The crisis in the NHS is now so acute that Chris Hopson, chief executive of NHS Providers, which represents NHS hospitals, has warned that the years of underfunding have left hospitals facing ‘impossible’ demands, and that if there is no extra money in the November budget statement, it will have to face what he calls ‘unpalatable choices’, adding: ‘The logical areas to examine would be more draconian rationing of access to care, formally relaxing performance targets, shutting services, extending increasing charges, cutting the priorities the NHS is trying to deliver or, more explicitly, controlling the size of the NHS workforce.’ (The Observer 10 September)
- NHS performance continues to deteriorate on nearly every significant measure as a result of the funding crisis. By June 2016:
- The proportion of patients still waiting to be seen 18 weeks after referral had increased to 8.5%. This breached the target (8%) for the fourth month in a row. There were more than 307,000 patients who were still waiting to begin their treatment 18 weeks after referral.
- 20% of admitted patients had waited more than 18 weeks for treatment.
- Waiting lists had grown to 3.63 million, 336,000 more than in January 2016. The waiting list is at its highest level since December 2007.
- The proportion of patients waiting more than six weeks for a diagnostic test had missed its target (1%) for the past 31 months in a row.
- No more than 15% of patients should wait more than 62 days from an urgent referral from their GP before receiving treatment for cancer. This standard has not been met for the past two and a half years.
- Only 69.2% of urgent calls for ambulances were responded to within eight minutes; the target is 75%.
- 9.7% of patients (572,000 in all) arriving at A&E had to wait more than four hours, the highest figure since 2003/04 and well above the 5% standard.
The government is grinding the NHS into the dust by forcing it to make £22bn savings over the next four years while extending its weekend services. The rationing of NHS services is being normalised: treatment of cataracts, hernias and varicose veins is routinely delayed until they become an emergency; in some areas there are moves to delay treatment for smokers and patients with obesity; patients are now being charged up to £3,000 for hearing aids, and access to mental health services for children is more and more limited. The NHS is being turned into a bog-standard service where the working class gets no more than basic care while the better-off go private for the health care they cannot get on the NHS.
Sustainability and Transformation Plans
The government’s answer to any national campaign to defend the NHS is the local Sustainability and Transformation Plan (STP). This is described as a new approach to health which ensures that health care services are built around the needs of local communities. England has been div-ided into 44 STP ‘footprints’, each a collaboration between health and social care statutory bodies. They are sold as collective discussion forums for cooperation between previously separate bodies. Every such ‘footprint’ must produce a multi-year STP to show how local services are sustainable over the next five years, and start implementing them during autumn. The 44 ‘footprints’ must meet their share of the £22bn savings as well as the current hospital deficit of £2.45bn; the plans are a new way of implementing cuts and closures while localising the process to diffuse opposition. Some STPs have already been leaked. They include:
- in Leicestershire and Rutland, proposals to reduce the number of acute hospitals from three to two,
- in the West Midlands, proposals to reduce the number of acute units from five to four and to close one of the two district general hospitals,
- in North West London, a proposal to reduce face-to-face meetings of doctors and patients and replace these with ‘virtual consultations’ while giving coaching to patients to manage their own conditions without seeing a health professional.
In many cases, any extra money put into the STP is being used to sort out the local deficits, leaving nothing for the so-called transformation part which would develop services.
Junior doctors and the new contract
The only significant resistance to the NHS crisis has come from junior doctors who have fought the imposition of a new contract to make them work longer hours for less money, which would make the NHS less safe. Strikes over eight days between January and May had overwhelming support both from the doctors and the public in general. Subsequent negotiations between the BMA and the government resulted in a new offer in May which the BMA recommended junior doctors accept. However, a ballot showed overwhelming rejection by 58% to 42%. On 6 July, Health Secretary Jeremy Hunt declared he would impose the contract on doctors from October. In response, junior doctors decided, with the authority of the BMA, to undertake a series of five-day strikes starting on 5 October. On 24 September, the BMA backed down and called off the strikes, citing concerns about patient safety. Four days later, Justice for Health, a group founded by five doctors, failed in a High Court action to have Hunt’s decision declared unlawful. The BMA says it will continue the struggle by other means which will exclude further industrial action. The response of many junior doctors has been intense anger, with many ripping up their BMA membership and calling for a new trade union run by junior doctors for junior doctors.
Increased privatisation and industrial action to come
NHS capacity is falling: 20% of beds have been lost over the last ten years. The number of adults receiving social services in the community has fallen by a third in less than five years as a result of local authority cuts, and criteria for access are more and more restricted. The dismantling of the NHS must be stopped across the board, by student nurses fighting for bursaries, by the doctors in training fighting for decent contracts, by the cleaners, domestics and porters working for tendered out companies fighting against cuts in hours and pay. For the health of us all, these struggles must come together to reverse the destruction and break-up of the NHS.
Hannah Caller and Robert Clough
Fight Racism! Fight Imperialism! 253 October/November 2016
