The working class faces more austerity, more poverty, more mental health crises and more challenges to its health and wellbeing in every age and stage of life. Meanwhile in the NHS more people wait for appointments and treatment, for admission and discharge. They are cared for by too few staff struggling to give the care they are trained to give, feeling more disheartened and demoralised under the increasing pressure. The NHS has over 120,000 vacancies. The workforce plan awaiting Treasury approval is looking at a 15-year time span and therefore will have no immediate effect. About 40% of the NHS workforce is older than 50 years, and incentives to return after retirement are poor.
Britain has just 2.5 beds and 2.9 doctors per 1,000 population compared to the European averages of 4.7 and 3.7; fewer than eight nurses per 1,000 population compared to France with 11, Germany with 12, Switzerland, 18. There are 2.8 doctors per 1,000 population compared to the EU average of 3.4, and Britain spends 18% less per person than the EU14 average.
At the end of January 2023, the government published a two-year recovery plan, with the promise of £1bn ring-fenced for 5,000 new beds (5% more capacity) and 800 new ambulances for the winter to come, and a promise to increase the number of people seen in A&E in the requisite four hours to 76% by March 2024, up from the current 70%, but well below the 95% target. How these promised services will be delivered or staffed has not been addressed. It may not even be possible to procure, convert and deliver that many new ambulances in the time allotted. Furthermore, such a number of ambulances need a minimum of 3,200 paramedics/ambulance crew, and they would need to be trained as they do not exist.
5,000 beds spread across 200 trusts is 25 beds per hospital and minimally over 1,200 nurses to staff those beds. Midwifery vacancies are up to 11%, physiotherapist vacancies vary from 6% to 20% depending on the hospital, and there are currently 39,652 nurse vacancies. Billions of pounds are being spent on agency staff to make up the shortfall. The February 2023 figures for applicants for nurse training show a drop of 18.6% compared to January 2022.
The NHS financial settlement which the government imposed in the 2021 Spending Review covers the period to 2024/25. Efficiency savings of at least 2.2% each year are required. This is much higher than the historical 1% per year and is in the context of an NHS budget that has been reduced by 3.4% in real teams in 2022/23 and will only increase by 2% or less in the coming financial years. This means more cuts.
Mental health crisis
Rates of mental illness are increasing, particularly among children and young people. The number of people in contact with Child and Adolescent Mental Health Services has increased by 310% since April 2016. One in seven doctor positions in mental health are vacant, and there is a 19% mental health nursing vacancy rate in England – agency/locum bills in the service now total about £3bn per year. There has been a greater than 350% rise in number of people with mental health issues waiting more than 12 hours in A&E departments from 2016/17 to 2021/22. In 2021, there were a record 4.3 million mental health referrals, a 13% increase from 2019. Bed numbers have been reduced by 69% for those with learning disability and by 23% for those with mental illness since 2010/11. The extra £2.3bn announced for mental health in 2019 is utterly inadequate.
General Practice crisis
A recent survey found that 17% of GP posts in England are unfilled, a third of practices has one vacancy and 16% had two. Similar figures are found in Scotland. The government has promised 6,000 more GPs by 2024. GP leaders reacted angrily to the government and NHS England’s recent proposed changes to their contracts which does not address the rising expenses for staff, bills and services. 400 GP practices have closed since 2019 in England and each practice now has on average 2,224 more registered patients than in 2015. There is the equivalent of 2,078 fewer fully qualified, full time GPs in January 2023 compared to September 2015. Meanwhile in January, 26.8 million appointments were booked, a 9% rise on the previous month. Internet searches for a ‘private GP’ are up 151% in England.
Money and deals
In March 2020, the NHS paid £2bn for the entire capacity of England’s 200 private hospitals and associated staff and equipment, to help manage the Covid-19 pandemic as well as urgent care. A British Medical Journal investigation revealed:
- Just 30 of the 200 hospitals treated patients with Covid-19 at the height of the first wave – and only 52 patients using 0.6% of their 8,000 beds – when the NHS had nearly 19,000 Covid-19 patients.
- The 143 private hospitals owned by the Nuffield, Circle, Ramsay and Spire chains delivered just 51% of their total episodes of inpatient care to NHS patients in the first year of the pandemic. The remainder were for private patients.
It is now emerging that NHS doctors are being offered cash bonuses of up to £5,000 to recruit colleagues for jobs in private hospitals. HCA Healthcare, which runs over 30 private hospitals in London and Manchester and is opening a £100m private hospital in Birmingham later in 2023, is spending tens of thousands of pounds to recruit NHS-trained doctors, who will either leave the NHS or reduce their NHS hours to work for the private company. HCA Healthcare was doing this during the pandemic and offering 10% of their annual salary as a starting perk, along with gym membership, life insurance and private GP access. HCA offered £10,000 to paediatric nurses to join the new service at the private Portland Hospital in London.
While Britain poaches doctors and nurses trained abroad, now the private sector is overtly poaching from the NHS. We must fight for health care for all, free at the point of delivery, decent pay and conditions for all NHS staff and for the lowest paid working for tendered-out companies to be brought in-house.
Hannah Caller
FIGHT RACISM! FIGHT IMPERIALISM! 293 April/May 2023
