The NHS is demonstrably very strapped for cash, as a long list of the biggest hospital Trusts in the country are revealing the largest overspends in the history of the NHS.
The trust with the largest overspend, Barts Health NHS Trust, based in East London, is on course to have a run up a deficit of at least £134.9 million (10% of its budget) by the end of the NHS’ financial year on 31 March. Its overspend is 69% bigger than that in 2014-5, which totalled £79.6 million.
Jeremy Hunt, the Health Secretary, had earmarked £1.8 billion of extra funding for next year, but it looks like this figure will be insufficient, and will be used to plug NHS deficit, rather than go towards any improvements, such as more staff, or greater resources.
Trusts are stuck in a vicious circle where lack of cash and limited resources mean they’re struggling to provide the service required, leading to fines being levied for missing key targets. They’re striving to ensure that money procured through fines will be reinvested in the Trusts, so they can spend less in the future.
Some are saying that next year will be “make or break” for the NHS, as Trusts struggle to keep their deficits in check. It’s hardly surprising when one considers the cuts which have been made to the NHS over recent years. Concerns have also been raised about “horse-trading” between agencies and hospitals, where locum doctors and nurses are seeing more generous salaries when they work for agencies.
This has meant that huge numbers of staff are leaving the NHS for agencies, resulting in hospitals having to pay huge premiums on top of wages. For example, of the £80 million-a-year spent on agency staff at Barts, £30 million comprises charges made by staffing agencies.
This too, is unsurprising however when considering that NHS wages have been cut band conditions have lacked flexibility. Nurses, for example, have had their pay cut by 10% in real terms since 2010. The cash squeeze is having a huge impact on our NHS. It is the background to the current dispute over junior doctors’ new contracts (which if implemented would mean a rise in hours and cuts in pay). It is behind the government’s intransigent stance on the contract issue. And it will increase pressure for further privatisation in the NHS.
In order for the NHS to provide the care we need, then we need more funding coming from central government to employ more permanent staff, improve pay and conditions, and increase resources. For a fully-funded NHS we need to tax the rich!
“Doctors’ ideas have changed; they’ve realised that they are workers”
Emma Runswick, medical student, socialist and British Medical Association activist in Manchester,
spoke to Solidarity.
Negotiations have been going on between the BMA and the government for three years, since the government approached the BMA to renegotiate our contract. We agreed with a lot of things the government said, particularly about training; we wanted to negotiate. However, when we entered negotiations they weren’t interested in the things we wanted; they wanted negative changes on unsocial hours, and pay progression, and everything else that’s in the new contact.
The BMA walked out of talks and the government referred the contract to the supposedly independent DDRB [Review Body on Doctors’ and Dentists’ Remuneration]. The DDRB doesn’t include any clinicians — it’s mainly made up of Human Resources officials – and it was the first time they’d been asked to rule on any contract issues. They came down pretty much entirely on the side of NHS employers. The DDRB made 23 recommendations, which were mainly awful. The BMA consulted and members said the recommendations were unacceptable, but the government said this had to be the basis for negotiation. There was a period of limbo and then last August Jeremy Hunt said he’d impose the contract. At that point it all kicked off… Suddenly junior doctors who’d never previously been particularly interested in either the BMA or NHS issues were demanding the BMA did something. We were flooded by new members.
In June last year we had about 150,000 members and now it’s 170,000 — more than 80 per cent of all doctors in UK, and the big majority of the membership increase would be junior doctors. There have been similar issues before; for instance the Modernising Medical Careers plan, which was about training, in 2004-5, caused an upswing of activism which died down. There’s never been such a direct, out-and-out attack on the terms and conditions of doctors – not just on training, but hours, pay and everything else. I think that big influx will permanently change the culture of the BMA for the better. It has sometimes been a bit sedentary in the past. We’ve got Council [national executive] elections happening in March.
