05.01.2023

NHS in meltdown

The Tories have a barely hidden agenda to wreck the post-1945 health service. But James Linney warns against trusting Sir Keir’s alternative government

Having said goodbye to 2022, it is clear that 2023 is going to be even bleaker. The rate of inflation, down a tad, is still 10% plus - and falling real wages sees more and more working people struggling just to secure the basics: housing, food and heating.

The lack of any meaningful political opposition has meant that the front line of the fightback against real poverty has been led by the trade unions and we have seen a marked increase in strike action. December alone saw an average of almost one strike a day, with university staff, postal workers, fire-fighters, security workers, bus drivers, railway workers and UK Border Force staff all balloting in favour of strike action. So many strikes have not been seen since the so called Winter of Discontent of 1978-79, although there are only about half as many trade union members now (6.4m) compared to 1979 (13.2m)¹ and the political influence of the unions has been in decline over the decades.

It has been the strikes by nurses and ambulance crews though that has had most media attention. These strikes have been in protest against the government implementing only a 4.5% pay-rise for National Health Service staff for the year 2022-23, way below inflation rates and on the back of nearly a decade of pay ‘restraint’. The Royal College of Nursing is asking the government to restore pay to the 2010 level and the ambulance crews are looking for a pay increase at least in line with the current inflation rate. While pay is the basis of strikes, unions and their members have continued to highlight that more is at stake: the low pay levels are directly related to the staffing crisis in the NHS - currently there are an estimated 130,000 job vacancies - and that the strikes are part of a bigger fight to prevent the NHS from collapsing.

So far the RCN has organised strikes on December 15 and 20. These were the first in their 106-year history and they plan further strikes on January 18 and 19. Paramedics and ambulance crews, represented by Unison, Unite and the GMB, have so far held a strike on December 21 and further actions are planned for January 11 and 23.

Let’s remind ourselves what has led to this very unusual situation of NHS staff striking. Public sector wages have been declining more than the private sector, with the biggest fall occurring in the past two years. Between January 2021 and September 2022, average real pay in the private sector fell by 1.5%, but in the public sector it dropped by 7.7%². Nurses’ pay has been declining more than any other sector. According to a recent report by London Economics,³

Between 2010-11 and 2022-23, nurses’ salaries in England, Wales and Northern Ireland at the top of Band 5 and Band 6 have declined by at least 20% in real terms. In other words, an experienced nurse in 2022-23 is being paid the same amount for 5 days’ work as for 4 days’ work in 2010-11.

It goes on to conclude:

Looking into the future the very high expected levels of inflation mean that nurses at the top of Band 5 in England would need a 45% cumulative pay rise in 2023‑24 and 2024-25 (ie, around 21% per year) to achieve the same real earnings as in 2010-11.

As has been widely reported, on a current nurse’s wage (starting salary just £27,055) people have had to resort to skipping meals, taking a second job or using food banks in order to get by and provide for their families⁴.

As the wages of NHS staff have declined, at the same time their working environment has become ever more challenging. The reality of Tory disdain for the NHS is clearly evident to anyone unfortunate enough to find themselves in an Accident and Emergency department. Waiting times are at an all-time high: in November, 45% of people had to wait more than 4 hours to be seen and for elective care 7.21 million people are waiting for treatment. And things are going from bad to worse. Ambulance response times are equally alarming, with crews being unable to respond to almost one in four 999 calls because so many were tied up outside A&Es waiting to hand patients over.⁵ In addition to this, more cancer targets are being missed than ever, primary care is in complete crisis and all the time more and more of NHS care is being provided by private companies able to cherry-pick services, leading to ever diminishing quality of care. It takes intent and determination to mismanage the NHS as well as the Tories have over the past decade, and the result is a service on the brink of complete collapse.

Pay review

The government’s opposition and refusal to negotiate with the NHS strikers has been predictable but at the same time seemed rather half-hearted. For the most part Rishi Sunak has tried hard to avoid answering questions about the strikes. And when he has answered, he has repeated the same rhetoric about following the guidance on pay as set out by the NHS Pay Review Body (NHSPRB). Let’s remember the government is under no obligation to follow these pay recommendations and that this so called ‘independent body’ is no such thing: it consists of a group of Tory hand-picked, pro-business bureaucrats.

Of course we have seen NHS staff being vilified by Tory MPs for taking strike action; just as striking teachers supposedly don’t care about the children, or railway workers and border staff wish to impose chaos on travellers, we are by told by health secretary Stephen Barclay that striking NHS staff “have made a conscious choice to inflict harm on patients”.

Striking NHS staff strive to limit harm to patients: nurses still provide urgent care and ambulance crews still respond to urgent (category 1 and 2) calls. But any harm resulting from the couple of days striking is dwarfed by the daily suffering and death at the hands of the Tories’ sabotaging of the NHS. So, for example in October, according to the Association of Ambulance Chief Executives, almost 44,000 patients experienced potential harm as a result of long handover delays and nearly 5,000 of these experienced severe harm (including deaths).⁶

This week the president of the Royal College of Emergency Medicine, Dr Adrian Boyle, said:

What we’re seeing now in terms of these long waits is being associated with increased mortality, and we think somewhere between 300 and 500 people are dying as a consequence of delays and problems with urgent and emergency care each week.

These harms are evident to the public. They are the ones unable to get general practitioner appointments or have 10-hour waits to get care in A&E. Despite the attempts to blame NHS staff, there is much solidarity and support for the strikes. Most people can clearly see that NHS workers are doing their best in horrendous circumstances. Hence a recent YouGov poll finding that 66% of the public support the nurses’ strike, with 45% of people saying they “strongly” support it, and 63% supporting ambulance crew strikes.

Unfortunately this support isn’t shared by Keir Starmer. In a recent interview, when asked if he would pay nurses more, he replied, “I think 19% is more than can be afforded by the government” - and he has repeatedly refused to say whether he supports the call for better NHS pay. The only difference in his outlook compared to Sunak’s is a tactical one. Even if we did take him at his word, which is never advisable, and believed he would sit down and talk to the unions, no doubt he would be offering a meagre increase on the 5% pay that the government is currently offering. In other words, an offer that will neither significantly improve the lives of NHS staff nor stall the decline of the NHS. Of course Starmer has previously shown his disdain for striking workers and although the public support for the strikes has meant Starmer being less vocally critical this time, his message to capitalists is clear: “I’m on your side, I’m a safe pair of hands, no threat here”.

This year will certainly see more strike action than the previous one. Nurses and ambulance crews have further strikes planned, and on January 9 the British Medical Association - the largest union representing doctors - is balloting junior doctors for strike action, and they are certainly going to vote in favour. Junior doctors too, crippled by tens of thousands of pounds of graduate debt, have seen their wages declining for over a decade. They work long hours, often doing unpaid extra hours and, like nurses, are working in an environment that increasingly looks like a war zone; the proletarianisation of doctors has resulted in a new generation that is increasingly politicised and anti-Tory.

Whilst we must fully support and champion the strikers’ cause, strikes alone will not save the NHS. Both the NHS strikes and the increased industrial action generally are defensive, a reflex against the increasing attacks on the working class. They can help give relief and they can enable a more politically conscious workforce, but unfortunately they do not mean the working class is in a stronger position. For that they need a party that can give voice to their potential. Never has this goal been more urgent.