An adequate system of health care needs people to deliver it and the funding to sustain and develop it. In Britain, both are severely threatened, despite this being the fifth richest nation in the world. Services are being closed or handed to the private sector, poorer working conditions are being imposed on the remaining staff, and increased zero-hour contracts and job losses introduced for the already lowest-paid, tendered-out hospital staff, such as domestics, porters and caterers, vital members of any health care team.
The NHS employs more than one in 20 of the working population in Britain and nearly 80% of its workforce are women. Across the country there are tens of thousands of unfilled doctor and nurses’ posts, while training places are cut and student nurses, midwives and others are about to have their bursaries axed. Thousands of pounds are spent recruiting abroad for short-term gain in the NHS.
In 2013, Britain spent 8.5% of its total GDP on health care, ranking it 13th out of the 15 original EU members. For NHS spending to match the average European country’s level of expenditure by 2020 would require a 30% increase, equivalent to £43bn a year. The government has promised a mere £8.4bn extra, little more than 1% more a year. In the past five years, the average increase in NHS spending has been 0.8% per year. Yet annual spending on the NHS has to increase by 4% just to keep up with the annual increase in costs of treatments and running services. The future is one of yet more cuts, with the NHS facing continuing financial crises.
Not enough doctors
The doctors’ industrial action, a result of breakdown of talks between the British Medical Association and the government, with an overwhelming majority of the 45,000 junior doctors voting to take action about pay and conditions and the new contracts, has kept the issue of the NHS in the headlines. Large numbers of junior doctors are leaving. Of those who finished the first two years after medical school in 2015, only 52% have chosen to apply for the next training stage towards becoming a GP or a specialist hospital doctor. This is the largest annual drop-out since the NHS was founded. It will add to the current recruiting difficulties and heralds a future with fewer specialists in training. There are just over 7,100 doctors who completed these first two years by August 2015 and each of them cost £250,000 to train to that point.
There is a 25-30% shortage of middle-grade maternity doctors (half way to becoming consultants) prompting a leading obstetrician, Dr David Richmond, to declare that up to one in five obstetric units across England may have to close as a result. The proposed solution is fewer units to concentrate the service where doctors are on site and an increase in midwife-led units. Centralisation is always seen as good when there is no choice. However, with the current shortage of 2,600 midwives in England, proposals to increase midwife-led units may not be possible, while the axing of bursaries for student midwives and nurses will prevent many people from embarking on a midwifery career.
Critical shortage of permanent nurses
London has 10,140 unfilled nursing posts, equivalent to an average 17% vacancy rate per Trust, up from 14% in 2014, with an average of one in five nursing jobs vacant. Nine London NHS employers reported vacancy rates up to 20-30%. Barts Health NHS Trust has the largest actual number of nurse vacancies, over 1,000 or 19% of its nursing workforce. This is the hospital with the largest Private Finance Initiative debt in England. From 2009 to 2012, nurse training places across England were cut by over 2,500 and the pay of qualified nurses has run 10% below inflation since 2010. With the soaring rent prices and lack of affordable housing, many nurses cannot afford to live in London. The shortage of staff is reflected in the spending on temporary and agency staff, on whom hospitals are forecast to spend as much as £4bn this year. This figure has been rising year on year: £2.6bn in 2013/14 and £3.4bn last year and accounts in large part for soaring hospital trust deficits, now over £2bn. Hospitals have now been told to cut staff to meet financial targets
Poor pay and conditions
Domestics, porters, caterers and security services are increasingly tendered out to private companies and as hospitals fall further into the red, the cheapest options are taken. ISS Facilities Services Ltd has won contracts in many NHS hospitals. In a London hospital where the company recently won the tender, they are operating dirty tactics, stopping overtime for those with full ISS contracts and only allowing overtime to those on their new zero-hour flat-rate contracts, reducing Sunday pay, doubling the workload, and burning people out. Their highest paid workers can hope to take home a maximum of £1,300 per month with London weighting. The chief executive turns a blind eye.
Commissioning changes puts health at risk
On 1 October 2015, local authorities across England took over commissioning of child public health services, including health visiting, from NHS England. However, this responsibility does not include childhood immunisation, which remains with NHS England. NHS England advised the London borough of Hackney that immunisations are the responsibility of the GPs and that health visitors should promote but not deliver them. Hackney health visitors provided immunisations for around a third of children, reaching those who weren’t registered with a GP, providing immunisations at home if needed, targeting specific communities with low immunisation uptake, as well as immunising children during outbreaks. The council gave 60 days’ notice to the Homerton Hospital NHS Trust to end all health visitor immunisations for the 0 to 5 year olds. The health consequences will be devastating, as GPs are not equipped to deliver the required level of immunisations alone.
A movement to save the NHS will be built by coming together as health care workers, joining forces with those who use the services, opposing all cuts and educating people about capitalism, a system that makes you sick.
Hannah Caller
Fight Racism! Fight Imperialism! 249 February/March 2016
