Every day the media publishes stories illustrating the crisis in the NHS. Waiting times for emergency ambulances, waits in those ambulances outside A&E, waits in A&E for treatment, waits for a hospital bed, waits for a care package to be available for safe discharge, waits for mental health treatment. Former Chancellor Rishi Sunak talks of putting the NHS on a ‘war footing’ to deal with the backlog of 6.6 million people awaiting an operation as he campaigns to replace Boris Johnson as prime minister; his opponent Liz Truss talks about excessive management costs. But everyone knows that since 2010 the NHS has had its funding slashed even if the Tory government and the media say otherwise; that staffing levels as a consequence are dangerously low, and that furthermore there are no serious plans to recruit and train the tens of thousands of nurses, doctors and paramedics needed to make up the shortfall. It is evident that capitalism cannot afford a health system which meets the needs of the working class. HANNAH CALLER and ROBERT CLOUGH report.
The scale of the problem is immense and the government is consciously making it worse. The 3.8% annual uplift in funding it announced in October 2021 between now and 2024/25 means the NHS will in fact experience a real-terms cut of between £4bn (GDP deflator) or £9.4bn (CPI). This is because the government, having offered a miserable 5% salary increase to NHS staff, intends to fund only 3%, leaving the 2% balance – £1.8bn – to be found by the NHS. On top of this the funding is reduced by the high rate of inflation, and the withdrawal of Covid-19 funding despite the continued prevalence of the virus and the fact that waves of infection mean that its sufferers periodically take up more than 10% of hospital beds.
A July Nuffield Trust report revealed the true extent of staffing gaps in every area of care in the NHS. In summary:
- NHS Digital says there are almost 39,000 nursing vacancies and 8,000 doctor vacancies. But the Nuffield Trust says the true numbers are 50,000 nurses and 12,000 doctors since many posts that are vacant are not advertised and therefore not picked up in the statistics. This could be because either the post is has been abolished or because the hospital cannot afford to fill it.
- The NHS in England is short of 2,000 midwives and 500 obstetric doctors to provide adequate care in pregnancy and childbirth. Between March 2021 and March 2022, 553 midwife posts were lost.
- Almost half the advertised medical (non surgical) consultant jobs in hospitals in England and Wales went unfilled in 2021; of these, nearly three quarters had no applicants at all. 44% of the current medical consultants will reach retirement age in the next ten years.
- In mental health, there has been a 52% rise in emergency referrals for under 18-year-olds for mental health crisis care over the last two years alongside a cut of 20% in the number of dedicated mental health beds over the last five years.
- There are at least 100,000 vacancies in social care, although some estimates are that the real figure is up to 160,000.
Before his resignation, Health Secretary Sajid Javid admitted that the government’s target of increasing the number of GPs by 6,000 by 2024 would not be possible. Worse, recent analysis predicts that more than a quarter of England’s GP and practice nurse posts could be vacant in the next ten years.
In July 2022, all ten ambulance services across England declared a critical incident due to unrelenting pressure across NHS services. The managing director of the Association of Ambulance Chief Executives warned that services are operating at a level usually reserved for major incidents. Crews and vehicles are stuck in queues outside hospitals. The London Ambulance Service’s sustained demand on 999 and 111 services has meant a move to Resource Escalation Action Plan Level 4, usually declared when an ambulance service can no longer effectively deliver. One ambulance in the West Midlands was forced to wait 24 hours just to hand over a patient to A&E.
Health Secretary Steve Barclay – who once called the NHS ‘a bottomless pit, resistant to change and unaccountable’ – has ordered a ‘hackathon’ whose purpose is ‘to address the crisis in ambulance performance’; this is a gimmick that not only suggests that the problem is that of the ambulance service alone, but that the deep-seated health crisis can be solved by some kind of technical quick fix. Everyone knows that the crisis (quite apart from inadequate funding and staffing) does not start with the ambulance service; it is about patient flows. Ambulances are stuck in queues outside A&E because A&E is overwhelmed. A&E is overwhelmed because it cannot move patients onto the wards as the wards are full. Wards are full because they cannot discharge patients safely. They cannot discharge patients safely because social care is broken. Whether there are 100,000 or 160,000 vacancies, the fact is a privately-run care service can only remain profitable if it pays the minimum wage of £9.50 for what is often gruelling shift work. But it is not the purpose of Barclay’s ‘hackathon’ to address this: it is merely to make a show of doing something.
While Sunak spoke about ‘war footing’, Truss talked up the need to end what she called ‘micro-managing the frontline’. Attacks on NHS ‘bureaucracy’ are as old as the NHS itself, and are a diversion given that management costs at about 4% are far lower than those in the private sector – around 10%. But they are useful in directing attention away from the real problem – that the scale of investment in hospitals, training and adequately paying staff in health and social care to provide a decent health service is beyond capitalism. For that, we need socialism.
FIGHT RACISM! FIGHT IMPERIALISM! 289 August/September 2022
