In the midst of all the guesswork around Brexit, what remains a certainty is that as we approach Christmas and head into January and February, we will be inundated with images in the media of overcrowded A&Es and patients left on trolleys in corridors – in some cases dying in those corridors. Stories will run on how ambulances were diverted from hospitals because they physically couldn’t take new admissions, whilst the Care Quality Commission will most likely – as it did last year – cancel all inspections of hospitals routinely scheduled to take place in January, and the National Emergency Pressures Panel (NEPP) will end up requiring NHS Trusts to suspend all (or most) planned operations. This may sound like fearmongering, but it’s all happened before. It happened last year, and I’d like nothing more than to be proven wrong and for none of the above to occur this year or in the next. Unfortunately, I fear I won’t be proven wrong – and for good reason.
NHS Providers recently released a report entitled ‘Steeling Ourselves for Winter 2018/19’. Its findings make for grim, but not entirely surprising reading. It begins by pointing out that NHS Trusts are in a worse position than they were this time last year when it comes to being able to cope with extra demand at winter time.
Given the fact that the Conservatives have waged an all-out war against public sector workers since 2010 this is hardly surprising. Doctors and nurses have had their real incomes slashed and their workloads increased, whilst a special blend of Tory incompetence and sheer vindictiveness has seen the student nursing bursary scrapped at a time when there are 42,000 nursing vacancies. On top of this, the xenophobic nature of our immigration system has made it near on impossible for the NHS to recruit enough doctors to fill the 11,500 vacancies which currently stand empty. This was perfectly encapsulated by recent revelations NHS Trusts were spending thousands to recruit doctors from outside the EEA, only for them to be refused entry into the UK because Theresa May as former Home Secretary had placed a cap of 20,700 on tier-2 sponsorship visas.
This meant that between November of last year into April of this year 2,300 doctors – sponsored by NHS Trusts – were refused entry to work in the UK. That number includes specialists in cancer treatment and GPs. Ironically the government did this whilst setting itself a target of recruiting an extra 5000 GPs by 2021. Unsurprisingly, it has failed to meet this target and has actually presided over a total decline in GP numbers by 460. Meanwhile a recent survey by the Royal College of Practitioners has found a third of GPs plan to leave their post within the next five years. All of this is further compounded by Brexit, which has demonstrably put greater pressure on social care as carers from the EEA either leave the UK or simply don’t bother coming here.
NHS staff are overworked, understaffed and demoralised and this of course feeds into the current lack of capacity to cope with what promises to be the toughest winter yet. But, to focus solely on staff is to miss the point that the NHS is experiencing system wide pressure and crises as a result of austerity. It suits the Conservatives – and their backers in the mainstream media – to present the winter crisis as some sort of freak external anomaly, something that happens to the NHS rather than as something produced by its mismanagement at the hands of government. The blame being shifted to land at the feet of staff or at the feet of the weather itself, rather than at the door of Number 10.
What we are now seeing is a widening gap between demand and capacity across all levels of the NHS. The list for elective surgery is at its longest since records began with 4.15million people on the waiting list. It has increased 7% from last year alone. The number of patients waiting longer than 52 weeks for initial treatment has doubled in the last 12 months.
Cancer treatment targets are at an all time low. The NHS is failing to meet 5 out of the 8 core targets for cancer treatment. The target for initial cancer treatment to begin within 62 days of an initial diagnosis has not been met at a national level since 2013/14. NHS Trusts and acute hospitals are now finding themselves struggling to juggle treatment for cancer and A&E care in the winter. As a result, the former is now being prioritised in the summer and autumn months in anticipation of a cessation of activity in winter due to the pressures.
Social care has also been decimated by austerity. There are 110,000 vacancies in the sector, whilst the sector has also experienced a £7bn cut in adult social care funding since 2010, and at a time when the total amount of money being spent on social care by Local Authorities has risen from 34% 2010/11 to 38% in 2018/19. Nursing homes are closing, or contracts are being given back. A lack of care packages means that this winter there will be people in hospital beds fit enough to be discharged, yet unable to leave because no provision has been put in place for them.
The recent Budget was an exercise in damage limitation in order to avoid recriminations when the issue inevitably comes to light – again. Prior to the Budget the government announced social care would be receiving an additional £240million pounds in funding. This was then bolstered with an additional pledge of £650m. However, a brief read of ADASS’ most recent report shows that Councils plan to have made £824m in savings from their adult social care budgets this year alone. The government’s continued use of flash in the pan, PR emergency funding injections is akin to nothing more than beating someone to a pulp in public, paying their medical bills so they don’t die and then repeating the process ad infinitum whilst maniacally shouting to onlookers about how much you love the person.
Winter crises are now merely the window through which we can see – in a condensed form – the consequences of market penetration into the NHS and austerity politics. Radical, root and branch reform is needed if we are to have a health service – and public services – fit for use in the coming years.
The National Health Action Party has made clear that this entails – as a mere start – repealing the Health and Social Care Act 2012 – an Act so pernicious that it allows private companies linked to the Grenfell Tower disaster to sue the NHS for not being awarded contracts. It also entails nationalising social care. On top of this, progressive taxation and the clamping down on tax evasion and avoidance needs to be relentlessly pursued.
However, our bigger task – and a much longer one – is to force a sea change in how we think about the relationship between capital and public services. In short, we need to bring about an end to the neoliberal dogma which believes that injecting, or forcibly fashioning, fashioning market structures into public services is somehow a stepping stone on the path to a collective good when it isn’t – this winter will be the proof of that.
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