Recently I sat down with Larry Sanders, brother of Bernie Sanders, veteran social care worker and academic on the subject, and long-time progressive and Green Party member. In part one of our talk, we talked about Bernie 2020, and the US presidential race that's just kicked off.
A friend of mine whom I worked with on two of his campaigns, I was keen to hear his opinion on several key issues.
In part two, we talk about Larry's area of particular expertise: health and social care, and the UK health system.
With decades on the frontlines of service and in academia, and now as the national Spokesperson for Health for the Green Party, Larry has a lot of insight on the crisis facing the NHS and social care.
Once more, my comments are tabbed for clarity
P: Yeah, no I totally agree. I wanted to move then to talk about politics in this country and some of our issues. So obviously you’ve had a lot of experience with the green party, social care and things like the health service. So I want to talk about some of the problems we’re facing in this country.
Let’s start with the health service. Give us a rundown of what people should know with the health service and what people should know about the crisis facing it.
L: Ok, well the first thing is that we’re 100,000 people short in the NHS. I forget - 10, 000 doctors, 40, 000 nurses, 50,000 of all the other people that make up the system. So, this means the system cannot work adequately. We have fallen in terms of expenditure - now that’s in terms of post that have been identified as needed by the system.
Beneath that you have a structure that’s been underfunded, really from almost the beginning of its existence the NHS, but drastically underfunded over the last 8 to 10 years.
P: As part of austerity.
L: Yes, part of the austerity thing. So we’re probably around £20 bill a year underspending on the health service, now. That means - and that connects up in some ways with the lack of staff that I was just talking about because people are not attracted to the work, It’s very difficult work, it’s terribly difficult when you’re understaffed and you’re under tremendous pressure. The pay has been cut dramatically over those years. Zero percent increases, one percent increase and so on, which means people in real terms have been falling further and further behind.
So one of the reasons for the lack of staff is finance. But it’s not the only one. We haven’t got enough hospitals, and we haven’t got enough staff in the community. We haven’t got the infrastructure in the community, so I think - so that’s on the formal NHS side, we have not got people to do the job, and if you don’t have the people it can’t be done. We don’t have the money to hire the people. But if you had the money it would be difficult. Because you have to train them, you have to find them and so on - and encourage them and keep the others in posts. So, if you don’t have the money to even begin to process it, well, it’s sad.
So that’s one part of the hands-on health care.
Now, there are two parts to healthcare in this country - one was the NHS side, and the other is social care.
My opinion, although it costs much less, the social care is equally important. Social care in this country has never been adequate, and in the last 10 years it’s been cut in half. So you have well over a million people who’ve identified having needs -mainly older people but not only older people - who don’t get any help ever. Social care is means tested which means you have to be extremely poor before you get any public help. It’s needs tested which means you have to be extremely needy before you get any help. So prevention and care in the early stages was gone a long time ago, so we’re mopping up the smallest bits at the end of the process.
Now, those are two parts of the formal structure which - take another step back. We know, everybody knows, that it’s an immense part of illness and is based in part on the way in which people live their day to day lives. In a narrower sense of public health, it will always help the people to smoke less and eat less bad stuff and all the rest of that; our public health has been decimated.
And then underlining all of that of course: the key thing that means whether people have a healthy or unhealthy life is their general social and economic position. You can’t have the level of poverty that we’ve got, and you start at the most obvious level - you can’t have people living on the street and have healthy people. You can’t have children growing up in poverty who don’t have enough heating, who don’t get enough good food, whose parents are stressed out of their minds, and have healthy children. You don’t have healthy older people when you have people living in houses but they can’t eat.
So we’ve had unnecessary poverty, growing unnecessary inequality. We’ve had the formal kind of public health structure failing over many years. And we’ve got the NHS and social care, which are very important though they’re not determinative, under enormous stress, and there’s no intention to make it different.
And you have structure full of people who are very bright, who are very hard working, who want to do the right things, but think the right things to do are to keep their mouths shut. So, the bulk of the public have very little idea what’s happening.
So, I think, and already it’s turning up in statistics - we had over a hundred years, every year, year in and year out the average age of death has gone up: people live longer, and longer and longer. Very nice. That stopped - in parts of the country it’s turned down. The average age is getting less. In the parts of the country where the statistic is usually at its best, it’s plateaued. Ordinary, normal improvement in the length of life, which we’ve expected for over a hundred years, has stopped happening. Now, in terms of a historical event that’s big.
