In support of the NHS

It would be churlish not to applaud 99-year old war veteran Captain Tom Moore, who has raised over £25 million for the NHS by walking around his garden. Or for that matter, Geraint Thomas, the Tour de France winning Welsh cyclist who raised £325,000 by cycling for 36 hours non-stop in his home gym. Meanwhile, Lenny Henry is hoping to raise huge amounts for the NHS hosting a telethon featuring top stars including Peter Kay and Catherine Tate which is airing on Thursday as I write this. It will probably raise upwards of £100 million.

It is not just the rich and famous, of course who are “doing their bit”, the average donation is probably coming from ordinary people who want to do something in these unprecedented times. For “celebrities” raising money is both a way to give something back and to raise/maintain their public profile. Captain Tom has become an instant celebrity, with a chart topping record, and there is now a petition to get him knighted which has been signed by over 850,000 people. 

Strangely enough I did sign a petition this week which was asking Parliament to Increase taxes on high earners to fund emergency Budget measures, rather than expect pensioners to take a cut in their pensions. At the time of writing I was the 299^th person to sign. I also signed a petition calling for NHS workers to have a pay rise. That was doing slightly better and had just over 35,000 signatures, still some way below Captain Tom. So, how is it a petition to have a 99-year old knighted is so much more appealing than one to protect pensioners or even one to give NHS workers a pay rise?

The Captain Tom story has been all over the media. In a time of relentless bleak headlines this was a feel-good story. As far as I’m aware at no point did Captain Tom or any of those who surrounded him use their newfound fame to criticise the Government. Indeed he “appeared” alongside under fire Health Secretary Matt Hancock at the opening of a Nightingale Hospital in Harrogate. His was an act of solidarity with NHS workers, but one that had nothing to say about why they are so under fire currently. His age, his apolitical stance and the fact that it was all about charity made it an instant hit with the media who are obviously becoming quite bored with a story that is almost exclusively now about how useless their chosen Government is.

I have not sponsored Capt. Tom, or any of the others. This is not because I am too mean to do so, or because I lack the resources to do so, or even that I fundamentally disapprove of what they are doing. My reluctance to contribute to these fantastic efforts is based on my suspicion that for all this goodwill pouring toward the NHS at the moment, once this virus is beaten (if it ever is) people will return to their apathy about the NHS. For some of us who have been pounding streets, knocking on doors and signing petitions for the past how many years, what is happening now is simply the inevitable outcome of the years of ignoring the developing crisis in the NHS. It is, in short, rooted in a political crisis.

Good intentions are not going to change the fundamental issues that if we want first rate healthcare provision and we want that free at the point of use we have to start listening to the people who actually work in it. Politicians will always claim that “we are spending more on the NHS” and produce an impressive sounding number which supports their claim. Analysis by the Kings Fund, an independent health think tank, supports them.

What this chart shows is expenditure from 2008/09 through to 2020/21 (planned funding). The graph is pretty clearly rising. Which suggests all those of us who have been complaining about a lack of funding for the NHS were wrong. Or does it? The Kings Fund note that since 2008 the funding has been rising by just 1.8% each year on average, considerably lower than the 3.9% per annum rise in the years leading up to the imposition of austerity.

It is not just how much is being spent but whether it is being well spent. Most people would, no doubt, think “well spent” was on doctors, nurses, hospitals, and vital equipment. But, the current crisis has exposed chronic underfunding of, for example, PPE. One reason why we are sending our medical staff into a potentially lethal situation without adequate protection is that in an age of austerity updating equipment that might not be needed was not a priority. Until, of course, you do need it.

I have had rather more interactions with medical staff than I would have liked in recent times. I spoke to one cleaner who explained to me that the major problem with the NHS was not funding as such but poor purchasing. He told me of top of the range vacuum cleaners bought for the cleaners which stayed in the cupboard because they were domestic cleaners that continually broke down when used on the wards. A nurse said to me that it was not more money but getting the money where it was needed. “I don’t need another management consultant standing behind me with a clipboard telling me how to do my job,” she explained “What I need right now is protective equipment.”

It seems that the problem is not one of money as such but poor management making bad decisions with no recourse to the people most affected by them. This, I should point out was in Wales which, of course like Scotland, has a devolved budget for health and so is not obliged to follow the example set by England. To be fair, the Welsh government led by Labour, was quick to ban parking charges, make prescriptions free and allow free eye tests for the over 60’s. But, there is only so much you can do with an ever shrinking budget.

