170 years ago, the Public Health Act 1848 for England and Wales came into force, recognising the need for protection of all citizens from sanitary and social threats. After two more terrible cholera outbreaks, the 1875 Public Health Act made the 1848 Act part of local authorities’ powers. Thereafter, partly due to sanitation and clean water, housing, food provision, changes for the better were made to the living conditions and health of the population.
Now, since 2008, austerity Britain and savage capitalism have reversed the progress. Health inequalities are widening, life expectancy is levelling off, poor nutrition is evident by rising levels of obesity, while at the same time increasing numbers of people need food banks and many are going hungry, including children. Simultaneously, we are witnessing the decline of the health of the planet we live on.
The private sector
Hospitals continue to be told to send people to private providers in a plan to reduce waiting times. In June 2018, 4.7 million people in England were awaiting treatment, the highest number since data collection started in 2007. NHS England’s national director for operations, Matthew Swindells, has written to Clinical Commissioning Groups (CCGs) to say that CCGs and trusts lagging behind on elective care should enlist private providers to catch up. All the evidence is that this hampers training, staff retention and morale.
The 2012 Health and Social Care Act enshrined in law the opening up of the NHS to the private sector and removed the duty of the Health Secretary to provide universal health coverage. Private providers with profit as their goal have short-term plans and don’t tackle wider longer-term health issues; they are allowed to pick and choose what services they will provide and for whom. The three highest-paid charity chief executives in Britain in 2014 were in the independent (private) health sector. The consequences are that the NHS deals with complex cases, long-term conditions and complications, while investing in staff and training. Private sector providers take on the simple cases and train no one. The private sector relies on the NHS, for example private maternity units transfer sick babies to the NHS and the new online private GP consultations accept only the healthy callers.
The total number of full-time and part-time GPs in England fell by almost 500 in the three months from March to June this year. The government pledged to recruit 5,000 more GPs by 2020 but is struggling to do this. An example of what is happening in Wales shows the difficulty that primary care is experiencing. There are 601 GP practices in Wales, of these 13 have been closed, 23 are being managed by the health board, and 74 are at risk.
Mental health services in crisis
The government pledged to end out-of-area admissions by 2021, where patients can be sent hundreds of miles from where they live in order to have a bed in an acute mental health hospital. There is evidence of increased suicide risk with such practice and recovery is compromised. Yet in 2017, over 1,000 children and young people alone were sent away for NHS inpatient treatment and 61% of CCGs sent at least one person out of area due to lack of local beds. One third of CCGs sent some under-18s over 100 miles away from their families, friends and support networks and one in seven CCGs sent them to acute units over 150 miles away. There are huge disparities across the country: north London patients were sent no more than ten miles, but patients from Canterbury and Cornwall, over 250 miles away.
In the year to May 2018, 8,600 adults were admitted to hospitals out of area. Of the 53 specialist mental health trusts in England, 36 responded with information showing that all had to send people out over the previous five years, 28 of them did last year, 24 sending some adults over 100 miles away and 17 over 200 miles away.
This crisis is exacerbated by the staffing situation, where 2,000 mental health staff in the NHS in England are leaving every month, while at the same time there is a dramatic increase in people seeking help for anxiety, depression and mental health issues. Between June 2017 and May 2018, 23,686 mental health staff left their post, equivalent to one in eight of the whole workforce. One in ten mental health posts were unfilled at the end of June. There are currently 187,215 whole time equivalent staff in mental health services when there should be 209,233.
In early 2017, former Health Secretary Jeremy Hunt promised the government would increase the mental health workforce by 21,000 staff by 2021, and treat an extra million people a year. By March 2018 the number of extra staff was just 915.
NHS understaffed
The NHS has to attract and retain its staff, something that becomes harder with fragmented services, tendered-out workforces, leading to the vicious circle of lack of staff and low morale with more resignations and early retirement. The NHS is more understaffed now than ever. As of September 2018, there were 107,743 vacancies including a shortfall of 11,576 doctors and 41,722 nurses. The King’s Fund health think tank is calling this a national emergency. In hospitals, the NHS reduced its spending on agency staff by £528m in 2017-18 but NHS Improvement says that this is not enough and has set a target for 17% reduction in agency costs for 2018-19. The most expensive locum doctors currently costs the NHS more than £2m per year.
Building morale requires collective health organisations and unions, and a need for conscious workers to understand and educate about the underlying issues and fight for a publicly-funded and provided health system, free at the point of delivery. Part of this work is to understand the contradictions of capitalism, which is keen to employ the cost effectiveness of a state-funded system, but not prepared to fund it, relying on the use of an inadequate private sector, with the enrichment of some at the expense of the reduction in healthcare quality and quantity for the majority. Capitalism is bad for our health and we must fight for socialism.
Hannah Caller