In terms of how many people know that it’s happening - not big.
P: Yeah, I couldn’t agree more, it’s a disaster. And as much as a disaster as it is, so is the lack of knowledge about it, coverage and action on it. And, yeah, that’s gonna lead to my next question.
L: Well, maybe I’ll say something else just to have a cheerful theme.
P: Aha, please - I think we need it, we need it.
L: The social care, in my opinion, and I won’t go to the details, but I think most people will see that it’s fairly obvious - we can’t begin to solve the problems unless social care becomes funded and provided like the NHS. That is to say publicly funded, publicly provided publicly accountable. At the moment, 90% of it it is private.
And it’s means tested at the very high levels I was saying before. And there’s been astonishingly little interest from the left in this. In the last 3 months, the three main campaigning organisations - healthcare campaigning organisations - have changed their policies. Keep Our NHS Public, Health Campaigns Together, and the Socialist Health Association, all now have a policy which is in favour of social care which is publically funded and provided.
Now, this is just the beginning, because the Labour Party at a leadership level has not come on board.
The Green Party is about 2/3s on board in that we’ve had a policy for quite a while of free and non-means tested and publicly provided care for over 65s. But not for the 3rd of people who need care, who are under 65. So we’re two thirds of the way there, but not there. But the Labour leadership has not arrived - although 1 or 2 people near the leadership have.
So that’s something positive.
Privatisation of the NHS
P: So, the privatisation within the NHS - the drive to do that- where do you think that that drive is coming from?
L: Well, I think that it’s two things. First of all, there’s a lot of money. They’ve only managed to privatise, to outsource about 8 or 9 % of the budget. Now, that’s a lot of billions. I think that’s about £10-£12 bill. It’s not only that they make a profit on all the money that they spend, but that playing - the way the financial system works is that much more money gets made playing with the system.
So, we’ve had huge examples within the health and social care, of companies re-organising the capital, reorganising the structures of the companies. And withdrawing millions, hundreds of millions out through that.
We’ve got compulsory sale parts of the NHS. People have made a lot of money out of that. We have PFI, which for no reason at all has - so, there are a lot of very bright, capable, self-interested people, whose day job every day is to figure out ways to get some of those billions into their pockets. And they succeed, frequently. And they can play a long game.
FIve years, ten years, twenty years. I mean, if you’re into big investment, that’s not so long.
P: So you think they put pressure on the -
L: So they are there, all the time. They’re there, every day. I don’t think there’s anybody involved that’s spending money in the NHS who doesn’t see these people, and hear from them.
And they’re professional people, they’re educated people. They may know a lot about the structures of the system, and they’re there. So that’s the first big thing. If you, you know you set out a table with lots of honey on it, you’re going to get a lot of creatures coming after it.
The other thing of course is that there is an underlying ideology. The NHS as a successful organisation. At the very least, the NHS is a good system. Some research says it’s very good, and some say it’s good. I don’t think anybody has come up with less than that.
The idea that you can run a very large, very important business in that terminology well, without having capital ownership, without having profiteering, is an enormous example.
If that’s true, you could run a large part of the rest of the country the same way [as the health service]. And in lots of ways better because you get people a lot more interested in what they’re doing, you don’t have people destroying the system in order to make money out of it, and so on.
So, I think that that’s - it is a terrible example to people whose basic ideology is that the way you run a system, a country, is putting more power into the market, into the hands of people with capital. And that’s a very powerful strand in British politics. Obviously not just British politics.
So, the combination of real money that you can work for day by day, and in very important political ideology, that you think you would undermine your whole way of thinking, if it succeeded.
Those are the two drivers, and they won’t go away.
P: Yeah - doesn’t sound good.
L: Well, it means that it’s a serious battle, it’s serious stuff
P: Do you think that the cuts, the funding cuts that the NHS is experiencing - do you think that that potentially in part are trying to starve the HS to say “Well look, it needs privatisation because public funding can’t cut it”?
L: Yeah, yeah - I’m sure that - you know there’s a famous kind of parable: how do you destroy a public service? You underfund it, then it doesn’t provide well. You say it doesn’t provide well, so it ought to be privatised, so you privatise it. So, you’ve got a model, and I’m sure that’s a part of it, yeah.
Check out part three, where we talk about the state of grassroots movements and activism, here and in the US.