Currently there are three juniors on a Council out of 34 members. Loads more juniors are standing this time, which is great. Also standing are people who haven’t been active in the BMA before because of its weaknesses, but now see the opportunity to push for it to be a more active trade union. Six of us are standing under the banner Doctors Represent, on a manifesto which includes a strong contract campaign, fighting NHS privatisation, making the union more democratic and transparent, and integration and training for new and grassroots members. We are supporting other left-leaning candidates too.
If we do well this could be very significant in terms of making the BMA a politically better as well as more effective organisation. The major issue in the dispute is about how we define what social and unsocial hours are. If we lose on that issue it will hit every other staff group. People at the top end of the pay scale could probably take a 30 per cent real terms pay cut [if the redefinition of social/unsocial goes ahead], but for other healthcare workers lower down the pay scales redefining Saturday as a normal working day would be devastating.
More broadly their aim of redefining Saturday as a normal day is to help redefine when other workers outside the NHS can take sick leave or visit a doctor; it is about saying, don’t go to the doctor during the week, go on Saturday, when you’re off work.
The attack on NHS workers is also part of the Tories’ ultimate aim of privatising the service. If the contract goes through in anything like its current form, we are going to lose huge numbers of doctors, and then nurses and other healthworkers, and at a much greater rate than we’re losing them now.
The NHS is already at critical point, so we’ll have a totally overstretched and demoralised workforce. With a health service in crisis, the next obvious response will be to get private companies to step in and take a much greater role. Junior doctors increasingly feel the government’s stated reasons for wanting this contract are absurd, so there must be another reason; people are starting to make the links. Take the case of Dr Chris Day, and the fight with NHS management about whether doctors have whistle-blowing rights (see 54000doctors.org).
People are making the links between attacks on staff, underfunding and the fact that the government don’t really care about patient safety, and linking that to privatisation of the NHS. The campaign has gone alright so far, although we’ve made mistakes. I think offering to meet the government at ACAS was a good move, and cancelling the initial strikes gave us more time to prepare. I wouldn’t have cancelled the strikes on 26 and 27 January, but I’m not in the negotiating team. Ultimately we’re still on the front foot. We’re winning the arguments, where we’re allowed to make them in the media, and more importantly with the public. We haven’t moved on any of our key positions. We haven’t been sold out, which was a possibility at the beginning of the dispute. Sell-out The committee gets a lot of abuse when they cancel or postpone action, so a sell out is inconceivable at this point. The committee is made up of junior doctors themselves and if they gave up Saturdays or safeguards on unsocial hours they would be slaughtered.
The fact we got Johann Malawana elected as chair of the Junior Doctors Committee has helped, as he was someone who wanted to stay firm and take action. So did the huge vote for action (98 per cent for strikes, 99.4 per cent for action short). And the big turnout on the last strike.
That 10 February has been downgraded (so it still includes emergency cover) will increase turnout. There are lots of doctors who are very angry and want to fight but aren’t quite ready for withdrawing emergency care. By taking another day of action we can build up a head of steam. We need to be continually holding days of action, not necessarily prolonged action, but intermittent. We need to put the Trusts under pressure, make them worried about missing targets, and try to split individual Trusts off from the NHS employers as a whole. In some Trusts the management are reasonably supportive and on our side. If we can do that and create a publicity problem for the politicians, then we can start to split up their side, while our side remains strong.
Some doctors are worried about losing money, particularly people who are the only earners in their household, and younger people, but BMA Charities can assist those people in difficult circumstances. In some wards, where there’s a good relationship with other staff, nurses are completely onside, wearing the badges and so on. In other places, their knowledge about the dispute is the same as or maybe worse than general public’s level of knowledge, for instance some nurses have been repeating Jeremy Hunt’s claim we would get an 11 per cent pay rise under his deal. We have people specifically working on counteracting these claims with other staff.
The link between the doctors’ fight and the NHS bursary fight by student nurses and other allied health professionals has been really excellent. BMA members, including our Junior Doctors’ Committee, have been very supportive of the NHS Bursary struggle and we’ve had support in return. And that has strengthened our relationship with nurses, particularly nurses who are doing teaching.
