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Notícias Internacionais / 06/01/2021


How “austerity” devastated English health

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How “austerity” devastated English health

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Public system was dismantled: fragmentation of management and cuts in thousands of beds and jobs. Conservatives saw, in the pandemic, an opportunity to accelerate privatizations - under suspicious contracts and without bidding

On May 10, 2020, British Prime Minister Boris Johnson went to British television and radio to explain the government's plan to reopen economic activities in England, which would remove England quarantine due to the covid pandemic. -19. The statement, which explained the “stages” of this plan, was widely criticized by public opinion, on the one hand, for being confused and full of inconsistencies, on the other, because the relaxation of quarantine measures had not been recommended by health experts. public and infectious diseases in the country, who argue that the current level of contagion could result in a new outbreak of the disease.

At that time, while the population tries to understand how life will go after more than three months in quarantine, political noises echo towards the renewed Conservative government, reelected in December 2019, due to the terrible result achieved by the “fantastic NHS”, as Prime Minister Boris Johnson referred to the National Health Service (NHS) at the beginning of the UK epidemic.

The numbers speak for themselves. Of the nations that make up the United Kingdom (England, Wales, Northern Ireland and Scotland), it was in England that covid-19 caused the largest number of lives lost, in nominal and proportional terms (taking into account the population density of nations ). As of 8 June 2020, England recorded a total of 36,244 deaths by covid-19, while Scotland 2,415, Wales 1,401 and Northern Ireland 537 died. The death toll in the kingdom, victims of the new coronavirus, had reached an impressive 40,883 victims. With this result, the country now boasts the shameful second position in number of declines resulting the new coronavirus in the world, with the worst performance on the European continent. In the world, the country is second only to the United States, known for its private and exclusive health coverage, and to the unbelievable Brazil, with a continental, but deficient public health system.

So what happened to the “fantastic” NHS? Why did the pride of the British people produce such bad results?

One era of cuts, institutional disorganization and privatizations

According to public health experts, NHS workers and government critics, who take turns in British news networks and newspapers to comment on the damage caused by covid-19, there are constant accusations that the poor results witnessed come two aspects that are distant in time , but related.

On the one hand, some criticisms are directed at the government's delay in taking tougher measures, such as quarantine, to prevent the pandemic spreading, when it had already arrived in the country. Part of these criticisms accuse Boris Johson's team of wasting many weeks in fruitless discussions about the idea of ​​"herd immunity", abandoned in March.

On the other hand, the criticisms refer to the almost ten-year history of budget cuts faced by the public health sector, followed by institutional rearrangement and privatizations, under the command of the Conservative Party.

A decade of cuts led by Conservatives

On 22 June this year, the longest period of peacetime budget cuts in UK history will be completed. The day marks the date, 10 years ago, that George Osborne was appointed chancellor (equivalent to Minister of Finance or Minister of Economy in Brazil) by the then government of Conservative Prime Minister David Cameron.

Under the argument that it was necessary to end the “era of irresponsibility” of the labor governments of Gordon Brown and Tony Blair, David Cameron said that he was starting an “era of austerity”, justifying this measure with the argument that it was necessary to contain the advance of the debt in relation to GDP and the budget deficit that was present at the time. All of this is adorned with a discourse on fiscal responsibility and public spirit, to “protect the most vulnerable” and “plan for the future”.

Therefore, since 2010, there has been a 40% cut in the central government budget for financing local public services. Such a budget constraint meant that government departments had up to a third of their budget cut; and most public sector workers have had to live with their wages freezing for many years.

In health, specifically, until 2019, the depressed budget resulted in a shortage of 40,000 nurses and 7,000 doctors, who accompanied the reduction in health posts and specialized clinics. This scenario was revealed after an audit in the sector, promoted by Health Fundation, in partnership with the thinktank The King’s Fund, which also indicated that there was an 8% increase in the number of patients registered in the system in the same period, putting even more pressure on the already stressed NHS structure.

But it is the numbers of beds that best demonstrate the impact of the austerity period, especially during the covid-19 pandemic. Since the beginning of the cuts, about 32 thousand hospital beds have been eliminated, in England alone. This was about the same number of beds that the NHS endeavored to make available to patients with covid-19, that is, 33,000 beds, which were hurriedly improvised and released by the system.

