Declining health of the nation
In an appalling indictment of austerity, life expectancy in Britain has started to fall – the first time in 100 years. Compared with 2015, projections for life expectancy are now down by 13 months for men and 14 months for women. Health inequalities are growing as well. Office for National Statistics figures show that there is a 16 years difference in the average ‘years in good health’ between Blaenau in Gwent (54.3 years) and Wokingham in Berkshire (70.7 years). The Infant Mortality Rate – the number of deaths in the first year of life per 1,000 live births – that fell continuously between 1980 and 2014, is now increasing every year, with the 2017 figure of 4.0 significantly higher than in 2014. Key factors include the falling number of midwives, overstretched ambulance services, increasing poverty among pregnant women, fewer health visitors and less postnatal support together with difficulty accessing GP services. Danny Dorling, Professor of Social Geography at Oxford and one of the leaders in this research, has confirmed that Britain now has the worst trend in health in Western Europe since 1945. In Britain, working class people are paying for austerity with their lives.
Mental health horror
Alongside this, the suicide rate of young people, once on the decline, is now on the rise, with the largest increase being in the age group 10 to 24 years old, with an increase of 83% in young women in that age range since 2012. Suicide is now the single biggest killer of men under the age of 45 years in Britain. These shocking figures come at a time when the number of mental health nurses in England is 10% lower than ten years ago: a loss of over 6,000 mental health nurses since 2009. These vacancies are among the 40,000 empty nursing posts in England. Applications for nursing have dropped by 32% since bursaries were stopped in England in 2016.
The government says that part of the NHS Long Term Plan is an additional £3.2bn a year invested in mental health provision. It envisages flexible undergraduate degrees in mental health and learning disability training in order to get 4,000 more people into training in five years’ time – far short of what is required.
A recent Freedom of Information request has revealed that over 122,000 people seeking help with their mental health are hidden on waiting lists where they wait over eight weeks to see a doctor a second time after their first appointment. In 90% of Clinical Commissioning Groups, people who received initial talking therapy sessions waited longer for follow up. Once someone has ticked the initial waiting list boxes, they then disappear into a black hole. As well as declining numbers of mental health nurses, psychiatry is an unpopular choice for trainee doctors, as within five years of completing specialist training, one third of consultant psychiatrists have yet to be substantively employed in the NHS.
Debts, cuts and rationing
New figures suggest that some NHS Trusts are spending up to one sixth of their entire budget on debt repayments due to PFI schemes. The initial £13bn private sector funded investment will end up being £80bn when the last contract ends in 2050. There is still £55bn to pay. There are still 109 active contracts which are costing Trusts £2.15bn in 2020-21 which will rise to £2.5bn in 2030.
The Barts Health Trust in London has the biggest NHS PFI contract in England. The new Royal London Hospital in east London was commissioned in this way at a cost of £1.2bn. It opened in 2012 with 845 beds and 110 wards. By the time the debt is paid off, the spending will amount to £6.2bn. Barts Health Trust spends over £9m per month servicing its debt. This is over 7.5% of its annual income. Other outrageous examples include Sherwood Forest Trust in Nottinghamshire with a £326m PFI deal costing it £50.3m a year, 16.5% of its annual budget, the largest percentage of any Trust’s repayments. University Hospitals Coventry Trust spends £89.3m a year on its PFI debt, and Manchester University Trust £77.2m. These huge debts are part of the reason for understaffing and cuts.
Performance data usually catches up and recovers in the summer months, particularly with regard to waiting times in A&E. However this year in England it has only got worse. 86.4% of people in A&E were seen within the four-hour target in June, down from 86.6% in May this year 2019 and 90.9% last year in June 2018. The target of 95% of people seen within four hours in England’s A&E departments has not been met since July 2015.
At the beginning of September, the North West London collaboration of Clinical Commissioning Groups, which funds NHS health services for over two million people in London, sent out a letter with rationing plans aiming to save £60m in the next few months. GPs will be encouraged to reduce referrals to hospital outpatients by trying to find ‘alternative’ ways to deal with people needing to be seen by specialists, and outpatient appointments will be removed, with the suggestion that some are replaced with phone conversations. The ‘recovery plan’ includes suggestions that some people receiving treatment from more than one hospital consultant team should only be seen by one team, treatment that was being given at a specialist centre may have to come back to the local hospital (presumably even if they are not the specialists) and intense scrutiny of GPs will take place to vet the referrals they are making.
Health care is a human right! Stop the NHS cuts and rationing!
Hannah Caller
Fight Racism! Fight Imperialism! No 272, October/November 2019
