Winter crisis: rebuild the NHS

Submitted by Matthew on 11 November, 2015 - 1:08 Author: Pete Campbell, junior doctor

Regardless of the validity of meteorological predictions by the Express, this winter is set to be the worst on record for the patients of the National Health Service. Even Chief Executives of Hospital Trusts are beginning to cry out in alarm.

Chris Smallwood, Chief Executive of St George’s Foundation Trust recently told the Guardian, “The NHS is heading for a real smash, and practically everyone running a hospital knows it. Hospitals are at 100% capacity at the moment.”

Last winter, Accident and Emergency departments missed their targets (of a maximum four hour waiting time for patients) every week. Some believe that this year the strain will be much worse. As Smallwood notes, finances are at the root of the problem. He said the NHS has done something remarkable in the past five years. The fact it the NHS is still here at all is astounding, because no healthcare system in the world, ever, has managed to sustain a service over such a prolonged period with so little investment and rising demand.

Smallwood is right. But this is not down to luck. It is down to the sacrifice of hard working staff across the service, who shouldered an incredible burden over the last winter. Recent OECD and Nuffield Trust estimates suggest that the UK needs over 47,000 more nurses and over 26,000 more doctors just to reach the average of other developed countries. (The fact that the NHS provides world leading care in these circumstances highlights its effectiveness.) As healthcare workers are increasingly being asked to provide more, for less, the government presses on with their political propaganda of providing a seven day NHS. The fact is the NHS already provides a seven-day acute and emergency service. It treats anyone who really needs to seen at a weekend.

The Head of the Royal College of Physicians believes that to provide an elective seven day service would require an extra 38,000 doctors! Not to mention pharmacy staff, physios, occupational therapists, radiologists, ward clerks, nurses, healthcare assistants. Under the current government and financial situation talk of this kind of seven-day service is only a rhetorical device for the Secretary of State for Health. Austerity has laid waste to social care, with billions in funding cuts leading to over 300,000 fewer over 65s receiving care at home. As winter bites the old and frail will end up at the door of Accident and Emergency. At the same time there is a projected £2 billion budget deficit for NHS providers. The estimated budget deficit by the end of the parliament is £30 billion, and so 2-3% cuts a year are required. The Conservatives pledged an extra £8 billion during the general election but the NHS has not yet seen this money. Without a radical upturn in funding we will see hospital trusts collapse. The response from Health Authorities to the coming winter crisis is advertising campaigns encouraging people to see their pharmacist if unwell, and to ensure their homes are heated properly. That is not much good to the 2.3 million living in fuel poverty.

Hospital trusts will be forced to cut staff numbers further, lengthen waiting times and decrease the quality of service. No other outcome is foreseeable. We need to argue and fight for root and branch change within our NHS. Front line health workers have performed incredible feats to keep our NHS alive. Imagine what they could do if they were genuinely empowered and given the resources to do their jobs without current stresses. To do this, they are going to have to learn to fight back. The junior doctors’ and Antrim nurses’ disputes are showing the rest of the health workforce that if they want to defend patient care they are going to have to use collective strategies of struggle, including industrial action. The NHS needs at least £5 billion a year extra just to maintain itself. We spend a relatively small amount of money in the UK on healthcare, for which we get incredible results. But we cannot just put money into the NHS. We need to radically transform the role of the workforce. We need to rebuild our social care system, as the two work hand in hand. We need to refocus our public health system on the social determinants of health, on poverty and inequality. We need to save our education system from rampant privatisation to ensure that we can train the next generation of health workers. The fight to save the NHS cannot be won alone in isolation from the fight for a future better society.

The Secretary of State for Health Jeremy Hunt’s recent “firm contract offer” to junior doctors has succeeded in causing further anger. The offer, leaked to the press and then emailed to individual junior doctors via the organisations in charge of delivering their training, was reported as an 11% pay rise. However it quickly became clear that it was in fact a huge pay cut. Junior doctors are currently being balloted for industrial action by the British Medical Association over the government’s decision to impose a new contract upon them by August 2016. This contract will remove key financial safeguards which prevent doctors from being overworked. It will have a detrimental impact on those who take time out of work for training, education or to raise a family. It also reclassifies normal working hours as Monday to Friday 7am to 10pm and Saturday 7am to 7pm. The latest contract offer from the Department of Health is seen as particularly sly as it has been released at the same time as a pay calculator. This calculator promises “pay protection” to all current junior doctors based on their current salary. It is through this mechanism that the Secretary of State can claim no junior doctor faces a pay cut. However pay protection will only last until 2019, when most juniors will still be on the contract, and does nothing for current medical students, those out of training on maternity leave or study. The ballot for action closes on 18 November with the results set to be announced shortly after. We expect a “yes”.