In November 2023, the government rejected a request from NHS England for a £1bn bailout to cover the effect of industrial action. It said that hospital and primary care leaders should instead reduce activity targets for routine care and focus on those who have waited longest for treatment, and those who need urgent or cancer care.
The result is that NHS services now face the ‘nuclear’ option. The NHS Executive has told local Integrated Care Systems (ICS) that they will have to slash services in the last six months of the financial year due to a huge financial shortfall from the first six months (April to October 2023). The total deficit was £1.5bn; with winter here, finding savings will be next to impossible. £800m has been raided from capital and IT budgets; this will defer much-needed hospital repairs and electronic patient record projects. The only other option is to cut services even more. South East Region, one of the seven NHS regions across England says that their system’s share of the funding ‘won’t touch the sides’, while another source said they had identified ‘a set of nuclear options’ to balance the books, but these would be ‘catastrophic for quality of care and/or nigh-on impossible to deliver’.
There is no progress in training clinical staff to fill yawning gaps. Doctors and nurses in training are not only paying for their right to be healthcare workers but year on year are qualifying with rising debt. For every two GP training places filled, only one full-time practitioner joins the GP workforce; less than three fifths of doctors in core training remain in NHS hospitals and community services in England eight years later, with half leaving in the first two years; one in eight nursing students drops out during training; one in nine midwives do not join their profession after graduating; around one in five nurses leaves NHS hospital and community settings within two years. Doctors continue to leave the NHS in increasing numbers and doctors who qualified overseas made up 63% of the 23,838 new additions to the medical register in 2022.
Decades of underinvestment in the NHS go hand in hand with the expansion of the private health sector, prepared to poach NHS staff by offering better pay and conditions, while NHS staff experience a relative drop in earnings. Nurses are at food banks, young doctors can no longer get a mortgage and hospitals are tendering out the lowest paid jobs – such as portering and domestic services – to the companies that pay their staff the least. Britain has fewer practising doctors (3.2 per 1,000 population) and nurses (8.7 per 1,000 population) than the majority of the 38 OECD member countries.
The Care Quality Commission’s (CQC) annual report on England’s state of care noted the unsustainable pressure creating a two-tier system where people who can afford it are paying for treatment, and declining CQC ratings show deteriorating maternity and mental health care, ambulance services, lengthening waiting lists and increasing racism in healthcare.
More people waiting for care
The latest NHS waiting list for elective care procedures stands at 7.8 million with more than 391,000 waiting over a year. In winter 2022/23, dozens of NHS trusts in England declared critical incidents contributed to by care backlog, workforce shortages and discharge delays. The government recovery plan for urgent and emergency care promised £1bn to fund 5,000 new beds (a 5% capacity boost) and 800 new ambulances for winter 2023/24. But the Royal College of Emergency Medicine says that England is short of about 10,000 beds and the target of 76% of people being admitted, transferred or discharged from A&E within four hours means managers focus on those going home rather than the care needed for those who have to stay. Even so, last year 400,000 people waited more than 12 hours in A&E departments, an increase of 80% on 2021/22.
Hannah Caller
FIGHT RACISM! FIGHT IMPERIALISM! 297 December 2023/January 2024
