As we go to press at the end of January, the situation facing the NHS remains critical. While Covid-19 inpatient numbers had started to fall in London and the southeast, they continue to rise in the north of England. Predicted and completely preventable second and third waves of coronavirus infections have created an NHS crisis worse than during spring 2020, with even higher numbers of hospital deaths despite improved treatments as the majority of hospitals are treating more patients than in the first wave. The proportion of inpatients with Covid-19 in many hospitals exceeded 50% during January: better treatments also meant longer inpatient stays for many who would otherwise have died. Although the daily numbers of Covid-19 admissions are falling, few are being discharged, so that hospitals will remain full of such patients for many months to come; at the end of January 2021 they were still double the numbers at the peak of the first wave in April 2020. HANNAH CALLER reports.
At the start of the coronavirus pandemic, there were 100,000 staff vacancies in the NHS including 40,000 nursing posts. Long-term social care of the elderly and vulnerable relies on 1.5 million non-unionised, part-time, low paid agency staff, mostly women; 112,000 care worker jobs are vacant. A 30% cut in school nurses means just one nurse for ten schools, with corresponding reductions in health visitor and community nursing numbers. The jobs of key hospital support staff – porters, domestics and caterers – have been contracted out on extremely poor pay and conditions. A decade of real-term cuts in funding had left the NHS struggling even before the pandemic struck.
Alongside this, the last few years have seen an acceleration of NHS services outsourcing. Health care has been passed into the hands of private companies whose priority is not health. For instance, Carillion, which went bust in 2018, costing the British government millions of pounds, had many NHS Private Finance Initiative (PFI) and Local Improvement Finance Trust (LIFT) contracts. The company owned or operated 11,000 hospital beds in hospitals in England and Scotland and several GP surgeries and community services. Its collapse left major hospital construction projects such as the Royal Liverpool at least five years late in completion, a delay compounded by the discovery of major structural flaws, with three of its 11 floors requiring strengthening.
PFI contracts lock NHS hospitals into contracts for decades, with very high interest rates. Making repayments on the contracts is a first priority, and money is diverted into the private companies at the expense of beds, services and staff. Tens of billions of pounds of NHS and social care budgets are being spent now in the private sector. In 2013, much NHS property was transferred to NHS Property Services, a Department of Health owned company, which is now charging inflated rents to NHS trusts for buildings already bought and paid for years ago. The company has the freedom sell on these NHS assets to the private sector. There was no public consultation on this step.
NHS overwhelmed
The huge rise in Covid-19 cases since Christmas 2020 has overwhelmed the NHS. Elective operations have all but stopped and routine services have been put on hold. Resources have been reallocated and staff redeployed. Studies predict over 3,000 excess deaths from breast, lung, oesophageal and colorectal cancer within five years; 14% fewer people with cancer had radiotherapy in England between April and July 2020 compared to the same period in 2019. A three-month delay to surgery is estimated to result in more than 47,000 deaths a year in Britain. The weekly number of admissions for heart-related illnesses fell by 40% between February and the end of March 2020; this was thought to be through fear of attending hospital, but it has put people at increased risk of long-term complications from heart attacks. Slow deaths from underlying conditions compared to quick deaths from lack of intensive care beds will escape media glare. The flip side of having to prioritise people with Covid-19 will be the less visible suffering of people with untreated conditions. It will take years not months to overcome the backlog of unmet health care needs, and the numbers of those waiting 52 weeks for treatment, currently 162,000 people, will continue to soar: the 18-week standard is a distant memory.
The effect of Covid-19 on mental health and wellbeing is also overwhelming the depleted services which are stretched to breaking point, with crisis referrals to Child and Adolescent Mental Health Services at over 100% increase in southeast England. There are estimates that 10 million people will require new or additional mental health support. Again, before the pandemic, waiting times for mental health beds ran into weeks and there were high vacancy rates among home treatment teams across the country. In 2018, the Chief Mental Health Legislation Officer, a consultant forensic psychiatrist, had already described services in the Birmingham area as being in such a crisis that deaths were occurring because of the lack of resources.
No way back in
Staff Covid-19 infections and the associated need for many more to self-isolate have compounded the NHS crisis. In March 2020, an urgent call for nurses and doctors to come back to the NHS was put out. Insufficient nursing numbers are one of the most critical problems that hospitals have. The Bring Back Staff scheme, which is being overseen by NHS England, was one way of addressing the nursing shortage. Organising the scheme was farmed out to Capita, named the worst major employer in Britain in 2019. The final Nursing Review Group report in November 2020 showed that only 1,007 out of 73,000 former NHS nurses have got back into the service – nothing less than criminal. Having completed an online survey, would-be returners have found themselves stuck in Capita bureaucracy, waiting an average of 26.5 days for their details to be sent anywhere and then experiencing complete silence. The cost of the scheme has not been disclosed, nor how or why it was awarded to Capita. Alongside this, retired doctors volunteering to be vaccinators were asked to complete 18 training modules including ones on fire safety and Prevent radicalisation, as well as having to submit over 20 pieces of documentation.
