I hear that in New York
At the corner of 26th street and Broadway
A man stands every evening during the winter months
And gets beds for the homeless there
By appealing to passers-by.
A few people have a bed for the night
For a night the wind is kept from them
The snow meant for them falls on the roadway
But it won’t change the world
It won’t improve relations among men
It will not shorten the age of exploitation.
Bertolt Brecht’s poem (‘A Bed for the Night’) wasn’t written for today’s NHS disputes but it does address the same contradictions. Brecht’s reflections oﬀer a stark contrast to the fatuous claims of John Redwood MP that if there’s a shortage of NHS beds, just buy some more. Here is a politician who clearly understands nothing.
On its own, a bed for the night might take someone homeless oﬀ the street. But in a hospital context you need doctors and nurses, ancillary workers and cleaning/catering support to deliver the wrap-around care that critical health issues throw at you. You need ambulance workers who can respond to emergency calls, not sit in log jammed queues outside hospitals. And if bed-blocking is part of the problem then you need wrap-around care in the community too. Ending the age of exploitation is the bigger challenge that government needs to address.
Britain’s problem is that its NHS is no longer funded suﬃciently to meet any of these challenges. Ministers can claim the NHS has never been so well funded. But the stark realities are very diﬀerent.
If Britain matched the average level of EU health spending we’d be putting £40bn more into the NHS for starters.
Then, if the cost of living crisis has sent NHS workers scurrying towards food banks (or searching for better paid jobs), then pay nurses well enough to retain and recruit.
It isn’t rocket science.
And when Ministers claim this would be unaﬀordable (“costing every family in the land an extra £1,000 p.a in tax”) they are either being scurrilously dishonest or just innumerate.
Britain could raise this from top earners alone, without impacting on the lower paid. The Chancellor could claw back the (unearned) bonus he gifted to Britain’s bankers. He could cancel tax allowances given to oil and gas companies. He could put a windfall tax of 50% on all financial sector bonuses and place a fractional tax on speculative financial transactions. And that is before you add in the payback from health workers themselves.
It may shock Ministers to know that the vast majority of people working in Britain bank onshore. Workers tend to bank in the UK, spend in the UK, and pay their taxes in the UK. This is the ‘patriotic’ money-go-round that the vast majority of Britain’s public sector lives within.
Mone(y), Mone(y), Mone(y)
Contrast this with the world of Baroness Mone. Her scam PPE contract began with the overnight creation of an oﬀshore ‘shell’ company to supply substandard PPE goods, unfit for NHS use. It was, however, brilliant at siphoning money from her pals in government and quickly transferring the proceeds into other oﬀshore accounts for herself and her family. Oh yes, and it paid for a new yacht.
Government MPs know that today’s cost of living crisis is not driven by public sector pay rises, yet they queue up to insist that a decent NHS pay settlement is unaﬀordable. Not one Tory MP has stepped up to the plate, saying we could pay the nurses if the rich merely paid for the profiteering they’ve been up to since before the 2008 crash. None have insisted that Baroness Mone to be thrown out of the Lords. None have called for the prosecution of all those looting the public purse throughout the Covid crisis.
There is no bandwagon of public support for such government intransigence. People know that today’s disputes are not the cause of a crisis within the NHS. It is the crisis of NHS underfunding that led to the disputes.
Vision not Revision
Labour is right to insist that this is a moment for both re-financing and re-structuring the NHS. But Labour too must avoid its own past delusions. New Labour tried funding the NHS through a raft of PPP (Public Private Partnership) contracts. It was an approach no less flawed and fraudulent than today’s Tory scams. (For a while) PPP was Labour’s ‘oﬀ balance sheet’ way of financing new health centres and hospital extensions.
The terms of PPP contracts were unbelievably generous. Private providers received guaranteed profits, on 30-year contracts, with all the risks absorbed by the public sector. To this day, private providers have the final say on any alterations to the premises and the NHS has to make its PPP repayments before any payment is made to NHS staﬀ.
Adding insult to injury, the funding of Independent Treatment Centres (ITC’s) also turned into a complete farce. It added to NHS workloads rather than reducing them. In Nottingham, the ITC routinely referred anything vaguely complicated back to the NHS. Surgeons in Nottingham hospitals complained that junior doctors (who would otherwise have sat in on more complicated operations) were doing basic level operations elsewhere and missing out on the supervised training needed for more complex procedures. These were left to surgeons remaining in the main hospitals. Everyone lost out, apart from the ITC.
All this came after the NHS had been mauled by a decade of competitive tendering. At one point I’d asked what impact the privatisation of ward cleaning services had had on staﬀ morale. Without any hint of embarrassment, the management response was that this question could not be answered because staﬀ turnover was too high!
A reforming vision for the NHS must begin by employing more consultants than accountants, more nurses than number crunchers. In the short term, it means Labour ceasing to arm wrestle with the Tories over who has the toughest immigration policies. Britain needs to recruit and retain NHS staﬀ on a huge scale. This has to be centre stage in any economic recovery plan. To do so, we need an era of Public-Public partnerships, not Public-Private ones.
Reclaiming the ‘us’
Not one of today’s crises have been caused by the public sector. But to get us out of the mess – whether it is the energy crisis, the cost of living crisis, or the (existential) climate crisis – the public domain must become the heart of a diﬀerent politics.
Deregulation, and an obsession with chasing cheapness round the planet, became the millstone around Britain’s neck. Our record of destroying the domestic capacity to produce anything for ourselves – be it food, renewable energy, zero-carbon housing or sustainable transport systems – means that Britain must fill its skills gap first…and fast. This involves an act of faith as much as investment. But in the midst of all the gloom, rancour and division that surrounds us, this is where there is a silver lining.
Unlike Marley’s ghost, my Christmas gift is to invite you to look back at two diﬀerent moments of inspiration, endeavour and inclusion; examples of Britain at its best.
First, take a look at Torvill and Dean’s last amateur performance of Ravel’s ‘Bolero’. It was at the Ottawa World Championships in 1984 – https://youtu.be/TVWHdu6yfvc. Nottingham’s finest were taking the ice skating world by storm. It was a display of grace and creativity people barely thought possible; a truly heart warming, show stopping moment.
Now skip forward to the Nottingham Playhouse ‘tribute’ version in 2014 – https://youtu.be/8WOO6qoEcgo. This moved ‘show stopping’ to a diﬀerent level. Nurses and fire fighters, rail workers and rugby players, pensioners and pupils, bus drivers and bobbies combined in a Mass Bolero that was even more uplifting.
Skipping past spurious divisions of age and race, the Mass Bolero shows the grace to be found in moving from ‘me’ to ‘we’ endeavours. Every generation, every occupation, choreographed its own part. But the tribute stands as testimony to the whole, not the fragments.
This is today’s biggest challenge; to rediscover the strength of our togetherness. Voracious capitalism is consuming itself and threatening to take human existence with it. The only alternative is a version of humanity (and economy) that dances collaboratively within earth’s limits; a mass Bolero not an individual one.
This is the Christmas spirit I want to invoke. Supporting those in poverty and struggle is a start. But tinkering around the edges of ecological implosion is not enough. Humanity needs a diﬀerent dance, and a place for everyone in it.
If we want to shorten the age of exploitation we all need to get our skates on.