On March 4th, around 250,000 NHS workers, patient activists, union members and members of the public from across the country joined a 'Save the NHS' march in Central London.
As we slowly made our way across Bloomsbury and down to Parliament, I chatted to fellow nurses, discussing the desperate state of the NHS. It was clear from the placards and union banners that this demonstration had pulled in people from across the country. The NHS did not seem like an abstract ideal to the people attending, it was something they relied on, worked in or knew that they would need at some point in the future. When compared to other demonstrations, such as the recent anti-Trump one, the average age of participants was noticeably much higher.
But in spite of the size and welcoming atmosphere of the crowd, there was a bittersweet feeling: if only this demonstration had happened twelve months ago; going back a year, in the midst of the junior doctors’ strike, a demonstration of this size would have helped galvanise those on strike, and perhaps slowed the eventual capitulation of the BMA leadership. Now, despite the media attention of the winter crisis in hospitals, very little press coverage of the march would follow.
If you've been lucky enough not to need access to healthcare recently, you may not be aware of how bad things have got. Below is one nurses perspective of how the NHS is buckling under an extraordinary amount of pressure.
People's experiences at GP surgeries can range from an inability to even get an appointment, through the other end of the spectrum, to excellent care. A few things are clear though: there are not enough GPs, whether in surgeries currently, being trained to replace retiring GPs, or to strengthen services where needed. This is due to a lack of money, but increasingly in the future it will also be about an inability to recruit. Horrible working conditions will lead to junior doctors leaving the public sector in search of less stressful jobs, or the country altogether, to work in medicine elsewhere. Uncertainty around Brexit (sorry had to mention it once) means recruitment in other countries is becoming more difficult.
Consultation sessions of ten minutes are increasingly insufficient to help patients manage their complex health conditions well. 'GP held' budgets in the form of Clinical Commissioning Groups (CCGs) promised, in name only, to allow GPs to commission the services their patients needed locally. However, their actual purpose has been to put the government at arm’s length as austerity budgets mean CCGs start rationing operations and care to their patients. Top tip: if the government gives you 'control' of a budget, they're trying to fuck you.
Poor access to adequate GP services can lead to delays in access to diagnostic tests, and late detection of certain diseases. Whilst the NHS offers (for the amount we pay in taxes) a pretty comprehensive range of drugs, treatments and surgeries for conditions such as cancer, UK cancer survival rates lag behind other large economies in Europe. This can be primarily blamed on late detection, because when they are diagnosed, they are at a much later stage, and therefore harder to treat.
As the population ages, the demands on the NHS are predictably rising. However, hospital services have largely stayed static, at best, when it comes to numbers of beds , nurses and doctors. In some acute clinical areas, like A&E and medical admissions wards, this cocktail of increasing demand and insufficient staff leads to avoidable patient deaths on a daily basis. As we speak, local NHS groups are being forced by the Department of Health to develop plans that will further cut hospital services. As you'd expect, they have a delightfully upbeat title, "Sustainability and Transformation Plans" or STPs. As staff skip breaks and work late to keep patients safe, whole swathes of 'salaried' workers are now working hour upon hour of unpaid overtime. Ten years ago, nurses and doctors did this routinely, now it is physios, occupational therapists, pharmacists, and so on. Everyone's goodwill is being manipulated to extract even more 'value' out of them.
In the community, things are worse, (if that's even conceivable). Social care budgets have been cut by 50% in some areas. This has led to councils cutting payments to social care companies providing care to vulnerable people in their own home or residential homes. Falling payments have led to falling wages for care workers with, for example, companies trying not to pay workers for their travel time between home visits. But the cuts have gotten to such a point that care companies are now pulling out of contracts with councils; there isn't sufficient profit for it to be worth their time. Money 'saved' by these cuts is then lost as people need to be admitted to hospital because their living environment is so unsafe their health is affected.
All pretty bleak, and that's not even getting into the creeping privatisation of NHS services. But bleakness is the strategy, as far as I can see. For the NHS to be a viable concept, it has to remain comprehensive. If it is funded sufficiently to meet the needs and expectations of the general public, it is in relative safety.
But when the more affluent in society view it as insufficient for their needs - due to cancelled operations, lack of GP appointments, or unsafely staffed hospitals - then they will vote with their feet and take out private medical insurance. A smart move by the government now would be to start offering tax incentives to people/companies that do just that.
Once the government creates a wedge between rich and poor healthcare users, it will no longer be alone in trying to keep NHS costs down; it will be joined vocally by the affluent and powerful parts of the population that no longer requires the NHS at all. At this point the NHS becomes the de facto healthcare system for the poor, will be severely limited in the services it can afford to provide and left to rot on the vine. At this point, anyone who can afford health insurance will then make the effort to buy coverage, causing the split to grow larger.
Where does that leave healthcare workers and the public in general that want an affordable, high quality, comprehensive healthcare system?
Firstly, the severity of the situation must be recognised: this is not a winter crisis, but the grinding down of the NHS until it is no longer a safe provider of care.
But secondly, and perhaps most importantly, although austerity is being designed at the national level, cuts will be at their most visible when local hospitals are closing maternity services, A&E departments, and so on. For these cuts to be effectively opposed it will require the collective action of health workers, patients and the general public. We'll need to be organised and creative, utilising every strategy that's proven effective in the past, pickets, bed occupations, solidarity strikes, and more.
Successful examples of these, like the campaign to save Lewisham Hospital, are all too rare these days but we’ll need much more of them if we’re to save the NHS. The alternative, of losing entirely the idea of a healthcare system that meets the needs of everyone and is free at the point use, really doesn’t bear thinking about.