NHS emergency services face collapse

Gloria Foster, aged 81, died in hospital in early February after being found at home by a district nurse on a chance visit. She had been stranded in bed for nine days with no access to food, fluid or medication. Until that time she had been receiving four visits a day from carers from the private company Carefirst24, contracted to provide care for elderly people by the London borough of Sutton. On 15 January, the UK Border Agency raided Carefirst24 and arrested staff whom they accused of employing undocumented immigrants. Despite warnings to Sutton and Surrey councils, no alternative arrangements were made for Gloria Foster. Surrey police have announced that there will be no criminal charges. Hannah Caller reports on the disintegration of the National Health Service.

Is this the care in the community that health minister Jeremy Hunt talks about as he calls for further A&E closures and blames old people and those with dementia for increasing attendance in A&E? People attend A&E because there is often nowhere else to go. Figures obtained from the NHS Trusts where Newark patients now go following the closure of Newark A&E in Nottinghamshire two years ago, show an increase of 37% in death rates. A&E departments are on the brink of collapse. The number of people going to A&E has risen by four million since 2004. The number of people waiting for more than four hours in A&E has risen by 50% in the last year and by 90% since 2011. Retaining and recruiting doctors-in-training to A&E is increasingly difficult due to the pressures. There are currently over 200 vacant posts for trainees, with some NHS trusts spending £2,700 a day for locum doctors to fill vacant posts in A&E departments. The College of Emergency Medicine warned that one in five A&E departments relies entirely on junior doctors in the evenings and at weekends and there are shortages of senior doctors. The average number of consultants per A&E department is 7.4, while the recommendation is 10-16. The funding system penalises A&E departments that have a rise in attendance – they are deemed to be over-performing.

In 2011/12, NHS organisations in England reported a combined overall surplus of £2.1bn. Yet the government is demanding £20bn in ‘efficiency savings’ by 2015. Health care provision is increasingly at the mercy of private companies. Private Finance Initiative repayments are bankrupting hospitals as repayments take precedence over patient care. Virgin earns about £200m a year running over 100 NHS services across the country. Conflicts of interests are evident when doctors providing care are also involved with private for-profit companies. A Nuffield Trust study reports that NHS spending on private providers has risen by £3bn since 2006 to £8.7bn in 2012. 20% of hip and knee replacements are now carried out by private providers – there were hardly any in 2003. In Yorkshire and Humberside, 10% of all NHS funds are going to private providers.

Out of hours (OOH) GP services are struggling to find doctors with some GPs being paid up to £150 an hour, while the Royal College of GPs states that there is a shortage of over 10,000 GPs across all services. Harmoni is a private company contracted to provide OOH GP services in some parts of England. It is so short of doctors that it is offering huge bonuses to doctors who refer a colleague to them. In north Somerset, Harmoni used one advanced nurse practitioner to cover up to 250,000 patients overnight. Harmoni has the contract for OOH care in parts of north and east London and has a base at the Homerton Hospital, where its contract, which had no formal tendering process, is still under an interim arrangement from 2010. There is evidence that rotas are not always covered and a GP on the local BMA division is leading an investigation. However, Harmoni has refused to supply information to the BMA requested under the Freedom of Information Act, saying it is exempt as a private company. It has refused to supply the information for NHS North East London and the City on the basis of commercial sensitivity. Harmoni’s secrecy over the rotas make it more suspicious. A full report from the Care Quality Commission is now awaited. While doctors enrich themselves in a chaotic increasingly unregulated system, access to health care worsens.

Meanwhile, NHS Direct, the phone support system which started in 1998 with 30 nurse-led call centres and 170 more nurses working from home, has been privatised and is now known as NHS 111. More than a quarter of the contracts have been awarded to Harmoni. The 46 replacement call centres are no longer nurse-led but have phones answered by people trained to use algorithms. Although the requirement is to answer calls within 60 seconds, some people have waited 20 minutes for a response. Seven of the centres remained non-operational in early May, others have been suspended. The whole implementation has been a complete shambles; three deaths have resulted and now £8m is required to bring back some NHS Direct staff to supplement the service at weekends.

In the Queen’s speech at the opening of Parliament in May, the government stated it will limit health care for certain groups of migrants. Temporary migrants will have to make a contribution before being able to use NHS services. This will be in addition to guidance for NHS bodies on recovering charges for overseas visitors issued in 2011. These state that if someone has not lived lawfully in Britain for the previous 12 months, they should be notified that charges might apply. This is also transferred on to their children. Not surprisingly the Royal College of GPs said that ‘General Practitioners should not be expected to police access to healthcare and turn people away when they are at their most vulnerable.’

The NHS is beginning to break under the strain as FRFI argued would happen with the introduction of the Health and Social Care Act. The Labour Party and trade unions, far from doing anything effective to fight back, are demobilising opposition especially in London.

It is time the working class took the defence of health services into its own hands.

Fight Racism! Fight Imperialism! 233 June/July 2013


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