‘The chaos currently engulfing the NHS is due entirely to its marketisation by the government and the transfer of up to 50% of public money to the private sector […] Increasingly, government has given away control of resource allocation and more and more of the NHS’s scarce funds are flowing into the pockets of shareholders, bankers, management consultants, and for-profit providers – away from the service.’
Allyson Pollock, head of the Centre for International Public Health Policy, University of Edinburgh, January 2007.
Such chaos is evident at every level in the NHS:
• The shortage of midwives and the closure of maternity units;
• The national NHS IT system and its continuing failures: Computer Weekly in September 2006 catalogued a series of failures around the country that were considered to have caused ‘significant adverse impact on the delivery of patient care […] or significant financial loss and/or disruption’. There is no sign that matters are improving as suppliers continue to fail to deliver.
• Nurse shortages in hospitals whilst, for instance, 75% of nurses qualifying in September 2006 from City University in London have no nursing job .
• The false assurances that services removed from hospitals will be available in the community when community services are also being savagely cut.
To cap it all, the government has announced a review to ‘look at the possibility of drawing up a package of [NHS] services that all users are entitled to’ – and therefore define the ones that people will have to pay for. Restricting NHS provision to core services will make it a two-tier service that penalises the poor.
Women and children
In February, figures obtained by the Community Practitioners and Health Visitors Association showed a 40% drop in training places for health visitors. This is mainly because health authorities have not commissioned courses for financial reasons. In Scotland, it has been proposed to merge the role of health visitor with that of district nurse. The number of school nurses has also dropped.
Ironically, an OECD report released in February showed that children and young people in the UK have the poorest quality of life of the 21 industrialised nations surveyed. The six assessment categories were: material well-being, health and safety, education, peer and family relationships, behaviours and risks, and young people’s own subjective sense of well-being. The UK came lowest overall and was in the bottom third in five of the six categories.
Britain now has one of the highest rates of maternal mortality in Europe: 13 deaths per 100,000. There has been a 21% rise in deaths of pregnant women over the past three years compared to the previous three years. In Britain Caesarean sections now make up over 20% of deliveries compared to the World Health Organisation guideline of 15%. Meanwhile, there is an estimated shortfall of 10,000 midwives, maternity units are being closed or health care assistants are being employed as a cheaper option.
Foundation hospitals
The Homerton hospital, a Foundation hospital in east London, exemplifies the current situation in the NHS. Morale is plunging as more job cuts are announced daily. The Trust has had to reduce costs by £6 million in 2006/07 and will have to cut a further £5 million in 2007/08. Management is proud that out of the 100 posts gone so far there have only been ten redundancies, but it takes no account of what the job losses mean for the service, the staff team or morale. Instead it claims that cutting ‘waste’ will reduce job losses. A nice message pops up on every computer screen: email goodideas@homerton. nhs.uk and any suggestions will be taken up! The chief executive writes that ‘if all those who use rubber gloves reduced their usage by two pairs a day, the savings would fund the salary of a band five nurse’. A ‘war on waste’ email circulated states ‘if we all reduced our waste by just 5p per working day, we could fund an extra trained nurse – small is not trivial’!
The chief executive announced in mid-March that it looks like the hospital will close this year’s £4.6 million financial gap. She mistakenly says that there is no evidence that this has been at the cost of patient care. Senior clinicians who are involved in this process are seriously harming the health of the community that the hospital serves. To add insult to injury, they are dressing it up as ‘streamlining services resulting in improved efficiency and quality of care’. This is happening up and down the country.
More and more campaigns are springing up to defend NHS services: the government review makes action all the more urgent. Everyone who cares about equitable, universal and high quality health care provision free at the point of delivery must begin to act together.
Hannah Caller
FRFI 196 April / May 2007
