As we go to press the depth of the NHS crisis is becoming ever more apparent. Waiting lists continuing to grow, inadequate and deteriorating staffing levels, a demoralised and exhausted workforce, half of NHS staff reporting illness from work-related stress, 24 hospitals declaring critical incidents in January, and more nurses leaving than joining, all signify a system which is broken. Going into the pandemic, Britain had fewer doctors and hospital beds per capita than most comparable economies. Ten years of real-term funding cuts are the cause; the Covid-19 pandemic revealed how bad the situation had become. The final straw was the complete contempt the Tory government showed for the NHS when it refused to implement serious public health measures to control the spread of the Omicron variant: at times nearly 20,000 Covid-19 patients occupied beds which should have been available for those needing urgent cancer treatment or other procedures. It was in truth an experiment in ‘living with the virus’ – but thousands died of Covid-19, and an unknown number more from other conditions because they could not receive the necessary care in time.
In January this year, the total waiting list was a record 5.8 million. Yet because millions were reluctant or unable to obtain initial medical advice during the pandemic there is a level of unmet need which is difficult to quantify, and the real waiting list is likely to be more than 12 million and could rise to 15.5 million in 2023. The Department of Health and Social Care was already warning in September 2021 that waiting lists could reach 13 million by the end of the pandemic. While those opposed to serious public health measures to contain the pandemic bleat on about the impact of lockdowns on mental health, they choose to ignore the pain, the mental ill-health, the shortened lives that have been the consequence of an NHS stripped to the bone.
Racism and discrimination in health care
Geographical and demographic inequalities are huge. People living in the most deprived areas have a life expectancy nearly a decade less than those in the least-deprived areas. Life expectancy is 78 years in Manchester and 86 years in Westminster. Calderdale and Huddersfield Foundation Trust found in 2021 that people from a minority ethnic background were waiting three weeks longer on average than white patients for an operation that must be done within a month; while people from the most deprived communities were waiting 2.5 weeks longer than those from the least deprived.
Conditions at work
The government proposes increasing the NHS elective capacity by 30% compared to pre-Covid-19 levels. This is a fantasy: the NHS is short of 50,000 doctors and there are 40,000 nursing vacancies in England. For the first time since 2017, there is a 25% increase in nurses leaving the profession. Every region across England reported an increase in the number of nursing vacancies compared to the previous year. Recruitment of nurses from underdeveloped countries is contributing to the global nursing workforce crisis. The Sustain and Retain in 2022 and Beyond study found that pre-pandemic, there was a global shortfall of almost six million nurses. The most recent prediction is that 13 million more nurses will be needed over the next ten years, equivalent to almost half of the world’s current 28 million nursing workforce. In Britain, one in three nurses leave during training and one in three resign in the first three years. Half of nurses are in their 40s and 22,600 European nurses have left as a result of Brexit.
Conditions are worsening. Most hospitals have nowhere to buy a hot meal at night as canteens are closed due to cuts and shortages. Dudley hospital has launched a crisis appeal to pay for hot meals for staff doing a 12-hour shift. At the Royal Preston Hospital, the canteen has been turned into an emergency overflow ward for 50 people with Covid-19. The visitors’ car park was closed in December for a temporary Nightingale surge hub to provide 100 beds for those recovering from Covid-19 across the north west of England. In the second week of January, with a 63% rise in absences due to illness or self-isolation in England’s acute care hospital trusts, the army was called in to London hospitals where 200 uniformed armed forces personnel had to fill the gaps. 400 military paramedics had to support ambulance trusts in Wales and Scotland and 1,000 military personnel are involved in the vaccine booster programme.
Healthy lives lost
The waiting times for elective care mean people have lost months or years of good health. Performance standards for the NHS include the requirement to start non-urgent consultant-led treatment within 18 weeks from referral. In October 2021, more than two million people had waited longer than this, and more than 300,000 had waited more than a year. This poor performance predates the pandemic, with key national targets on cancer, planned and emergency care missed for years due to the continuous funding and staffing cuts.
Emergency care services are also struggling. Timely care contributes to the quality of care. Ambulance response targets are eight minutes for life-threatening and 18 minutes for emergency incidents. In November 2021 in England, the response times were on average nine minutes and 46 minutes respectively. The target time for ambulances to hand over patients to A&E staff should be 15-30 minutes. In the last week of 2021, 23% of ambulances were delayed by at least 30 minutes, and 10% by at least an hour. Target times are intended to achieve good clinical outcomes. The target for A&E departments is to admit or discharge 95% of patients within four hours of arrival. This target has not been met since 2015 and currently only 62% of patients in England and less than 75% in Scotland are being treated within the target time. This is not a problem of the pandemic but systemic failure consequent on budget cuts.
People waiting over 12 hours to be admitted from A&E on to a ward hit an all-time high of 10,600 in November 2021, even with NHS England trying to fudge the data and calculating the time from Decision to Admit, rather than arrival. This number was five times greater than in 2020 and nine times more than in 2019. Waiting six to eight hours in A&E before admission to hospital increases all-cause 30-day mortality by 8% when compared with those who move on within six hours (Emergency Medicine Journal). The fact is that capitalism cannot guarantee adequate health care to the working class: for that we need socialism.
Hannah Caller
Fight Racism! Fight Imperialism! No 286, February/March 2022
