13.10.2022

Plan for sabotage

Though they are on the ropes, it is clear that the NHS is not safe in Tory hands. James Linney puts Thérèse Coffey’s proposals under close examination

New health and social care secretary, Thérèse Coffey, recently announced the Liz Truss era proposal for the national health service, called ‘Our plan for patients’.¹

There is, however, a good chance this particular plan may have a short shelf life. Given that Coffey is the fifth health secretary in the past four years and how astronomically inept Liz Truss has so far proven to be, there is a fair chance that the Tories could have yet another new leader very soon. Nevertheless, the plan is worth a closer look, not least because it comes as the NHS crisis is reaching breaking point and is approaching what could be its most challenging winter to date - which is saying something, given the last few.

The headlines focused on the introduction of a new two-week-wait target for appointments with your local GP and the promise to make sure patients with urgent need are seen on the same day. The document also threatens to publish a league table of data for how many appointments each GP practice delivers and the length of waits for appointments, allowing the local NHS (integrated care boards) to hold poorly performing practices to account.

To begin with, GP surgeries are already doing remarkably well at providing timely access for patients, despite the extreme pressures they are under. About 85% of appointments already happen within two weeks of being booked and 44% of these are same-day appointments. This is an improvement on pre-pandemic access,² despite the fact that there are now around 600 fewer GPs, and this data does not take into account that often patients do not need appointments within two weeks and have chosen to wait longer for a routine or follow-up appointment.

Further, these league tables will only serve to punish surgeries who practise in areas where resources are already scarce and patients have more complex needs: namely poorer areas. GPs are already dictated to as to how many appointments they have to offer each day, meaning that the vast majority of surgeries currently have to limit each appointment to 10 minutes - an absurdly small amount of time to deal with many people’s problems, which have and continue to become more complex. Try dealing with a patient who has multiple chronic health conditions or severe mental health issues (or both) in just 10 minutes! More targets and league tables will only serve to put more pressure on surgeries to sacrifice quality of care for the sake of quantity - further promoting conveyor-belt medicine that is dehumanising for both health professionals and patients alike.

What then is the plan for enabling GPs to meet the new two-week targets? Despite the continuing fall in GP numbers (there are 1,850 fewer since the Tories made their 2019 promise of 6,000 extra GPs by 2024), it seems that making “it easier to get through to surgeries by making an additional 31,000 phone lines available” will do the trick! So there will be 31,000 more ringing telephones, but, even if there were the staff to answer them (and there is not), the last thing the already overwhelmed clinical staff can deal with is waves of extra patients needing to be squeezed into their working day. GPs currently have an average of 46 daily patient contacts - 84% more than the 25 that the British Medical Association (BMA) says could be considered a safe limit.³

Not to be put off by something as irrelevant as reality, the plan continues in a similar vein, telling us that the government aims to fix the NHS by “focusing relentlessly on ABCD - ambulances, backlogs, care, doctors and dentists.” I can only assume the use of the ABCD acronym is mirroring the medical ABCD (airway, breathing, circulation, disability) assessment of a critically unwell patient - which is fitting, given how the Tories’ neglect of the NHS has left it like a moribund patient on a path towards a cardiac arrest. We are told ambulance response times and accident and emergency handover times (which are currently the worst since records began) will be fixed by “increasing the number of call handlers to 4,800 in NHS 111 and 2,500 in 999 by December 2022” and “facilitating ambulance trusts to support each other during the busiest periods, including by rolling out a new digital intelligent routing platform”. The ambulance service is failing, and without some urgent, effective intervention, may break down; yet here, Coffey - like a hopelessly ill-prepared student the night before their deadline - seems to have been just writing the first meaningless guff that came to mind. After all, ambulance trusts already support each other and know how to use the tracking systems they have.

Inadequacies

Next we come to the plan for reducing the current NHS backlog (which is also at an all-time high, with 6.8 million people waiting for non-urgent treatment⁴). We are told progress will be made here by “Creating additional capacity in hospitals by recruiting 50,000 more nurses by 2024. By June 2022, nursing numbers were already 29,000 higher than in September 2019.”

I am not sure where this data originates, because we are not given a reference, but it is highly questionable. Recent analysis by the Nuffield Trust found that a record number of nurses are leaving the NHS - more than 40,000 have done so in the past year⁵ - and, as we will discuss below, this is no surprise, given the dire working environment for nurses and the fact that their already pathetically low wages are being cut further in real terms.

