Simon Stevens, the chief of NHS England, is no socialist. He is a former top manager for a big US private profit healthcare firm, an advocate of “market solutions”, and paid about £200,000 a year. Yet at a conference on 7-8 November he looked around him and said the waiting list for hospital operations could hit five million.
He said that the government must immediately grant the NHS in England at least £4 billion more for 2018-19 in the Budget on 22 November. “If you think that Britain should look more like Germany or France or Sweden [than cuts-ravaged Greece or Portugal], then we are under-funding our health services by £20bn-£30bn a year”. He called on the government to deliver the £350 million a week — £18 billion a year — more for the NHS which pro-Brexit Tories implicitly named as necessary when they lyingly said that it could be made available by Brexit. Brexit doesn’t help get those resources. But taxing the rich would.
Even on current tax rates, the PCS civil service workers’ union estimates a “tax gap” of £120 billion a year from avoided, evaded and uncollected tax. A well-geared tax system, digging into the tax havens, tapping the vast wealth of the ultra-rich, could yield more. More resources can be put into social provision if they are diverted from providing mansions, yachts, and baubles for the rich.
At the same conference, the boss of “NHS Improvement”, an agency set up by the government itself, said the NHS would “pop” unless it gets the £4 billion in the Budget. The King’s Fund, the Nuffield Trust, and the Health Foundation jointly denounced “a projected funding gap of at least £20bn by 2022/23 based on the government’s projected current spending plans”.
“In the next months it will crumble”
An ambulance worker in Yorkshire spoke to Solidarity about the impact of the cumulative NHS cuts.
The ambulance service is the last port of call for many people. The impact of the cuts in social care, the cuts in council services, and the pressure on GP services, is felt in the ambulance service. Our workload has gone up massively.
Less than six months ago, our management did a complete rota change, which disrupted everybody, saying that would resolve the tensions of higher demand and workload. It hasn’t at all. Now the managers are just ignoring the rotas and calling people to come in to work even when they’re off shift. They’re continually pushing, working shifts out week by week or even day by day just to tread water. The flexibility we used to have for workers juggling childcare and other domestic problems has gone. People are waiting longer for ambulances.
The other day I went to an elderly lady who had fallen. It sounded like she had broken a hip, and she had. She was lying on the floor for an hour waiting for the ambulance. A couple of years ago we would have got there in 15 minutes, for sure. And there are worse cases. You can be on your way to a job which sounds critical — usually for an elderly patient — and you’ll often get diverted somewhere else. The targets have been moved, nationally, so that response within eight minutes is now the target for a much smaller group. At the hospital end, they’ve massively expanded the entrance hall to create a larger waiting area for A&E without having people in corridors.
In the next few months, as winter sets in, the service is going to crumble. Closures and centralisation of hospital services mean we have to travel longer distances with patients. There are lots of transfers between hospitals to get people into the right place for their treatment.
Some of this is justified by clinical evidence, for example the creation of regional trauma centres. But in many cases it’s about lack of staff and funding, where A&Es, maternity units, and strike services have shut. Loads more ambulance workers go off sick with stress.
Five years ago, say, you might have one or two people off sick with stress for a substantial period, over six months in an ambulance station with a hundred workers. Now it’s six or seven. Management bullying has escalated. And people are working on a maximum level all the time. In this last year paramedics have moved into a different pay band, which gives us potential for bigger pay rises, but that hasn’t stemmed the flow of people leaving the job.
When I became a paramedic, in 2005, it was a job which people just didn’t leave. I remember a manager arriving and saying that the trouble with the ambulance service was that there wasn’t enough turnover of staff. They wanted more young workers, fresh out of university, more compliant with management. Well, they’ve achieved that, and now they want to stabilise the workforce a bit with the change in pay, but it hasn’t done that.
We go to many people who have been given early discharge from hospital when it looks as if they weren’t medically fit to be discharged, but have been pushed out because of pressure on beds — or who haven’t got the social care they needed on discharge. More and more, too, we are going to people who are medically fit and have social care, but just not enough for them to be able to cope.
At least in our area, several patient transport contracts have been brought back into the public sector because private contractors provided a very poor service — constantly late, taking people to the wrong hospital or the wrong address, leaving people in vulnerable situations, not calling emergency services when they should have done. And some didn’t even pay their workforce on time. Even the management have come to recognise that the use of private contractors there has not been beneficial.