28.09.2017

Dedicated staff soldier on

The fight to save the NHS goes hand in hand with the fight to transform Labour, writes James Linney

The past seven years of Tory government have been the most devastating for the national health service since its birth in 1948. Never has the term ‘frontline NHS staff’ felt so befitting - as resources are spread more and more thinly, working in the NHS increasingly feels like fighting a losing military campaign.

As winter approaches, so begins the now familiar seasonal defensive battle that has sadly become the norm for our health service. The situation in hospitals was so bad last winter that the British Red Cross described it as a “humanitarian crisis”. This year demand is likely to be even greater. For example, Australia has just experienced one of its worst ever flu outbreaks and this is usually an accurate predictor for the number of flu cases we should expect in Europe.¹ A forbidding thought for accident and emergency departments that have seen a 342% rise in people waiting on trolleys for more than four hours since 2012.² One testament of the Tories’ underfunding and one of the main threats to the NHS’s existence is its severe staff shortages, and in this article I will examine the depth of this problem.

In July, NHS Digital published data relating to advertised vacancies obtained from NHS Jobs, the health service’s main recruitment website.³ It revealed that there were more than 86,000 NHS vacancies between January and March 2017 (these numbers do not include vacancies for general practitioners and GP surgery staff) - an increase of more than 8,000, compared to the same time last year. In March 2017 alone there were just under 31,000 full-time job vacancies on NHS Jobs - the highest number recorded in a single month since the data collection began. Yet these numbers are just a hint at the true problem. Years of severe underfunding have meant that for every job vacancy advertised there are many more posts that departments simply cannot afford to fill.

Nursing and midwifery represents the area with by far the most job vacancies and, considering the Tories’ vicious attacks on the nursing profession, this is no surprise. As of August this year, trainee nurses will no longer receive a government bursary and, as the Royal College of Nursing has noted, this has already resulted in a 20% drop in nursing degree applicants.⁴ You have to be pretty dedicated to the caring profession to face the dismal average starting wage of £22,000 (£26,000 in London), whilst being crippled by £50,000 of university debt. This is a workforce already left demoralised by a pay freeze which has meant that on average nurses have endured a real-term wage cut of £2,000 over the past seven years.⁵ Already we are seeing the shocking reality of this Tory-imposed impoverishment of nurses, with reports of some having to rely on food banks to survive.

There are equally worrying trends in doctor shortages. The Royal College of Emergency Medicine recently stated that in order to continue to provide a viable service more than 2,000 extra emergency medicine consultants would need to be recruited over the next four years.⁶ GPs too are desperately needed, as highlighted by Imperial College’s published data. Its analysis concluded that the government’s pledge to recruit 5,000 GPs by 2020 is vastly inadequate to meet the need, suggesting that in 2016 there was already a 6,500 shortfall and that this would rise to above 12,500 by 2020.⁷ This year has seen hundreds of GP surgery closures and a British Medical Association survey recently found that 54% of GPs would consider a temporary suspension of new patient registration, as they already feel patient safety is being compromised. A recently published BMA briefing leads us to conclude that the situation is only going to get worse, since medical degree applications have dropped by 15% since 2013.⁸

Add to these already alarming shortages the Brexit factor. The NHS has always relied on non-British nationals to fill gaps in the workforce. Past governments have led drives to recruit doctors and nurses from across the globe - most notably from Asia, where they could poach well-trained staff at bargain prices from other struggling health services. Of the total NHS staff 12% are other nationals and of this almost half (5.5%) are European Union citizens. A recently leaked department of health document revealed that the government is well aware that Brexit is likely to deepen the NHS staff crisis: it estimated that within six years of leaving the EU there would be a shortage of up to 42,000 nurses.⁹ Ten thousand EU staff have already left the NHS since last year’s referendum - an increase of 42% compared with two years ago. Yet despite this the government refuses to give any guarantee of rights to live and work in the UK for EU citizens after 2019.

Ultimate prize

So the current NHS staff shortages and recruitment crisis reveals a predictably bleak picture. The demoralised staff are overworked, underpaid and being forced to work in an environment that puts at the risk the very thing they most cherish: their ability to offer high standards of care to those in need. The demoralisation and undermining of NHS staff is only part of the Tories’ strategy. Running parallel to this has been an accelerated continuation of previous governments’ privatisation by stealth. The NHS brand name remains for now, but services are increasingly being provided by the likes of Virgin Care.

Yet the fight for the NHS has not yet been lost. As the Bob Dylan song goes, “Take the rag away from your face. Now ain’t the time for your tears.” In the short term, the survival of the NHS depends upon the election of a Labour government and that is looking increasingly likely. This week’s Labour conference has clearly demonstrated that within the party the left is in its strongest position in living memory. During the conference Labour leaders restated the manifesto promise of an extra £7 billion for the NHS, as well as bringing some ‘private finance initiative’ contracts back ‘in house’ and urging the government to immediately inject £500 million into emergency care in preparation for the winter season. This, along with Labour’s renewed pledge to scrap tuition fees, is a step towards saving the NHS.

Yet the party’s plans fall far short of what is needed. Its proposed annual funding increases are below even the 4% of Tony Blair’s government. In fact, the long-term fight for the NHS goes hand in hand with the fight to transform the Labour Party into a radical, democratic party of the working class - the only class that can deliver a society based on need. The truth is that the NHS has always been underfunded and understaffed, and under capitalism it always will be. In fact, our ultimate goal in relation to healthcare is not just to end the funding and recruitment crisis, but to remove the devastating ill-health burden that the working class shoulders for the benefit of capitalism. Of course there will always be illness, but the reality is that the vast majority of current physical and mental health diseases are the direct result of living under the conditions created by the current system.

So, as the NHS digs in for the difficult winter ahead, its survival will depend on the resourcefulness of its hardworking staff. While the chance of a Labour government in the next few years gives us every reason to keep soldiering on, it is more important than ever to focus not just on the immediate battles, but on our long-term strategy and the ultimate prize.

Notes

1. www.bbc.co.uk/news/health-41241639.

2. www.telegraph.co.uk/news/2017/09/24/ae-trolley-waits-soar-five-years.

3. http://digital.nhs.uk/catalogue/PUB30033.

4. www.rcn.org.uk/news-and-events/news/rcn-concerned-at-fall-in-nursing-degree-applications.

5. www.independent.co.uk/news/business/news/public-sector-pay-cap-nhs-staff-real-incomes-cut-government-wage-freeze-gmb-union-a7959806.html.

6. www.bmj.com/content/358/bmj.j3548.full.

7. www.bmj.com/content/358/bmj.j3191.full.

8. www.bma.org.uk/collective-voice/policy-and-research/education-training-and-workforce/state-of-medical-recruitment.

9. www.independent.co.uk/news/health/nhs-nurse-shortage-40000-post-brexit-trusts-hospitals-uk-healthcare-leaked-government-a7671791.html.