[music] Tony O’Sullivan: People talk about the NHS in crisis. Jeremy Corbyn: Our NHS Mr Speaker is in crisis. I would prefer to say the NHS is the victim of a political crisis. Boris Johnson: It is the NHS that has benefitted from Conservative policies and Conservative government. Jeremy Corbyn: We’re the party, the Labour Party that created the National Health Service. Mark Dayan: When people talk about a crisis in the NHS, a lot of the time they’re referring to either the problems with waiting times it now has or the problems with staffing. On waiting times the NHS in England and in fact across the whole UK is missing most of the main targets it has. Jeremy Corbyn: More people sharing hospital corridors on trolleys. More people sharing waiting areas at A&E departments. Tony: NHS performance figures were released recently and they showed the worst A&E performance since they’ve been monitored. John Lister: A reduction of 9,000 frontline hospital beds. Tony: 4.4 million people on waiting lists for elective surgery and operations. Yannis Gourtsoyannis: I’ve seen the consequences of delayed ambulance response times, whereby patients who require emergency care are having to wait half an hour, an hour, two, three, four, five hours for an ambulance to arrive at home. John: 1400% increase in trolley weights. Yaso Browne: The Red Cross in 2017, they said the NHS was in humanitarian crisis, and that was following two people dying on a trolley waiting to be seen. John: 38% of hospitals only can actually meet the standard to start cancer treatment within two months of referral. Yannis: Let’s be absolutely clear about this. When we talk about delayed ambulance response rates, when we’re talking about delayed access to A&E care and when we’re talking about more and more patients waiting on trolleys, what that means is that patients are getting care delayed and patients are dying up and down the country. Mark: There’s also a staffing crisis, I think it’s fair to say, in particular for nursing in general practice. We just don’t have the numbers that the health service really needs to run like we want it to. Jeremy Corbyn: Fewer A&E departments, fewer nurses and fewer people getting the care they need. NHS nurse: Especially on the wards where you used to be one to two, and now you’re one to six to eight patients. Gay Lee: What nobody says and certainly not the government is that it’s entirely the government’s fault that this has happened because they never invested enough money in the health service in training in the health services from 2010. Vivek Kotecha: For many years, the government has controlled how many doctors get trained in the UK. There was a period in the 2000s where they actually cut the number of doctors they were willing to train because they didn’t think they needed so many. Now obviously, that’s a very short-sighted move. Tony: There aren’t enough doctors trained, the population need has expanded and the pressure on doctors and indeed other professional groups is such that they are seeking ways out. NHS nurse: They end up outsourcing to agency staff members, so private nurses who work out for themselves or in a small group, and they get paid two to three times as much as the normal contracted staff, just for an individual shift. Because they’re need it, sometimes we have to rely on them so heavily. We do it less now, but over the last few years there’s been night shifts were 50% to 60% of people on have been agency staff. Tony: You see significant burnout, you see real depression, you see stress, you see high rates of suicide amongst nurses and amongst doctors. Yaso: 63% of doctors say they are burnt-out at work. Unfortunately, 430 healthcare professionals have committed suicide in the UK. Matt Hancock: The prime minister has committed an extra 20 billion over the next five years. £20 billion, it’s the largest, longest financial settlement in the entire history of the NHS. John: They keep telling us they’re giving us more money than ever before, which technically, I suppose is true because NHS spending has gone up every year since 1948. It just hasn’t gone up anywhere near enough to actually meet the rising costs and rising pressures on the NHS. Boris Johnson: Hospitals that are finally getting the investment to match the devotion of the staff. John: We’ve got something like £14 billion worth of borrowing that’s propping up the NHS finances. At the same time, we’ve actually got a backlog maintenance. The hospitals are actually falling apart. We’ve got crumbling hospitals, we’ve got leaking roofs. We’ve got clapped out machinery that’s been being used, that shouldn’t be. Sonia Adesara: We’ve seen over the past few years as the NHS is quite systematically and deliberately underfunded. As it’s been brought to its knees, more and more people, those who can afford it are going into the private sector to get treatments, to get surgery. We’re starting to see that two-tier system where those that can afford it can skip the waiting times and can get the treatment on time. Those that can’t afford it have to wait months and months and months to get care. Jeremy Corbyn: They want to sell off