In a demonstration of its contempt for the working class, the government has proposed a miserable 1% pay rise for NHS staff for the forthcoming year. Under pressure, it lamely argued that the final decision would need to be taken by the NHS Pay Review body but that it would not be possible anyway to raise the offer beyond 2.1%. This from a government whose bacon has been saved by the NHS’s organisation and delivery of the vaccination programme, a government which failed to say anything in its March 2021 budget about the funding plans for the NHS in 2021/22, and which still had not come up with any money to support any Covid-19 recovery plan days before the start of the new financial year. The Institute for Public Policy Research (IPPR) estimated in a report published on 16 March that an extra £12bn per year over the next five years would be needed by the NHS and social care to ensure both Covid-19 recovery and to meet the targets of the NHS Long Term Plan.
The impact of the pandemic on standard NHS hospital care has been colossal. As of January 2021, the British Medical Journal estimates that there have been three million fewer elective procedures and 20.73 million fewer outpatient attendances. There are now nearly a quarter of a million people waiting more than a year for treatment, operations and other hospital procedures – a 185-fold increase since January 2020. This represents a 12-year high of unmet health care need. There are demands for a Critical Care Capacity review as hospitals cannot suddenly or safely double or triple their capacity as a post-Covid-19 recovery requires. Britain has 7.3 critical care beds per 100,000 people compared to Germany’s 33.8 and 34.3 in the US.
The government promised to safeguard cancer care but in reality has allowed it to become severely compromised. There are approximately 500 fewer people referred from a screening service at the start of 2021 than in the summer of 2020. A Belfast study has shown that the progress in five-year survival from head and neck cancers has been set back by years, potentially leading to an estimated additional 450 deaths as a direct and indirect result of Covid-19. This is in part due to a near-60% fall in urgent referrals of people with suggestive symptoms being seen by a specialist. A study from Leeds and Newcastle found that in April 2020, the peak of the first Covid-19 wave, GP referrals to hospital clinics across England for possible bowel cancer had fallen by 63% compared to the monthly average in 2019. In addition, the number of investigations fell by 92%, the number of people with confirmed bowel cancer referred for treatment by 22%, and the number of operations by 31%. The IPPR report estimated that the proportion of cancers diagnosed while still highly curable has dropped from 44% to 41%.
Check-ups on those with severe mental illnesses have fallen below a third of target and 235,000 fewer people have been referred for psychological therapies. Eating disorders in children and young people have doubled and waiting lists have reached an all-time five year high. There has been a sharp rise in children diagnosed with mental health problems, affecting one in six. Child poverty is increasing and this is the greatest threat to child health and development. There has been recorded regression of skills in younger children, along with effects on the mental health of children.
The IPPR report recognises the need to address the 100,000 clinical vacancies in the NHS through increased expenditure on education and training. Of the annual £12bn it argues is necessary to enable the NHS to recover and meet its Long Term Plan, £4.1bn should be spent on a 5% pay rise for NHS staff, and £1bn to guarantee a living wage for all care workers through a government wage subsidy. It says the skills requirements and salary threshold for care workers to help fill vacancies from staff coming from abroad should be scrapped, and social care should be free at the point of need like the health service. It calls for NHS infrastructure investment to match OECD levels. In terms of social care, the report proposes a model that drives low quality providers out of the market, caps accommodation costs and brings care worker pay into NHS pay scales.
White Paper for NHS reforms
The government’s proposed NHS reorganisation is being painted in some quarters as a reversal of the marketisation of health care of the 2012 Health and Social Care Act. However, the core elements of that Act remain, including the removal of the government’s duty to provide universal health care. Entitlement to services will be dependent on the emerging regional Integrated Care Systems (ICS) of which 29 are now up and running, with 13 more in the pipeline together covering the entirety of England. The commercial contracts and purchaser/provider split will remain, and Foundation Trusts will still be able to get 49% of their funding from the private sector. Public health and communicable disease control will continue to remain outside the NHS. Where the 2012 Act is reversed is in the White Paper’s proposal to increase governmental control over NHS England and end the pressure for competitive tendering for clinical services. While this may be seen as progress, the fact is that the use of framework agreements allowed the Department of Health to award £10.5bn worth of contracts for PPE directly without competition between March and July 2020.
The proposals open up the way for more involvement of multinational companies. Local need will be ignored and local accountability lessened. It is not clear how the integration of health services and social services can be achieved while health services remain free at the point of delivery and social care is means tested. Central government will have more power to intervene and reconfigure services, and ministers will be able to transfer functions between Arms-Length Organisations and to abolish them without legislation – ‘an astonishing power to bypass parliament’ say health economist Allyson Pollock. She concludes that the White Paper will lead to ‘a depleted NHS and a privatised social care system, with over-centralised, fragmented and part-privatised communicable disease control and public health systems’.
Whatever fine words the government may have for the NHS, the fact remains that it has not the slightest intention of restoring services to the level they were at before the pandemic, a level that had already been compromised by more than 10 years of real-term spending cuts. A decent standard of health care for all will only be achieved by a massive working class struggle.
Hannah Caller
FIGHT RACISM! FIGHT IMPERIALISM! 281 April/May 2021
