With great skill
James Linney urges resistance to the ‘organisation of misery’
A ‘British winter’ can mean many things - we each have our own experiences and memories, adding to the complex and unique picture, but there will inevitably be many elements that we all share (usually featuring the weather).
But in recent times there has occurred a new, and much more malignant and worrying, shared winter experience. One which also dominates the news, but to a much greater extent than the weather: the annual crisis that affects the national health service. Each year the crisis seems to deepen, and its effects this year have been even more devastating than the last. And last year, we will remember, the situation was so dire that the Red Cross described it as a “humanitarian crisis”.1
So how bad is the current situation? And why is it that the winter, something humans have been able to predict since the birth of our very culture, seems to take the health secretary by surprise every year?
A quick glance at the news each morning gives an impression of how dire the situation in GP surgeries and hospitals is right now. But you only get a real sense of how bad things are if you are unfortunate enough to work in these conditions, where your desire for providing an efficient and high standard of care is virtually impossible to deliver; or if you are even more unfortunate and are seriously unwell, when you will be forced to wait many hours before you get your ‘urgent’ treatment. For example, in the last week of December, NHS England reported that more than 16,900 people were left waiting in ambulances for more than 30 minutes before being able to even get into accident and emergency departments.2 Considering that people who arrive by ambulance are obviously much more likely to require immediate, potentially living-saving treatment, this is a horrific statistic.
When people eventually arrive in A&E, the situation is no better. Patients are regularly having to wait very long periods - in some situations more than 12 hours - just to be assessed. Social media is full of pictures and videos of departments bursting at the seams, people squeezed into overcrowded wards or in trolleys lining the corridors. There are record numbers of people attending A&E. In 2017, nearly 24 million people were seen, an increase of three million compared to 2016 (another record-breaking year3). Of these 89% were reported to have been seen within the four-hour (!) target.
But the number is almost certainly lower than this, as a certain amount of ‘creativity’ has always been used on the wards to get better scores on targets, ever since they were introduced by Tony Blair in 2004. This is largely due to managerial pressure and threats toward staff, who are told to meet the targets or be disciplined. Meaning that patients are often moved to less well staffed holding wards, discharged home prematurely or admitted into hospital unnecessarily.
A&E is just one department and the overcrowding and bed shortages are affecting all wards. More people than ever are attending with acute illnesses, yet there are fewer hospital beds available. The total number of beds has halved in the past 30 years despite the record number of attendances - the figure has gone down from around 299,000 to 142,000.4
And the situation is made far worse by the social care crisis that is taking place in parallel. People who are medically stable but unable to look after themselves have nowhere to go. Both home care and residential care homes (which have always been hugely underfunded) have been in decline for decades, largely due to their privatisation.
So the bed shortages are a very real and a dangerous reality. In at least one hospital people were forced to sleep on the floor because bed shortages were so acute. Infamously, Tory health minister Philip Donne has since ‘solved’ this problem by helpfully pointing out in parliament: “There are seats available in most hospitals where beds are not available.” Tory NHS crisis management in all its glory.
Yet, hospital capacity is just a small part of the story - one which is more depressing than a Thomas Hardy novel. Every part of the NHS has suffered nearly a decade of Tory cuts: NHS salaries have been falling, nurses’ bursaries have been terminated, there are alarming staff shortages, junior doctors have been forced to accept a contract which they warned would be unsafe for patients and all the time inadequate numbers of overworked and overstressed staff are trying to do their best.
The sum of all this is that there is not just an NHS winter crisis: the NHS is in perpetual crisis, which just gets worse in the winter. Meanwhile the privatisation of the NHS continues, the next step being Accountable Care Organisations. These will open the door for private companies to take over responsibility for health and social-care provision for decade-long contracts.5 We are currently being given a demonstration of how this would end up with the collapse of Carillion. But when private healthcare companies go bankrupt then the situation will be unimaginably worse.
The Tory government, of course, wants us to believe that the problems in the NHS are a result of a run of bad luck. Its mantra has been: a spell of cold weather, followed by a bad outbreak of flu, has left hospitals overstretched but coping. OK, NHS England had to cancel 55,000 elective operations, but this was all part of the plan. This may very well be true, but what plan? The one the public are sold (albeit with less and less conviction), where the NHS is, according to Theresa May, “better prepared for winter than ever before”, or the plan that got discussed between May and Hunt in 10 Downing Street on the morning of May’s pathetic attempt at a distracting reshuffle? Hunt not only retained his job, but was given more control over social care. Whether this was the result of the prime minister’s weakness, or because he was simply being rewarded for mismanaging the NHS with great skill, is inconsequential. Either way, as the NHS approaches its 70th birthday, its future is looking more than bleak.
Yet the voices of resistance are growing louder. Some groups within the NHS have started to make strong statements in favour of more funding. For example, a group of 66 A&E consultants sent an open letter to May detailing their “very serious concerns for the safety of our patients”, because “the NHS is severely and chronically underfunded”.6 Similarly, NHS Providers - the body representing front-line trusts - has written to Jeremy Hunt, stating that the levels of underfunding mean:
We have now reached a key watershed moment. Put simply, the NHS can no longer deliver the standards enshrined in its constitution; standards that were drawn up to reflect safe, decent levels of patient care.
Additionally, there is a group of doctors and NHS activists, led by Allyson Pollard, attempting to force a judicial review to prevent the introduction of Accountable Care Organisations. But it is going to take much more than this to save the NHS.
The NHS is a special industry within Britain. Despite the creeping privatisation over the past two decades it remains in the public’s perception a unique service, that does its best to provide care to people independently of bank balance or class. The underfunding of the NHS is also very real and apparent to the working class - ie, those who rely on its services. It is workers who have to queue in A&E and witness the staff desperately trying to keep things going. They are the ones who make up its workforce (the NHS is the fifth largest employer in the world). This immediately exposes the government’s lie - that it cares about the NHS.
You still have a group of misguided lumpen who blame immigration or ‘benefit scroungers’ for the problems, but more than ever the vast majority of people are conscious that underfunding and privatisation are threatening its existence and causing harm on a daily basis. But the situation remains the same as when the NHS was created: it can only become a thriving, effective and democratic institution if the working class wills it. Obviously, will alone is not enough: there also needs to be a political organisation able to express this will.
Jeremy Corbyn’s Labour Party is clearly the only option for the NHS’s survival in the short term. Its pledge to increase NHS spending would be the defining issue if there was a general election this year. We will get a taste of the growing discontent on February 3 when the People’s Assembly hosts what is likely to be a very well attended demonstration in defence of the NHS.
However, now more than ever it is important that the left does not settle for just calling for more beds and more funding. Labour’s proposed increased funding has so far been pretty underwhelming - even the Institute for Fiscal Studies recognises this.7 We need to oppose Tory-led privatisation and demand more funding, of course. But this must run in parallel to our highlighting why people are attending A&E in such large numbers in the first place.
Workers are repeatedly subject to conditions that make them ill. The vast majority of mental-health problems, alcohol dependence, cardiovascular disease, cancer, diabetes, etc result directly from inequality. A&E attendance numbers are like a barometer, measuring how unhealthy capitalism is for the working class. And, to borrow a phrase from the communist poet, Pablo Neruda, to overcome these conditions we need to rise up against this “organisation of misery” l
5. See ‘Planning the final assault’ Weekly Worker December 7 2017.