of what remains of our public services? Yannis: There’s a accelerating process within the NHS of privatisation. This is the flip side of the fact that the government is deliberately underfunding the NHS. The government wants the NHS to fail. It wants it to be seen to fail. Therefore, there is then a pretext for private capital to find a way into the NHS. John: Over 9 billion a year is now being spent with private providers of health care services. Vivek: The Department of Health’s accounts’ say that only 7% of the NHS is – or the department’s total budget – is spent on independent providers like non-NHS. Actually now more and more people are saying it’s around 20% to 26%. The reason why is because when the government present their figures, they actually exclude a lot of spending on the private sector or independent sector in those figures. John: The only way in which the private sector can show itself to be apparently more cheap, is by actually paying staff less, or employing fewer staff, or actually delivering less work. As, for example, with contracting out of hospital cleaning, which we saw from the 1980s. Hospital cleaning has become a byword for what privatisation means to healthcare because it was just a disaster. Actually, all standards of cleaning hospitals plummeted. Hospital borne infections like MRSA became rampant during that period from 1984 onwards. Petros Elia: What outsourcing does, not in NHS but everywhere, is it looks for cost-cuttings, cost-savings at every turn. In the case of the NHS, that comes at a huge cost, for patient care, for patient, for hospital hygiene generally and for worker wellbeing. [protesters chant] Jeremy Hunt: We got a very good Health and Social Care Act which is doing very good things for patients throughout the NHS. Vivek: The 2012 Act changed the way healthcare is provided and delivered. What it did is, it created a market in the NHS. Now basically, there is competition. Different public and private companies are competing to provide NHS services. Tony: One of the examples of almost a criminal waste of public funds, has been the Private Finance Initiative. Vivek: The Private Finance Initiative was a way of building public infrastructure using private borrowing. One of the biggest drivers behind it was that governments have committed in the past to not borrowing more than a certain amount in a year or over time. If you build a new hospital, you have to borrow money generally to build it. The government didn’t want to do that. Successive governments have used private companies to borrow the money, they will then build the hospital and then rent it back to the public sector for 25 years normally. Over time when the public sector rents back this building from the private sector, they pay for the cost of the borrowing, they pay for the maintenance of the building and the upkeep. John: Now the catch, of course, of getting the private sector to do this, is the private sector has to spend more money on interest rates and so on borrowing the money than the government would spend. Vivek: When we calculated some of the interest rates for these deals, on average, it was about 7%, but the highest we saw was about 19%. John: Say you put up £100 million to build a new hospital, then you’re going to be looking at probably repaying in the region of £600 million pounds for the hospital over the period of time. Vivek: The total building cost of all the 127 Hospital Health PFI schemes in the UK is £13 billion. The payments that they’ll have to make over the lifetime of the project is estimated to be £82 billion. There’s been a big issue across the UK because some of the hospitals built have not met fire safety standards. A lot of work has been done to retrofit them. There’s been a number of cases that have been documented where hospitals have not been safe and they’ve not been built to the standard they are meant to. John: De facto, the NHS has a chunk of it already privatised and therefore prey to regulations that are agreed in trade deals. Trump: Look, I think everything with the trade deal is on the table. When you’re dealing in trade, everything is on the table. NHS or anything else, a lot more than that. Ruth Bergan: When you go into a bilateral free trade agreement, you effectively put in place a set of mechanisms that lock in privatisation. They’re called standstill and ratchet clauses. Ellen Lees: A standstill clause means that the level of liberalisation of free market access has to stay the same. A ratchet clause means that anytime you change the law, you have to make the liberalisation or the privatisation higher. Jeremy Corbyn: They want all of this locked in with a one-sided free trade deal that’ll put our country at the mercy of Donald Trump. Ruth: The other aspects of trade deals that can lock in privatisation is something called the Investor to State Dispute Settlement mechanism, which allows private companies to sue if a policy measure negatively impacts their profits. For example, Eli Lilly sued Canada because they refused to grant a patent on medicine. Heidi Chow: The biggest winners from this agenda for pushing high prices in a trade deal