For many healthworkers, the NHS is facing its worst crisis in memory. Small wonder the British Red Cross, called in to provide support with discharging patients from hospitals safely, describes the situation as a humanitarian crisis. Yet Jeremy Hunt and Teresa May deny there is a problem.
The deaths at Worcestershire Royal Hospital A&E are tragic, but sadly no surprise to those who work in the NHS. Increased A&E waiting times are now so common enough we don’t care about the four hour target, but only whether we have enough physical space for the extra beds and trolleys. Everybody is terrified that somebody will die on their watch, working at a level which is completely unsustainable.
This is not, as the newsreaders would have it, “just another winter crisis”. Indeed that dismissal displays a horrendous defeatism: increased demand at winter is predictable; a fully functional health system would have capacity to cope with seasonal variation by using a surplus capacity. This crisis cannot be blamed on, in fact, fairly mild weather. Nor is it due to a demanding and ageing patient population. Or “health tourists” (who account for 0.2% of our budget). This crisis is a political choice.
It has been caused by chronic underfunding, understaffing and the drive to privatisation. These three factors feed off each other in a vicious cycle, creating a perfect storm which produces crises like this one. Year on year, the UK spends a smaller proportion of GDP on healthcare. At the same time, costs to the NHS from PFI debt continue to rise: St Bartholomew’s and the Royal London hospitals pay £2 million a week in PFI debt interest alone. At the same time, transaction costs increase as more and more services are pushed into the market. And more and more funding is sucked out into the profits of private providers, who increasingly win contracts to provide services. The massive contraction in the funding available for care has led to deliberate and chronic understaffing in most grades and professions.
This has been assisted by the corporatism of the NHS, which is deliberate antagonistic to healthcare professionals. Poor workforce planning is part of the picture: gaps in staffing on specific rotas make our jobs unsafe. The upshot then is bed, service and hospital closures. Cuts and closures are covered up by administrators and politicians mouthing the “efficiency” mantra. But there is no surplus capacity anywhere in the system. Bed occupancy is well over 95% in many places, although 85% is considered to be the safe level. The UK has fewer beds per person and fewer doctors per person than most countries in Europe.
According to the OECD the UK lost 7,525 beds between 2010 and 2014. Social care has also been cut to the bone by councils struggling to manage cuts. That means frail patients cannot be discharged to the community. The same patients without support and care in the community end up at A&E. Regardless of the current crisis, the government are pushing ahead with the Sustainability and Transformation Plans — further cuts and privatisation – which will lead to a third of regions losing an A&E, and half of regions losing significant numbers of inpatient beds. This is dangerous.
Make no mistake, the “long-term solution… ducked by government over the years” that Theresa May describes is yet more privatisation. It may mean patients paying for some care. This will lead to further decreased provision and quality of care. The NHS, our great redistributive health system, free at the point of use, will become even more of a profit machine; it will be destroyed. The NHS needs a massive injection of cash to help it deal with this emergency. In the long-term solutions lie in the total removal of the market from healthcare – the renationalisation of the NHS.
This must include a cancelling of all PFI debt, which is predominantly owned by RBS. That could free up 9% of the NHS budget to be spent on staffing the NHS properly and providing patient care. If those reform are insufficient for need, we must commit to higher funding levels; the BMA has called for UK health spending to rise to the European average. That’s a good start.
The Labour Party has good policy on the NHS, due to the work of Momentum NHS at last year’s Labour Party Conference. We need to ensure that this policy is in the next manifesto and that any Labour government implements it. Corbyn and Jonathan Ashworth, the Shadow Secretary of State for Health, need to put political pressure on the government for emergency funding for the NHS and social care . Constituency Labour Parties should participate in the campaign day for the NHS on 4 March, and reach out to support local NHS campaign groups to build bigger campaigns and actions on the back of this latest crisis. Many local areas will lose hospitals and services under the STPs, so battles may be won on a local basis by strong campaigns. We can learn from the Save Lewisham Hospital campaign about community mobilisation and organisation.
Left must defend freedom of movement
After weeks of intense pressure from the Labour right (and from some supposed to be on Labour’s left), Jeremy Corbyn has retreated on freedom of movement. In a speech on 10 January he said: “Labour is not wedded to freedom of movement for EU citizens as a point of principle... Labour supports fair rules and reasonably managed migration as part of the post-Brexit relationship with the EU”.
But the same day he told the BBC that he was not proposing new restrictions on the rights of people to move to the UK and does not think immigration is “too high”. In his speech Corbyn hinted that Labour might back freedom of movement as part of a deal to keep Britain in the EU “single market”:
“But nor can we afford to lose full access to the European markets on which so many British businesses and jobs depend. Changes to the way migration rules operate from the EU will be part of the negotiations”.
This is a weak political position: it has neither leverage to convince working-class voters currently hostile to migrant workers, nor capacity to placate them and hold them back from UKIP. Nevertheless, it keeps the issue open.
Despite a large majority vote for freedom of movement at the 3 December National Committee meeting of the Labour left organisation Momentum, Momentum has put out nothing, not even a press release, to support that freedom. Jeremy Corbyn and Diane Abbott have been left alone, as individuals, to deal with the concerted push against freedom from the Labour right. Momentum members should demand Momentum speaks out now. The political retreat here is huge.
Solidarity supports open borders — freedom of movement for all workers. That principle may take some time to win. But the immediate issue here is about retaining a right of free movement for workers from neighbouring countries which has been in operation for 44 years (for the core EU countries), over 30 years (for Spain, Portugal, and Greece), or 13 years (for Poland and the Baltic states). The issue is not about how far we can push forward for freedom right now. It is about stopping a retreat to decades past.
A bold, clear campaign by Labour could win over, or at least win assent from, the majority. Almost certainly a majority for at least accepting freedom of movement for EU workers has already been won in London, which has by far the biggest concentration of EU migrants. London has high house prices and rents: but a majority understands that the answer is increased council house-building and rent controls, not the exclusion of immigrants from the EU (or, for that matter, of “immigrants” to London from elsewhere in the UK, though the fact that a quarter of all English university graduates are gathered in London six months after graduation surely creates market pressures pushing up housing costs).
The answer to strain on the NHS and other public services is to tax the rich. In fact, those services depend on migrants working to provide them, and on the fact that migrant workers, mostly young and fit, pay much more in taxes than they get in benefits and services. Jeremy Corbyn declared: “Labour will take action against undercutting of pay and conditions by closing down cheap labour loopholes, banning exclusive advertising of jobs abroad and strengthening workplace protections”.
Labour should strive for working-class unity to win social improvements and freedoms — unity between British-born workers; the 3.5 million EU-citizen workers already in the UK; their friends, families, and compatriots who wish to join them; and other migrant workers. Meanwhile, the Tories and the ruling class are in disarray, disarray that would give Labour great openings if only it had a bold policy.
Ivan Rogers, the British ambassador to the EU, resigned from his job on 3 January, saying that he did not know what the government’s “negotiating objectives” for Brexit would be, and urging his staff to “continue to challenge ill-founded arguments and muddled thinking”.
Theresa May said on 8 January that Britain would not retain “bits of EU membership”, a position which (if she understands what she is saying) excludes Britain remaining in the “single market” or even in the customs union.
It would mean Britain being more walled-off from the EU economically and socially than, for example, Turkey, or Albania. As the Financial Times commented (10 January), “markets [are] now concerned by Mrs May s lack of a clear plan”. And so are the millions of EU-citizen workers now under threat, and their workmates and friends.