Midway through the ‘plan’, we come to the first genuine statement of intent for reducing NHS work: namely the pledge to “maximise the use of the independent sector”. The Tories have proven more than competent at outsourcing and selling off NHS services - initially this was done with stealth and much track-covering, but, now that privatisation has become normalised, it is being done much more boldly. Sadly, but not surprisingly, Sir Keir Starmer also recently reneged on yet another of his previous pledges, telling an interviewer, “There is some private provision in the NHS and we’re likely to have to continue with that.”⁶

This one moment of honesty aside, the remainder of the document continues with little else but meaningless filler. So we have the promise of a £500 million fund to support discharge from hospital into the community, thus freeing up hospital beds - which we later learned is not new money, but to be reallocated from funds already in the department of health and social care’s budget. Even if it were new funds, it would be beyond inadequate to meet the social care crisis: as winter approaches, this is growing ever deeper (Covid-19 cases have already started to climb again - recent data reveals that 1.1 million people in England - about one in 50 - have the virus). Every day 12,000 patients are kept in acute hospital beds due to a lack of adequate social care; this is more than 17% of the total capacity. This also is not surprising, given the 165,000 vacancies for adult social care providers at the end of 2021-22 - an increase of 50% on the previous year.⁷

So it turns out that the new health secretary’s plan is in all fundamental ways consistent with the way the Tories have dealt with the NHS since they were elected in 2010; by gradually withdrawing the funds it needs to function efficiently, leaving patients and staff to become increasingly disheartened, whilst simultaneously opening the back door for private health companies to start cashing in. The main takeaway from Coffey’s plan is not the weakness of the details, but the enormous omissions. It fails to even recognise that the NHS is in crisis, let alone make any serious attempt fix it. The BMA said that it adds up to no more than “rearranging the deckchairs on the Titanic”! This is actually being generous, since it is not political ineptness that we are seeing, but a political decision to sabotage the NHS.

Fightback

There have been in the last couple of weeks positive signs that some of the NHS unions are starting to push back against the government. This week the Royal College of Nursing, for the first time in its 106-year history, started to ballot its 300,000 members, recommending that they vote to strike for better pay. This is a reaction not just to the insulting 5% pay raise the government announced in July (current inflation is 10.1%), but to years of pay freezes that have left nurses struggling to make ends meet - a newly qualified nurse starts on just £27,055 a year in England. A recent survey by NHS Providers⁸ found that some nurses have had to resort to calling in sick in the days before they get paid, because they cannot afford to travel to work; or skipping meals at work, so they can feed their families; or considering leaving for better-paid jobs in pubs or shops. Incredibly - and tragically - 27% of hospital trusts have opened food banks for their staff, and another 19% plan to open one to help relieve the acute financial difficulties nurses and others are facing.⁹

The BMA too will be balloting its junior doctors for strike action in January, after the government ignored its attempts to negotiate more than the 2% pay rise expected in 2022-23 - the BMA has calculated that “pay awards for junior doctors in England from 2008-09 to 2021-22 have delivered a real-terms (RPI) pay cut of 26.1%”. Additionally, for the first time in 40 years, thousands of ambulance crew and paramedics across the country are also being balloted for strike action by the GMB union.

These strikes (with, hopefully, more to come) are a welcome sign. But, of course, the government will already be preparing its anti-strike campaign and lobbying their friends who run the media outlets for their usual support. No doubt Liz Truss is relishing the opportunity to put on her Thatcher costume and play at trying to spook strikers - hoping no doubt it will win her back some Tory support and distract attention from her recent attempts to make the UK economy a write-off. Predictably her line will be about the ‘greedy workers putting patients’ lives at risk - never mind the countless millions who have died or suffered over the past decade as a direct result of NHS underfunding.

In the face of the media bias in favour of the government, no matter how much the general public supports the strikes, they could only hope to have any significant, lasting impact if the strikers had a political party able to give voice to their cause and demands, whilst linking their fight to that of strikers in other industries and the current general struggle of workers just to pay their bills. This, of course, is never going to happen with the likes of Starmer at the helm of the Labour Party. No doubt when NHS staff go on strike he will continue his anti-strike policing by punishing any front bench Labour MPs showing their solidarity on picket lines, etc.

We can only hope that the left - both within and outside Labour - will seriously consider how a political fightback can be coordinated.