An NHS in crisis?

Austerity has meant that poor people have suffered the most since 2010. They not only die, if they are men, 10 years sooner than the rich, but they can expect to become disabled two decades earlier. The geographer Frances Darlington-Pollock, in her book Disease, released last November to mark the 80th anniversary of Sir William Beveridge’s radical blueprint for the welfare state, writes that by 2021, life expectancy had fallen for the first time in 40 years, by an average of 1.3 years for men and 0.9 years for women; and those living in the poorest areas had suffered the greatest loss. It is a political choice, she says, to not properly fund the health and social care system.

The Guardian View on Prime Ministers NHS Problem: Editorial, 3rd January 2023

This is not the first winter we have seen headlines aghast at wait times or worrying over respiratory conditions, but the cumulative impact of year-on-year of questionable politicking and mismanaged or misguided reform is taking its toll. 

A global pandemic teetering, it seems, on the edge of resurfacing has not been enough to force political action on a crisis-ridden health service. Headlines abound with cries of soaring demand, rising flu and COVID, a collapsing workforce, and unfathomable wait times whether for an ambulance or an operation. 

This may not be the first winter we have seen headlines aghast at wait times or worrying over respiratory conditions, but the cumulative impact of year-on-year of questionable politicking, of mismanaged or misguided reform, and of disinvestment in training, is taking its toll. Add into the mix austerity, COVID, and a cost of living scandal and the consequences may well be catastrophic. 

Yet too much of public outrage is directed at the Doctor, the Nurse, or the Paramedic balloting to strike. Too little is unleashed on the political machinery that is letting this happen. It is a political choice to not properly fund our NHS. More importantly, it is a political choice not to properly fund our social care system

We do not value those who care for us, whether the porter, the care worker, or the paramedic. The consequences of underfunding health and social care, while also undervaluing key occupations within it, are severe. Not only does it limit individual ability to provide high-quality care, it undermines public confidence and trust in a system where people who are at the limits of their capacity to cope become the focal point for public anger. 

We misdirect frustration and demands for action when we only condemn a failing NHS hospital or struggling care home. Yes, urgently address failings in any care provider, but this is a symptom of the root problem: chronic underfunding, mismanagement and politicking seeking to jettison responsibility for health and social care. 

In 1942, Sir William Beveridge outlined a system of social security for the British population, introducing the National Health Service we now see in crisis. The basic tenet of his vision was premised on a biomedical model of health favouring the silver bullet of medical and, increasingly, pharmaceutical intervention. 

The goal? To return a body in the deviant state of ‘ill-health’ or ‘dis-ease’ to wellness, to ensure that all men are able to continue contributing to a prosperous and growing economy. This did not leave space for the wider provision of social care needed to maintain health and wellbeing. Today, those care needs are more complex than ever and yet there still seems no space for a uniting of the provision of health and social care. 

We live in a society where our health and our life expectancy are shaped by where we are born, where we live, where we work, play or school. For those who may live a life of relative disadvantage,  the cumulative affect in older age can be significant. We do not, however, account for that in our system of care.

Pushing responsibility for care into the realms of our private lives feeds inequality. The health of people with caring responsibilities suffers, and the degree of care for people in need varies according to their and their family members’ time, resources and flexibility to manage  are provision alongside their own lives. We can fix an NHS in crisis, but not just by analysing wait times and worrying about flu or COVID (all of which are needed). Integrate and properly fund our health and social care system, building outwards from the individual and the social networks that sustain them. View individuals as more than a vehicle for economic output, and see populations and resources as more than components on a budget sheet.

Arguments extracted from my new book, Disease.


We need more than patchy reform

We need more than patchy reform
New book: Available to buy Agenda Publishing

“There is mould and damp in all of the rooms and the window panes are rotting. In the kitchen, the rot has caused the glass pane to fall out, meaning the cold air seeps in”. This is quite the Dickensian image of poverty, squalor, and decrepit housing. It is in fact line three of an article published in The Guardian, Wednesday 19thOctober 2022. 

It should be impossible to imagine, in a society once lauded for the depth and breadth of its welfare provision, for such conditions – or versions of them – to not only exist but to be increasingly widespread. And yet, the combination of a decade of government austerity, the ravages of a global pandemic, and the uncertainty of an exit from the European Union means this is the reality for too many of the British population. 

80 years ago, Sir William Beveridge delivered a report to parliament signalling the birth of a welfare state premised on tackling the ills of society blocking its journey to growth and prosperity in the aftermath of war. Those ills were characterised as five giants: want, squalor, idleness, ignorance and disease. In tackling those five giants, Beveridge’s vision weaved a safety net below the population, from cradle to grave. It looked to safeguard against poverty, improve housing, secure employment, educate, and treat and prevent ill-health. 

It was not without its flaws. It was patriarchal, ableist and nationalist, framing men as the breadwinners of society and women as it’s mothers. Receipt of the many benefits the welfare state afforded was tied to citizenship and continued input into that system. Ill-health was treated, but the deviant state of ill-health was always expected to be temporary. 

Nevertheless, it was radical. The reforms it ushered in have had no small role to play in a lot of the subsequent development and growth of the British society and its economy. One of the flagships of this vision of welfare was our National Health Service, a healthcare system that really has been, at times, the envy of the world. 

But the system Beveridge designed and his attack on those five giants of want, squalor, ignorance, idleness and disease has run its course. Those giants are both more monstrous and in fact, less constrained. Despite the many benefits the implementation of Beveridge’s vision has heralded – and his attack on ‘Disease’ is an excellent example – the politics of today are now not only actively dismantling the essence of the welfare state he created, but significantly contributing to the burden of those who depend on it.

Meaningful welfare provision was, for Beveridge and those who enacted his vision, perhaps little more than a means to an end, the route to economic prosperity and growth. However, the intervening years – particularly those of the last decade or so – should show us with startling clarity the extent to which prioritising growth over people is not only catastrophic for that growth, but the people it should benefit. 

As we edge closer to the anniversary of Sir William Beveridge’s landmark report, a reassessment of where we stand in the fight against those giants he once sought to slay is urgently needed. But now, let’s frame that reassessment in different terms. Let us centre that assessment on the people and the planet that constitute any growth or progress, let care of them be the goal and not the means. Let’s have more than patchy reform, but let’s do it in a truly revolutionary way. 

Giants: A New Beveridge Report – published Thursday 20th October 2022

Disease – Fran Darlington-Pollock

Want – Helen Barnard

Idleness – Katy Jones and Aswin Kumar

Ignorance – Sally Tomlinson

Squalor – Daniel Renwick and Robbie Shilliam