When people walk out for an hour in defence of bursaries on 10 February, they should be joining the pickets and that will hopefully strengthen things further. In Manchester the student Save our NHS campaign that I’m involved in is building those links, with an event in that hour with speakers from both struggles, and from the free education campaign too. We should be demanding that the Labour Party explicitly and actively supports the strike action – members of Parliament should get on the picket lines. We should be demanding that they support the NHS Bill to reverse privatisation, and that they wake up and recognise the problems with health devolution, including the threat it poses to national terms and conditions for staff, as well as everything else. That also applies to councillors, who should know better than to listen to George Osborne but unfortunately have sometimes gone along with the devolution agenda.
Doctors’ ideas have changed; they’ve realised that they are workers as well as professionals, and therefore that they are open to attacks by the Tories, and just as easily lied about. Seeing the way the media lies has had a really dramatic effect, as people clock that other groups of workers must also have been lied about. Obviously this hasn’t been so for everyone, but it has been for many. I think that’s where the opening for socialist politics is — the realisation that we are workers and that we can be open and proud about organising in a trade union, not just an apolitical professional association.
I went to Wigan trades council recently, and I said go to the picket lines, yes, but tell them about your union, what it does, and basic things like asking postal workers not to cross the picket lines, basic labour movement solidarity. And talk to them about politics. And people are receptive to that – really receptive to the public turning up and expressing their support. I’m not so sure how socialist papers will go down, but why not try! The other political angle, something which Yannis [Gourtsoyannis, prominent BMA, People’s Assembly and Momentum NHS activist] has been successful with, is spelling out the links between our fight and fighting austerity, that if we’re going to stand up for patient safety, that means taking a broader view of patient interests by opposing austerity as a whole.
This dispute has pushed most junior doctors to the left. Some have a very long way to go, but the process is not over yet.
Why we joined the protest
Junior doctors on the central London protest on 6 February spoke to Solidarity.
“Since this dispute has started the BMA has shown real strength in the way it has organised junior doctors. Unfortunately the government is not willing to negotiate. In order for us to win our demands we are going to have to escalate our action. It's been made clear that a single strike day is not going to be enough to change the government’s mind.”
Pete Campbell, BMA junior doctors committee
“The newspapers make it sound like we’re just up in arms about our pay packet, but that’s just a part of it. This is about the quality of care that patients get. It’s about whether we’re going to let the Government get away with wrecking the NHS. The media will probably attack us for it, but we should go through with the strikes. I suppose they’re attacking us anyway though! It’s not ideal but it’s obvious Jeremy Hunt doesn’t listen to argument on its own. You need something to back up the argument.”
Junior doctor, Queen Elizabeth, Glasgow
“The government are trying to put through a contract that puts patients at risk and will lead to the failure of the NHS. It’s definitely a deliberate attack. And the government cannot understand a service that doesn’t run for profit. It is going to force the NHS to failure by undermining staff, so that the public will think that privatisation is the right option.”
Anonymous junior doctor
“I’m on the demonstration because I wanted to do my bit to show we’re not going away. To keep the pressure up. Jeremy Hunt is talking nonsense. You have to wonder — if he’s telling the truth than why do virtually no doctors agree with him? It looks like after the negotiations with the BMA the government might just try and force the contract through. So we shouldn’t ease off. That would be a disaster at a time when things might go one way or the other.”
George Eliot, junior doctor Nuneaton
“We’re protesting against the contract: it will force us to work particularly unsociable hours in A&E and ITU as anaesthetists. Plus alongside this we’re going to have so much student debt that we could not afford to live properly. This shouldn’t be a profession for the elite, and the fewer people who are left the harder it is. We need to get the message to the press that with this protest we’re not even asking for more, even though we’re working too hard as it is.”
Roselyn Perring, Anaesthetist at Chelsea and Westminster Hospital, and Karen Stacey Anaesthetist at Hillingdon Hospital