The Seriously Sick NHS, Down the Tory Rabbit Hole

 

The Sick Child
Edvard Munch ( 1863-1944)
Photo Credit: Tate [CC BY-NC-ND]

An obtuse government refuses to discuss pay as 100,000 nurses strike tomorrow in 53 English NHS organisations... Ambulance drivers follow next week - the most severe threat of all the strikes, as this struggling service already fails to reach people experiencing heart attacks and strokes.

... From now on, expect all such events to be blamed on strikes rather than the "decade of neglect" outlined in Monday's King's Fund report into NHS dilapidations caused by years of underfunding... 

Everyone in the NHS I speak to echoes the certainty of Alastair Mclellan, the editor of the Health Service Journal, that "people have died needlessly due to the state of the NHS", but expect front pages about the first named case the Tory press can blame on the strikes. One human case is worth a welter of statistics...

More nurses have quit this year than ever before, says the RCN [Royal College of Nursing], not just over-50s retiring early but alarming numbers leaving after four or five years, exhausted by overwork, understaffing and pay they can't live on...

In every interview, ministers hide behind the sanctity of the "independent" pay review bodies, claiming they set public pay. They don't, and nor are they "independent". The government decides on pay, using PRBs as camouflage.

The 60 or so members of these eight bodies covering public sectors are picked by ministers, as is their Office of Manpower Economics secretariat. I tried to speak to some members - no luck. Only two of those 60 people come from the employees' side says the TUC; one from the army, with no affiliated union... But they are given a fixed spending envelope, with a set pay rise baked in. Any extra pay comes out of the departmental budget, causing cuts...

This is its  [The NHS] worst ever crisis, says everyone inside it whom I talk to. NHS England will privately point to the obvious reason why: beds have been cut, running hot at a dangerous 95% occupancy; in 2019, the OECD average was 76%. Look, they say, at pre-Covid years 2010-19 to see the UK spending 18% less per head than the EU's richest nations, 21% less than France, 39% less than Germany...

The government ignores the one quick fix for the NHS: good funding and pay for social care...

(Polly Toynbee, The Guardian, 2022)

For how long has the underfunding of the NHS been taking place? For at least 10 years. A first class NHS must be funded properly. Raise taxes on those that can afford it.

A Few Days Later

The Scottish government has pledged to spend another £1bn on tackling the crisis in health and social care by raising taxes on high earners and holiday homes.

John Swinney, Scotland's acting finance secretary, said the burden of increasing NHS funding would fall heavily on everyone earning more than £43,663 in Scotland as part of a "social contract" to protect the weakest and the poorest.

From next year, pay above that rate would be taxed at 42p in the pound, an increase of of 1p. He mirrored the UK government decision to cut the top rate band from £150,000 to £125,140 but in Scotland they will pay 47p, also an increase of 1p, and lose all of their £12,570 personal allowance.

He said the changes, which provided warnings they will hit consumer spending, included freezing the tax bands for lower earners and an immediate increase in property sales tax on second homes of 2 percentage points to 6%. He said the measures would generate £553m extra for health and care spending, which will be ringfenced for the NHS...

(Severin Carrell, The Guardian, 2022)

And this from an NHS respiratory consultant who works across a number of hospitals and who wishes to remain anonymous.

... Social care and community mental health provision is wholly inadequate and we cannot discharge well patients for days or weeks, leaving patients who do need to be on a ward waiting in A&E for hours or days. Ambulance crews cannot unload or answer new calls, and the patients they do bring in are often sicker after long waits outside.

... We are told that the NHS is at "breaking point" and has been for years, underfunded and poorly planned by successive Conservative governments.

But this is different. What is breaking now is not the system but its people, and in a rapid, tangible way. I regularly see colleagues in tears. Every few weeks I hear of someone else who is leaving, retiring early, going part-time, moving to a less stressful area.

We need compassion more than ever and, while I regularly see this from our patients and the public, it is notably absent from our leaders.

Most of all, though, we feel taken for granted. The expectation seems to be that we should just continue doing what we do - without proper appreciation or support - because we are the NHS heroes and our work is some noble vocation that should sustain us regardless of how hard it may be.

And so these strikes are not just about pay. They are also a cry for help, a critical symptom of a stressed and failing workforce. Perhaps if we were shown a little more kindness by those in charge there would be a way forward.

