In key marginals, a Conservative election leaflet masquerading as an NHS prescription has been posted to voters in the last few days. It’s a deception that’s already caused outrage.
But whilst the version reported on so far, sent to Tory/Lib Dem battleground seats like Richmond Park, Oxford West, and Cheltenham, is relatively bland, openDemocracy has seen a second version of this leaflet. And that version reveals a darker story about Johnson’s Conservative Party. It shows just how blatantly the Tories are using immigration to neutralise concerns about the NHS – and, worse, how they are using concerns about the NHS to stoke the division and racism that the Tories appear to think will benefit them electorally.
This second version of the Tories ‘NHS’ leaflet (pictured below) has been sent to voters in Tory/Labour battlefields in the North and Midlands, including Middlesborough, Newcastle-under-Lyme, Leigh, Dewsbury, Derby, Coventry, Crosby, and my own home town of Stroud.
It contains 40 short sentences – and astonishingly, fully half of them talk about immigration.
We need “an immigration system that takes pressure off the NHS”, the Tory anti-Labour leaflet tells us - not just once, but eight times, in slightly different forms of words. It tells us repeatedly that we need to “take back control of our borders”. That Corbyn wants “uncontrolled immigration”, to “extend freedom of movement”, and “give everyone the right to bring their whole family to the UK”.
Both leaflets hint darkly that we might need to start paying for hospital treatment – “when we leave hospital, we leave with a prescription – not a bill”. The anti-Lib Dem leaflet says in the next sentence that the solution to prevent this is “a growing economy that can support the NHS”, the anti-Labour leaflet suggests that the way to avoid us getting a bill for treatment, is “an immigration system that supports the NHS”.
This is the leaflet sent out in Tory/Labour battlegrounds (first two pics), followed by the one sent out in Tory/Lib Dem battlegrounds (second two pics)
But where the anti-Lib Dem leaflet pledges twice to “give mental health the same priority as physical health – so everyone gets treated with the respect they deserve”, the anti-Labour one offers in its place, pledges to “clamp down on health tourism” and deliver “an Australian-style points-based immigration system – so we have control over who comes to our country”.
Each time the anti-Lib Dem leaflet talks of the need to “support the economy so that we can invest in” the NHS, the anti-Labour version says nothing about investment, but repeats mantras about the need to “control immigration” by “getting Brexit done”.
Remember – this leaflet is entitled “A Prescription for the NHS”. But it seems to be far more about voter suppression – putting people off voting for their preferred party by offering fear, confusion, division, and scapegoating.
Neena Modi, immediate past President of the Royal College of Paediatricians and Child Health, told openDemocracy that the anti-Labour leaflet “would appear to be a blatant attempt to fan northern Brexit sentiment by implying that the woes of the NHS are due to the health demands of immigrants and health tourism. Apart from being false, the former claim is particularly nasty in its racist undertones.” Modi went on, “The government’s own figures suggest health tourism equates to at most £300m per year. Contrast this with Department of Health and Social Care figures showing the NHS spent £9.18bn on the independent sector in 2018-19 compared with £8.76bn the previous year. The NHS is on its knees for 2 reasons. First, it has been underfunded while in parallel an increasing percentage of public funds are being diverted away from frontline care and into the profit margins of private companies that are demonstrably providing inferior care. Second doctors and nurses have been deliberately kicked in the teeth.”
But despite all this, reports from my own marginal seat and those my openDemocracy colleagues have been reporting on, suggest that the Tories’ divisive arguments are landing with some voters.
This week I spoke to NHS insiders in my home county, to find out whether it really is getting harder for patients to access the NHS, whether that’s got anything to do with migrants, and if not, to uncover the real reasons the NHS is under pressure. Most have worked in the NHS for decades, and all the NHS staff spoke on condition of anonymity.
A local hospital governor told me the migrant-blaming leaflet posted out locally was “bullshit”. A senior hospital consultant told me it was “absurd”. All told me that the problem was more about cuts to services and workforce, than about increased demand from patients. About how since 2010, too few staff have been trained, and too many have left, or retired early. Staff are demoralised over pay, but even more demoralised by the impossible demands imposed by cuts and the bureaucratic, fragmented system imposed by competition-obsessed governments, requiring every patient interaction to be monitored, coded, and priced. This isn’t what health workers came into the NHS for, and many are voting with their feet. Faced with staff shortages, managers respond by making it harder for patients to access services – changing eligibility rules, cutting opening hours, beds and hospital clinics, and expecting patients to figure out the right part of the service to approach amidst the chaos.