will be the big pharmaceutical companies. Tony: The UK trade department has been in discussion with the US trade department and has actually met US pharma companies’ officials to discuss drugs and drug prices being part of trade deals. Asad Rehman: It’s all kept in secret. MPs are not allowed to see the trade mandate. It’s not made open or available for civil society or the general public to be able to scrutinise that. It’s not shared with any Select Committee. In fact, even when it’s signed the parliamentarians are not allowed to see the detail of the trade negotiations. John: Obviously, the NHS is a monopoly purchaser of drugs. It’s in a very powerful position to keep the prices controlled. The Americans have always resented the fact that their drug companies have been covered by these restrictions. Trump: The United States will no longer turn a blind eye to unfair economic practices, including massive intellectual property theft, industrial subsidies, and pervasive state-led economic planning. John: Bear in mind the pharmaceutical sector is an extremely powerful political lobby on the Trump government. Heidi: They’ve long wanted to see stronger intellectual property rights, stronger monopoly protections to ensure that they can charge high prices for longer. Asad: They also want to be able to access the data within the NHS. Of course, this is really valuable. As we know, data is as they say, is the new oil. There is immense data in the NHS from, of course, patients’ records, from the clinical trials, from all of those things. These drug companies basically want to be able to access them. Jeremy Corbyn: -being denied life-saving medicines by a system that puts profits for shareholders before people’s lives. Tony: At the moment, the drug bill is about £18 billion a year for the UK’s NHS. Responsible work has been done that shows that if these things were to come to pass and drug pricing and contracts for drugs and the protection of patents beyond what would be normal, if all that came to pass the drug bill could more than double to £44 billion a year. Heidi: Pharmaceutical companies have been under fire a lot in recent years for the high prices that they’ve been charging. They’ve been trying to change the narrative around pricing. They’ve been saying, “We need to stop talking about high prices. We need to start talking about value.” This line of argument is really dangerous because they are essentially saying that we want to– It’s like writing a blank check to charge whatever they want. When you start talking about value, how do you place a value on a drug that’s going to save your life or how do you place value on a drug that’s going to prolong your life and let you live an extra few more years? Ruth: The US has a different approach to regulations and standards than we have here across the board. Their approach is- they call it science-based, which means they rely on research done by a range of institutions, sometimes universities, but often also the very corporations that want to push a particular agenda. In fact, you have to prove that something is going to be damaging to health if you want to ban it. Whereas in the EU, what we say is we use the precautionary principle, which says, if you haven’t proved that it’s safe, then we’re not necessarily going to allow you to market it. What that means for healthcare is that you could have medicines being marketed that hadn’t been proven to be safe. Vivek: In terms of why the UK is particularly attractive for pharmaceutical companies, the UK is considered a reference country. What that means is that the price we set for drugs here is also used in the price negotiations of other EU countries and countries in wider Europe. Any increase in drug prices in the UK will have a domino effect in that it could over time increase the prices paid for the same drugs across Europe. For a drug company getting the prices high in the UK, will have a knock-on effect across Europe. It will mean overall their prices and sales revenues will go up. Tony: Unless the NHS is returned to a wholly public service and unless the government declares it as a service of social purpose, of social solidarity, and it’s owned by controlled by the government, Unless they do that there is not protection of the NHS from trade deals. John: We’ve got to take the next step which is actually bring the NHS back properly into public ownership. Jeremy Corbyn: It’s our duty to defend it. We will end the sell-offs and privatisation. Our NHS is not for sale, not to Trump or anybody else, it’s our NHS for our people. Asad: The NHS for me is more than just an essential service. It’s symbolic of people’s ability to be able to imagine something and make it real. That’s partly why neoliberals hate the NHS because it stands as a monument to the idea of the collective will of people. NHS nurse: The NHS is there for you, and it’s difficult to say, but be as patient as you can with us. We are all there to help irregardless of your waiting time, and we understand that you are vulnerable. We will take anything, we’ve got thicker skin than you can think of, just be patient the NHS is there for you.