Those currently raising money for the NHS and those giving are well intentioned but there is an element of conscience salving going on. I should say here that I looked for some academic articles that took a critical perspective on charitable giving, but couldn’t find many academics that didn’t see charity as anything other than a form of altruism and therefore to be encouraged. That was slightly disappointing but hardly surprising given that the majority of academics are safely embedded in the middle class for whom the act of charitable giving is a form of positive self-affirmation. Think about it, when you raise money for charity it brings with it the affirmation that you are a good person. Somebody prepared to give up their time for the greater good. With positive affirmation comes positive acclaim. If Captain Tom Moore had not raised money for the NHS do you think you or I would have heard of him? And, without that feat of charity would he really be in line for a knighthood? A knighthood he is probably not going to get, incidentally.

I have no idea of the class make-up of those currently giving to the NHS, but I’ll hazard a guess that those struggling on universal credit aren’t at the front of the queue. I rather suspect that there are a couple of things going on both with these charitable donations and the clap for the NHS which we are all encouraged to do every Thursday. First and most importantly, these are acts of solidarity with workers who, in the context of a dangerous and potentially fatal virus, are highly esteemed at present. But, secondly, they provide a sense of doing something positive whilst at the same time, for many of those taking part, being able to claim that the crisis is not political. Or, at least, only political in a way which we cannot influence. More so if we voted for the very government who are now proving so inept both at managing the crisis and managing the public perception of their ability to manage the crisis.

Twenty five million pounds sounds a lot of money. It is a lot of money. Or it would be for an ordinary person. And, in charitable terms it is an extraordinary amount for one person to raise. But, to put it into context the health budget for the UK in the current financial year is £166 billion. The money raised by Captain Tom is 1/6640^th of the annual budget of the NHS in England. If you were on a wage of £50,000 it is the equivalent of getting given £7.53. You wouldn’t turn it down, but it wouldn’t change your life.

As I watched these charitable exploits unfolding I did wonder what would happen with the money. Captain Tom never said what he wanted it spent on, but I assume he would approve of a ventilator as those are desperately needed. They are approximately £50,000 each for the high grade ones used in ICU, so he could afford around 500. There are around 1,200 hospitals in the UK, so that means that Captain Tom can not afford a single ventilator for each one. But even if he could where would he buy them? If the government can’t find any, what chance an enthusiastic volunteer?

Of course, when Captain Tom Moore decided to do something to honour NHS workers he had no idea he would become the story of a weekend news cycle. Nor, I suspect was he thinking what to do with the money he raised. Besides he was only aiming to raise £2,000. And, all those people who sponsored him probably never stopped to think how their pounds and fivers would actually get spent. They saw an NHS under pressure and wanted to do something about it. And raising £25 million was beyond all their expectations.

Some further context. As of the end of December 2019 the NHS in England employed 1,270,619 people. Of those 667,965 were qualified clinical staff. That includes doctors, nurses, midwives, paramedics etc., the very people the nation is so grateful to at the moment. If the £25 million were divided between them they would receive £37.43 each. Or if not money then equipment equivalent to that amount. It would buy about 5 or 6 surgical masks at current prices. That would be a fine gesture and would be much appreciated by the medical staff. Unfortunately, they are in short supply, so any masks that were bought with the £25 million would simply prevent the British government from buying them. But, unfortunately the NHS has rules that would not allow the purchase of ventilators or PPE. NHS Charity NHS Together says: "PPE is part of the core operation of the NHS and is funded by government."

My point is not to denigrate those that raise money nor to suggest that the money will do no good, although it may not do quite the good that people think. My point is a simpler one. The NHS, whether in England, Wales or Scotland is a core part of our social fabric. At the moment it is being stretched to breaking point. This, of course, is a consequence of an unprecedented pandemic, but it is also, and primarily, a consequence of years of budget reductions and poor management. To normalise charity as a means of funding the NHS, or any part of it, is a huge political gamble. Charities cannot hope to replace the billions spent through our taxes. Nor should they be expected to.

Clapping NHS workers, walking or cycling for donations or giving money is a gesture that makes people feel better about themselves but it does nothing to overturn years of neglect of the NHS. Nurses and ambulance workers are heroes now, but how long before we go back to the party of Government cheering as they vote against a pay rise for those heroes. I don’t want to accuse the middle classes of having caused the crisis that they are now making charitable donations to overcome but every person who spent any effort undermining and ridiculing the Labour Party over the past three years helped to facilitate the election of a government that will call health staff heroes whilst at the same time planning another wave of austerity cuts to pay for the crisis which will inevitably impact negatively on NHS staff.