Here’s what people in my local NHS told me this week. I hear similar stories from across England.
Community-based NHS clinician
We’ve got more bureaucratic control of clinicians, and less autonomy. We’ve got increased fragmentation, between NHS providers and private ones all competing with each other for patients, and all of this has led to a lot more admin for NHS staff. There’s so much more admin now, we are taken away from our patients for several days a month, which we never used to be.
GPs often now send patients to non-NHS organisations to get their scans like ultrasound done, thinking they’re being helpful, but that just wastes time as NHS staff can’t access the images, so patients often end up being sent for a repeat scan.
Community nurses are short and health visitors have been cut, so they have reduced their remit, in other words, reduced the patient eligibility for accessing their service.
Former acute NHS hospital governor
The shortage of GPs is the biggest single factor in the health service having problems. If you can’t get to see your GP for two weeks, then you’ll go to A&E.
Cheltenham’s A&E [one of only two in the county] has been downgraded. After 8pm it doesn’t take any blue light emergencies now, they’re all sent to Gloucester.
They’ve cut around 100 beds at Gloucester since 2010... They said they were increasing community beds to make up for it, to move people through the system. But that didn’t happen. You’ve had cuts in community hospitals too.
They’re running down community hospitals, Stroud hospital is being run down…They do these mealy mouthed consultations… to justify further cuts. They keep mucking about with the times, with the terminology, changing the rules, has it got an x-ray, is it open after 8, what will it treat, how will I know if it’s an ‘emergency’ or just ‘urgent’? It puts more pressure on the two A&E units because people default to the main hospitals. People come because they’ve been so messed about a lot.
We asked the Trust about [the impact of so-called health tourism]. It was so negligible; it was hardly even worth accounting for – it was in the tens of thousands out of millions. Generally the people who come are young and fit and therefore make very little demand proportionally on the NHS… They are working and paying taxes and they are actually subsiding our older people. The loss of GPs retiring early, and the loss of beds in both community hospitals and acute hospitals, outweighs by miles any potential increased impact from migrants… Since 2008, the number of people attending A&E in Gloucestershire nearly doubled, from 8000 a month to 15000 a month from 2008 to now…It’s inconceivable this is down to immigration…that’s marginal.
In trying to cut costs, they caused chaos in the system. And chaos cannot be efficient.
Acute NHS hospital consultant
The situation in the hospital is dire. Right now [in the middle of a working weekday] over a third of patients in A&E have been waiting for more than 4 hours [the target] to be seen.
We’ve got more than 100 patients ready for discharge [from acute beds], but we can’t because there are no beds available to discharge them to.
I’m really worried that if the Tories get in, we won’t have an NHS in five years’ time.
NHS junior hospital doctor
The NHS is haemorrhaging doctors - both temporarily (people off sick) or permanently. These gaps are then covered by locum doctors. The cost of locums is extremely high. The reason that locums are needed is because Tory cuts lead to overwhelming and punishing work schedules which are unsustainable.
Other ways in which I have seen costs increased is by the whole management structure. The NHS obviously needs managers but so much money is pumped in management - whether that's salaries or infrastructure (look at the quality of the Clinical Commissioning Group building in Gloucester compared to the hospital). Complex management layers divert money away from the frontline.
NHS mental health worker
Apart from rooms and staff we are not an expensive service to run, needing no beds, hospitals or medicines. But we are crippled by lack of funds to recruit and retain staff. Staff are worn out, burnt out by the increasing demands of the targets that give no second in the day to pause, reflect, have a break, recharge your depleted emotional battery. The pressure is so high to perform and achieve the unrelenting targets, experienced staff are leaving in their droves. It is getting increasingly hard to fill vacancies as we can't train enough to halt the flow of those leaving the profession. And when staff leave there is often a freeze on posts so we can't recruit. It feels like we are on a treadmill with no leniency , no compassion and no end in sight.