Financial shenanigans
It is well known that the government has used the pandemic to cut corners in procurement and award contracts without any due process. The National Audit Office found that the Department for Health and Social Care (DHSC) and its associated bodies have awarded contracts worth £10.5bn without a competitive tender process. Supplies of Personal Protective Equipment (PPE) accounted for 80% of the contracts and 68% of their total value. The DHSC awarded £1.5bn worth of contracts to 71 suppliers before standardising a process to assess applications. By 10 November 2020, public details were still missing for 55% of the 1,644 contracts awarded up to the end of July. Companies found that if they knew a Tory MP they could submit bids for contracts regardless of their experience – a high priority or ‘VIP lane’. Examples include:
- Pest exterminator Pestfix, which was erroneously added to the ‘VIP lane’, but not before it received £350m worth of contracts. Part of the Pestfix deal included a consignment of 600,000 PPE masks that did not meet required standards.
- Ayanda Capital, based in the tax haven of Mauritius, which won contracts worth £256m including £155m for 50 million masks; these had to be discarded because they were also sub-standard.
- Of 493 referrals submitted for inclusion in the high priority lane, only 250 sources were recorded, most of them coming from the private offices of ministers and a large number directly from Tory MPs.
Firms in the VIP lane were ten times more likely to be awarded contracts than suppliers who submitted bids through the normal process. Almost £50m was given to one individual who acted as a middleman for a jeweller in Florida called Michael Saiger, whom the government selected to deliver £250m worth of PPE.
The huge sums made available to chancers and friends of Tory ministers and MPs is in sharp contrast to the parsimony displayed towards the NHS. Promises in the spring and summer of 2020 that the NHS would ‘get whatever it needs’ to prepare for a second wave in the winter proved to be lies. Health Service Journal (8 December 2020) has found that of £567m worth of bids submitted by 138 hospitals, £335m-worth had been rejected or gone unanswered by the Treasury. One hospital finance director said they were not aware of anybody having a significantly better ratio than 20:80 for ‘approved’ to ‘not approved’ bids. The journal estimated that the total of such rejected or unapproved bids across all hospitals would amount to around £500m. Compare this to the £500m dished out for the unused Nightingale hospitals – which could never have been adequately staffed, the billions spend on vastly over-priced PPE, let alone the £22bn committed to the shambolic test and trace system.
At the start of the pandemic the NHS took over all the capacity of the private hospitals, 8,000 beds, 680 operating theatres and 20,000 staff, to carry out non-Covid-19 emergency treatments for cancer, stroke and heart patients. These beds were bought in a block contract at an estimated cost of £1bn. The contract with London hospitals ended in August 2020 with an ongoing price dispute. As the NHS overflows, the private hospitals see new opportunities and NHS England is currently trying to negotiate the use of some beds for urgent cancer surgery. Spire Healthcare, fined £1.2m in 2020 for illegal price fixing, is one of the many private providers that signed a £10bn deal with the NHS to clear the Covid-19 backlog. According to the Health Service Journal, the new contract covers only a minimum volume of activity which equates to activity provided in October and November 2020. These looser arrangements have created such difficulties that leaders in the London region had to write to all the medical directors of the capital’s acute hospital trusts asking them ‘not to support’ their staff who were performing non-urgent work in the private sector during January.
Crimes of capitalism
Throughout the pandemic the NHS has been hobbled by the Tory government and its universality undermined. Thus the NHS charge for migrant workers has not been lifted. Because access to vaccination depends on having an NHS number, many migrant workers or those who are not registered with a GP may miss out; some have been told to bring a passport to their vaccination centre to prove their eligibility. Yet the NHS and especially the care sector depends on such migrant labour, and having pockets of unvaccinated migrants means the virus will eventually spread into the rest of the population. The ‘hostile environment’ continues. The Tory government’s ideological commitment to private sector as against state intervention remains undimmed: as if to rub salt in the wounds, it voted down a Labour proposal in parliament to exclude the NHS from the provisions of any future trade deal. The news that the new Covid-19 variant is not only more contagious, but possibly more lethal than the original virus, adds to the pressure on the NHS. With many frontline staff facing physical exhaustion, and others experiencing post-traumatic stress because of the sheer number of patients dying after lengthy periods of acute suffering, the blame for the crisis lies with a government which first underfunded the NHS, then repeatedly delayed key decisions to limit the spread of the virus, and finally created as many difficulties as possible for the NHS to meet the challenge.
Fight Racism! Fight Imperialism! 280 February/March 2021