(The Secret Consultant, The Guardian, 2022)

Two letters from doctors regarding the situation in the NHS

Sir, Regarding your headline "Heart attack patients to be denied ambulances" (Dec 20), I am a GP in Cornwall and this has actually been the situation for months without strike action. I have been involved in several situations in which patients suffering stroke or heart attack symptoms have called 999, only to find the ambulance arrives 24 hours later or sometimes not at all. A patient of mine died recently while waiting for a 999 ambulance, which arrived eight hours after the initial call. The situation is desperate, which is why ambulance staff feel the need to strike. It is no longer possible to rely on an ambulance coming to help even in these life-threatening situations, and GPs, who are trying to cope with unprecedented demand on their services, are being required to deal with the fallout. Sadly this appears to have become a state of affairs that is accepted by the government.

(Dr Will Webb, GP, St Ives, Cornwall, The Times, 2022)

Sir, Grateful as I am for the King's supportive comments on Christmas Day, I have to say that "tireless" is not an accurate adjective for healthcare workers. We are not tireless, we are exhausted, demoralised and angry, and are fed up with working in a service that is understaffed, underfunded for what it is being asked to provide and which is being used as a whipping boy by anyone with a political axe to grind. We are tired of being expected to carry on despite this, and despite decades of real-terms pay erosion. We are also tired of being told by politicians that industrial action puts patients' lives at risk while they refuse to acknowledge that their failure to act has resulted in a state of collapse for the NHS, which is a far greater threat to patients.

Using adjectives such as "tireless" fails to acknowledge that burnout and exhaustion are causing thousands of healthcare workers to leave, either for other jobs or for countries that value us more.

(Dr Cath Livingstone, Consultant anaesthetist, Galashiels, Selkirkshire, The Times, 2022) 

Down the Tory Rabbit Hole

Can I be honest? I am struggling to get my head round the events of recent weeks. Jeremy Hunt trashed everything that Kwasi Kwarteng advocated when the latter offered us his mini-budget less than two short months ago...

But that isn't the only reversal we have seen. Kwarteng had already taken down a great deal of what Boris Johnson stood for on economics. He cancelled the rise in corporation tax, reversed the increase in national insurance and blew a hole in the wider approach to macroeconomics...

And yet here's the thing that wacks one between the eyes: Tory backbenchers cheered wildly through all these different, flatly contradictory statements. They waved their order papers, stamped their feet and seemed delighted with it all. You might retort that this is merely a case of MPs showing loyalty to whoever is in charge...

Merry-Go-Round
Mark Gertler  (1891-1939)
Photo Credit: Tate [CC BY-NC-ND]

These people look less like democratic representatives and more like children or puppies. Some were apparently proclaiming their glee in how Hunt's statement had "wrongfooted" Labour. Did they not have the self-awareness to see it had wrongfooted them too? ...

The security minister Tom Tugendhat, who praised Liz Truss's policies - "Liz's  plan for the economy is founded on true Conservative principles of low tax, a lean state and bold supply-side reform" - is now vocally supporting a cabinet that despises those policies. The same can be said for the foreign secretary, James Cleverly ("the mini-budget is incredibly well thought through"), and his cabinet colleagues Penny Mordaunt, Suella Braverman, Ben Wallace and Chris Heaton-Harris...

Again, you might retort that this is merely straightforward hypocrisy and ambition... But I have also noticed ministers supporting a policy one week and then seeming dumbfounded when accused of a U- turn  the following week, not realising they had made one,..

The Tory party seems to believe a multitude of impossible things simultaneously: clusterthink? Isn't that why there is an Alice in Wonderland feel to this period, as if the nation is living in the rabbit hole of someone else's fantasies...

I can't help thinking that what we have had from the Tories is the worst of all worlds: low quality politicians deriding expertise and thereby taking the nation from crisis to contradictory crisis. That is why we have endured the gravest economic mismanagement since the overreach of the post-war consensus in the 1970s, perhaps since the second world war. And here's the thing we should never forget: a critical mass of Tory MPs cheered it all.

(Matthew Syed, The Times, 2022)

No you're not the only one confused by these events. You're not the only one who recognises that for many in a political party, loyalty to that party overrides any critical judgements that need to be made on policy. A kind of sheepthink.