Accident and Emergency departments are at crisis point. One in 10 patients admitted to A&E now have to wait more than four hours to be treated or discharged — double the figure this time last year.
Royal College of Nursing spokesperson Patricia Webb described the situation in the East of England: “Patients are woken up at three in the morning and moved around the hospital — cupboards and catheter laboratories are being used to house patients.”
In Oxford University Hospital there is now a “queue nurse” who looks after patients in the queue waiting to be triaged.
In Wales patients have been waiting on trolleys in corridors for over 24 hours and nurses struggle to find places to wash patients.
The crisis in A&E is a symptom of a much bigger problem in the health service. Successive governments have been trying to achieve two contradictory goals: privatising the NHS and creating a viable for-profit health sector at the same time as cutting spending.
All healthcare experts agree that the key to reducing costs in the NHS is to reduce the number of emergency admissions. Early intervention, public health campaigns and beefed up GP surgeries could help.
However, instead of increasing community services and then making savings, government tried to achieve the goal with artificial market-mechanisms.
First New Labour ordered £11.6 billion of hospitals to be built using PFI schemes. In return we will pay £79.1 billion — mostly to tax-dodging millionaires.
Then they decided to freeze spending at 2010 levels for five years, creating a funding gap of £20 billion. NHS managers had to come up with clever ideas to save money. But when these savings are added to the mounting PFI debt, the only clever ideas left were to shut down the hospitals. There are now 24 A&E departments under threat.
Then they legislated to punish any hospitals that have too many A&E admissions. Under the internal market Primary Care Trusts pay a set rate for A&E admissions. However, if more people turn up to A&E than in 2008/9 then the hospital only gets 30% of the going rate. The more admissions the hospital gets, the more money it loses.
Then the Tories shut down the PCTs and gave the money to new Clincal Commissioning Groups run by GPs who could use their control of NHS budgets to invest in community services. But why would they? At the moment they are getting 70% discount on A&E admissions!
Currently, A&E departments are subsidised from money gained from other parts of a hospital’s work.
An NHS hospital is paid for every treatment it performs. Low-risk treatments are generally “profit” making and high-risk procedures “loss” making. As long as all of these procedures are performed by the same organisation the costs balance out. But, with the Health and Social Care Act, many of the low-risk, profit making services will be lost to the private sector.
The more money hospitals lose, the more services they will have to close, putting further pressure on A&Es.
These innovations create a downward spiral where every failure is punished. Access to free NHS services will be increasingly restricted. A&Es will be increasingly overstretched. Departments will close.
“Profitable” treatments will be cherry picked by private providers. “Expensive” emergency services will be left to a rump NHS.
Longer waiting times will cause a middle-class exodus to private health insurers.
NHS providers will start offering multi-tiered services, where those who can pay top-ups will be able to skip the queue.
The scale of this crisis has so far not impressed itself on the minds of the Labour Party leadership. Labour is the only political party capable of reversing some of this destruction, but Labour politicians have been mealy mouthed about what they are prepared to do.
In contrast, the view of the Labour rank-and-file and the broader labour movement is clear. Last year at Labour Party conference, delegates voted to scrap PFI debt and reinstate the duty on the Secretary of State to provide comprehensive healthcare.
We can build a mass campaign. Our movement should be spurred on by the campaigns to save A&Es in Stafford, Lewisham and elsewhere.
The community campaigns and union rank-and-file will have to drag the union and Labour leaders into effective action.
• Join the Hunt for Hunt in Farnham, Surrey, 15 June.