That over half of the population, including many no doubt that are out clapping every Thursday and donating to 99-year olds as they walk around their garden, intend to vote Conservative at the next opportunity, tells us just how morally bankrupt the UK has become. Those same people tell us that the crisis is not political and I suspect if they were to happen on this blog would accuse me of being deeply cynical. Perhaps that is true and I look forward to marching with those people to demand better pay and conditions for our healthcare heroes. But, to be honest, those people only march when they feel their own interests are threatened not to defend others. One of the most successful marches of recent times was to prevent Brexit (remember that?) The people on it were nice, middle class people but a good portion of them had the most ire not for the Tory government which was and still is determined to have the worst possible Brexit, but for the Labour Party and particularly Jeremy Corbyn, who they suspected of not being enthusiastic enough about a peoples vote, so called.

Those people who actively undermined a Labour victory because they fell into the trap of hating who the establishment told them to, are now clapping for NHS workers and raising money for the NHS. Had they have been a little less self-centred they could have had a government with a commitment to the NHS. But, let’s put all that to one side. After all we’re all on the same side now. For our NHS heroes and against the virus.

Except it doesn’t feel like one side to me. It’s as if our side – those that didn’t wait for a pandemic to champion the NHS – has been drowned out by an assortment of liberal minded Tories and Tory minded liberals. Perhaps, if they have any sense of shame they realise that over the past few years they have failed to protect the NHS because it just was not as high on their personal agenda as lower taxes or cutting red tape or getting their kids into the best schools. Whatever the reason the NHS did not sit high in the priorities of those who now sing its praises in successive elections dating back to 2010 (perhaps before).

I have a genuine admiration for the likes of Tom Moore who give up their time to, in their eyes, give something back. But a part of me cannot get away from this feeling that what is being constructed as a matter of charity, is and always has been a political matter. The NHS is a marvellous institution, it is staffed by some of the most selfless individuals you will ever meet. But, it makes no sense to fund it other than through taxation. And, to do so at a level that provides adequate staff, paid a decent wage and with the correct equipment. Charity suggests that the NHS is a luxury which we can fund if we wish. 

Each year around £600 billion is raised through taxation in the UK. That money has to fund all the things the state provides including healthcare. Of this total about £181 billion is raised through taxation. David Cameron, remember him, when he was introducing austerity (often standing alongside Liberal Democrat Nick “I’m not like these two” Clegg) was keen on saying “all we are asking for is a saving of 1p in every pound”. It sounded so easy but it was that simple economics that ensured that PPE was not updated, that new ventilators were not bought, that nurses bursaries were scrapped and that pandemic training did not go ahead. 

A 1% increase in income tax (forget about corporation tax for the moment) would raise 72 times what Captain Tom managed by walking around his garden. And it would do it year after year. Moreover, because taxation is progressive those with the most would pay the most. At the same time as we were being distracted by a 99-year old walking around his garden, billionaire Richard Branson was in the news seeking a government handout to keep Virgin Atlantic afloat. How much do you think he contributed to Captain Tom? From a man who previously tried to sue the NHS perhaps that is an unfair question.

The NHS is a national asset. It was there for the Prime Minister when he needed it. It was there for me recently when I needed it for urgent heart surgery. And, it was there for the homeless woman I heard brought in whilst I was waiting in A&E. No part of the NHS (or social care system for that matter) should rely on charity. Whether it’s protective clothing, decent vacuum cleaners to keep wards clean, prescription drugs, decent wages, or proper training so that a pandemic we were being warned about for years does not become a crisis, the NHS should be properly resourced.

 This is why the current crisis is political. People have been playing politics with our health and our chances of surviving this pandemic for years. From successive Ministers of Health who were not prepared to take warnings seriously, presumably wary of headlines about waste from papers owned by the billionaires whose main interest in the NHS is how much they could make by privatising it, to those who thought paying less tax and worrying about health and social care later, was a wise economic move. To those who rejected a Labour Party committed to raising money for the NHS not through charity but by raising corporation tax. We currently have one of the lowest rates of corporation tax in Europe. A 5% increase, as proposed by Labour would still leave us below Germany, France, Spain and Denmark, and would yield something like £2.8 billion, around 109 times what Captain Tom raised.