When the disease started to spread in Europe earlier this year, the United Kingdom was among the 24 most vulnerable countries in terms of the number of ICU beds available per inhabitant, with only 6.6 beds per 100,000 inhabitants. While Germany, one of the most comfortable countries, boasted 29.2 beds for every 100,000. Brazil, to give you an idea, has an average of less than 2 ICU beds per 100 thousand inhabitants in the SUS network.

Institutional Disorganization

In addition to budget cuts, the NHS was reorganized during the government of Prime Minister David Cameron, under the baton of then Health Secretary Andrew Lansley. Starting a process of reorganization and fragmentation, which had started years before, in the labor governments of Tony Blair and Gordon Brown, the reorganization promoted by the conservatives in 2012, radically deepened the pulverization of the system.

During this period, regional health authorities and infectious disease control observatories, which were under the coordination of the Health Protection Agency (PHA), and which were essential during the swine flu epidemic in 2009, ended up being dismantled by the Lansley reform.

The reorganization proposal was to reduce the public sector and hand over part of the responsibility for health control and intelligence actions to local authorities. In place of the observatories and regional control teams responsible for health intelligence, the 2012 reform of the conservatives created another agency, called English Public Health (PHE), which today has concentrated the entire response to the corona virus epidemic.

Heard by The Guardian, the European public health professor at the School of Hygiene and Tropical Medicine in London, Martin Mckee, argues that this whole process of institutional rearrangements resulted in “a great weakening and fragmentation of the public health sector, with direct consequences [in combat] the covid-19 ”. Already a former director of one of the extinct pre-retirement primary health care units, Julie Hotchkiss, adds: "They took a perfectly functioning public health system and fragmented it."

In response to questions The Guardian and comments his critics, Lansley argues that the system was already fragmented when restructuring reforms were promoted and that “the problem was money” and the continuation of the reorganization, interrupted with its departure in 2015.

Privatizations in the fight against covid-19

The whole process of reorganizing British public health has opened the way for the growing privatization of the sector, which has taken on even clearer contours during the covid-19 pandemic. Since the beginning of the pandemic, the British government has entrusted a significant part of the actions to combat the virus through expressive contracts with large service providers, such as Serco, G4s, Mitie, Sodexo, Randox, Deloitte, PricewaterhouseCoopers, Ernst & Young and Amazon. Some of these won their contracts without a bidding process and, therefore, without competition, to provide everything meals and protective equipment for health professionals, to testing and telematic screening services for potential infected with the new coronavirus.

One of the most talked about contracts is with the company Faculty, which specializes in information technology services, and which had worked on the pro-Brexit campaign for the Conservative Party. During the Johnson administration, the company managed to win seven contracts with the British government in the interval of 18 months. Now, she will participate in the design and implementation of the application for tracking potential covid-19 patients.

The creation of an infected tracking system that the NHS would make available through a mobile application developed by the private company NHSX, a technological segment of the British healthcare system - with private partners, such as Palantir, Amazon, Google, Microsoft, in addition to Faculty, was one of the promises of the secretary of public health and social assistance, Matt Hancock, in mid-April.

In addition to criticism regarding the transparency of these contracts, there are also criticisms regarding the inexperience of these companies in the s health sector. This is the case, in addition to the Faculty, of the company Serco - specialized in providing public services in the area of ​​justice, which operates in the United Kingdom and abroad, and whose chief executive, Rubert Soames, is the grandson of former Prime Minister Winston Churchill . According to the newspaper The Observer, Serco won a £ 45.8 million contract to manage and implement the NHS testing and tracking program, even though it had no experience in the sector and, on top of that, it received a little more month, plus a fine for breach of contract with the British government. The recent £ 1 million fine adds to others, amounting to £ 18 million in contractual penalties. The newspaper also recalls that one of the health minister's assistants, assistant Edward Argar, is a former Serco lobbyist.

On 4 June, The Guardian reported that the NHS chief of operations, Tony Prestedge, admitted that the tracking system, launched in late May, would not be fully functioning until around September or October. This made criticism of privatization contracts even more so.

What now, Johnson?

In the meantime, scientists warn that the relaxation of social distance measures and the return to non-essential economic activities, which are being carried out by the government, are precipitated. And that, with this, a new wave of contagion by the new coronavirus may occur, and that this wave would reach the NHS during the winter months, when the system already faces overpressure due to the seasonality of some diseases related to cold weather.

Thus, it remains to be seen whether, by ignoring health experts once again, the prime minister and his advisers will be driving the British health care system to a “fantastic collapse”.


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