.

The NHS has been getting hammered for 40 years by the people whose job it was to look after it. Successive governments have thrown everything they can at it, opening up any crack that they can squeeze a private contractor into. It’s been reorganised, restructured, marketised, chopped up, PFI-ed and starved of funds. It’s now teetering on the edge of failure, but by god, the work they had to put in to get it here!

Far from proving the fundamental weakness of the system, I’d say the fact that it hasn’t collapsed yet after everything that it’s been put through shows a frankly astonishing strength. A lesser health system would already be nothing but a corpse getting picked apart by American private equity vultures.

There are layers of culpability here. Of course there are those who did the damage, who set about dismantling the health system in this country for reasons of malice, corruption, ideology, stupidity, or some combination of those. The hand that holds the knife bears the primary responsibility.

But there are also the accomplices, who ran interference, telling us that there was no alternative, that simply “investing more money” was a stupid idea for stupid babies. They told us that the obvious thing wouldn’t work, that if only we weren’t such simpletons we’d be able to see we in fact needed an incredibly complicated plan with lots of management consultants. They told us that the problem was too many foreigners using the NHS, and then too many foreigners working for it. They told us it would be too expensive to make it work.

When it was pointed out that people in Europe get better results by the arcane strategy of “spending more money,” they told us that simply wouldn’t apply here for some reason.

Whether delivered with frothing, red-faced xenophobia, or an accountant’s sombre demeanour, the message was consistent. The editorial teams of some newspapers and broadcasters, the think tanks and the political spin doctors all told us that the last thing we could possibly do is tax people like them and spend that money on health and social care. There was always a reason why that wouldn’t work.

Propaganda doesn’t work instantly. Nobody sees a poster saying, “vote for the destruction of the health system,” and thinks “by Jove, what a good idea!” It works gradually, over years and decades, by constant repetition and by elbowing out alternative ways of thinking. It submerges the population in a lie until eventually they’ve drowned in it.

As always, there are two types of people involved with the scheme to sabotage the NHS for fun and profit. There are those who truly believe it should be sold to the private sector in order to “unleash market dynamism” or whatever, and those who know that’s total tosh but who want to make a load of money by selling off state assets to their mates.

Likewise with the accomplices, even now trying to say that everything is impossible except the stuff that doesn’t work, I cannot speak to their conscious motivations. They, too, are products – as well as proponents – of propaganda. There will be many who truly believe that we cannot do the simple thing that works, we have to do the complicated thing that doesn’t, because they’ve lived in a world where this has been gospel truth for decades and it’s never even occurred to them it might be wrong. And there will be some who know exactly what’s going on, but who also know what side their bread is buttered on.

And, as always, it really doesn’t matter which people are the true believers and which the cynical profiteers. We don’t need to see into the depths of their souls on this one. The effects are all the same.

But if I may allow myself a hint of speculation, I suspect that deep down in the lizard hindbrain of a lot of the people involved in this mess, in the part that recognises the shadow of an eagle and runs to hide under a rock, there’s a growing sense of unease. If we start doing big simple things and they work, the people who spent 40 years saying they wouldn’t work are going to look like idiots or monsters – or both.

The very last thing they want people to do is to look at the interlocking catastrophes unfolding around them and start asking “why did you tell us this was the only way?”