Discussions about the state of the National Health Service are remarkably muted given the desperate reality. NHS campaigners, the left and the labour movement need to introduce a real sense of alarm — and clear, appropriately radical solutions.
In the Guardian earlier this month, one doctor wrote about her difficulty even getting an emergency ambulance for a baby with falling oxygen levels. She commented that “this incident was only one of many examples I could quote which illustrate how close basic medical care is to collapsing in the UK”.
The Financial Times has found that 2,047 more people died this year in the week ending 12 November than during the same period between 2015 and 2019. Only 1,197 had Covid-19 on their death certificates: so an extra 850 non-Covid deaths in one week. Cardiovascular diseases and strokes, where prompt and efficient health services are vital, were the main causes of death. Office for National Statistics figures show that was not a one-week blip: the pattern of non-Covid “excess deaths” in similar numbers to Covid goes back three months or more.
The Royal College of Emergency Medicine estimates 4,519 excess deaths due to long waits in A&Es over the last year. It says the number of people waiting more than 12 hours in A&E rose by 40% — just between September and October. In 2010 the waiting list for pre-planned NHS treatments was two million. It is now close to six million and rising steadily. Health Secretary Sajid Javid has flagged up a possible peak of 13 million. There are plausible estimates that go even higher. The numbers waiting over 18 weeks and over 52 weeks have also grown dramatically.
Things are so bad that the NHS lacks not just facilities but often even just space. As another doctor put in the Guardian last month: “There is often a wait to secure even a cubicle to bring a patient in for examination. Sometimes I have to send a colleague to fetch a patient while I wait in some inappropriate location — on one occasion an equipment store — just to reserve somewhere with sufficient privacy before someone else takes it.
“Ambulances queue outside the door with waits of hours just to unload their patient and get back on the road; a criminal waste of their time.”
And all this before winter proper, December-January, the usual peak months of stress for the NHS. Before the impact of the new Omicron variant, which may be modest or may be large. While flu counts are still low.
Last year, in the early days of the pandemic, some governments requisitioned private hospitals and healthcare facilities for public use. Spain for instance. Even some Indian states took measures in that direction. The UK government did almost the opposite, handing over large sums of public money to private healthcare providers to access their facilities — but then making very little use of them.
There are various figures for the number of hospitals in the UK, but estimates hover around 1,300 NHS hospitals and 500 private ones. The deal the Tories made last year supposedly gave access to 187 of the latter, with 8,000 beds.
Research from the Centre for Health and Public Interest indicates that those beds were occupied by less than one Covid patient a day for 59% of the first year of the pandemic. On average private hospitals cared for eight Covid patients a day between March 2020 and March 2021, while the NHS averaged 10,000. NHS-funded activity in the private sector, the usual contracted-out tests and procedures, fell by 43% in 2019, as against a fall of only 21.5% in equivalent NHS activity (due to the pandemic).
The full costs of this disturbing farce have not been disclosed. Estimates vary from £2 billion and £5 billion — equivalent to a big chunk and maybe the big majority of the measly extra £6 billion NHS funding the government has just announced.
Moreover it seems the terms of the deal were renegotiated in a way that effectively bailed out many private providers from collapse. That allows them now to benefit from the huge treatment backlog in the NHS.
To address the growing NHS emergency, all private hospitals and medical facilities should be taken into public ownership, at the full disposal and under the full control of the NHS. The experience of the pandemic highlights how flimsy any objections that this is impossible or too difficult really are. The same goes for objections to public ownership of social care, also desperately needed.
Hospitals are not the only thing that needs requisitioning. The PPE crisis and scandals last year highlighted not just Tory venality and shamelessness, but the appalling mess NHS supplies and logistics are in as a result of decades of privatisation. Companies, production facilities and equipment in these sectors also need to be brought into public ownership, an essential measure to meet this emergency and to begin untangling the wider structures choking the health service. All outsourcing and privatisation need unwinding.
At the same time, perhaps the biggest NHS emergency of all is the staff shortage. Requisitioning private hospitals will help a bit, but only a bit: most of them rely on NHS consultants working in their spare time. Urgent measures are also needed to increase the size of the NHS workforce and its well-being and morale. The first step is to immediately accept the demands of NHS workers for a 15% or £3,000 pay rise to make up for the real-terms cut they have suffered for over a decade (and raise wages in social care sharply towards NHS levels). Major funding should be made available to recruit more workers. We are against all tuition fees, of course, and for living grants for all students, but the imposition of fees and loans on those who want to train for NHS jobs is particularly grotesque. It should be ended.
The labour movement must rally round health workers’ pay demands, the new campaigning by midwives and birth workers over their conditions, and struggles to drive up conditions and reverse outsourcing by United Voices of the World and other unions.
To fund the salvaging and restoration of the health service, we demand the government requisitions wealth from the rich through heavy progressive taxation.