Hospital emergency
Hospital emergency

On brink of collapse – Can we save our National Health Service?

Our health service was once one of the best in the world – but not any more.  The NHS is on its knees. What can be done? Lesley Ellis writes 

Scale of the problem    Over seven million sick people are languishing on hospital waiting lists. In December last year, more than 54,000 people in England had to wait more than 12 hours for emergency admission. Seriously ill people are dying before they can be seen by an A and E doctor. The NHS is failing patients and losing staff. 

Causes    Kath Fielder, a GP and Patient Advocate, is clear about the cause: ‘The collapse in our health services is a deliberate policy of this government, a managed decline over the years.’ (The Independent, 7 January 2023). Why would a government preside over slow-scale destruction? Dr Fielder is not the first commentator to conclude that the aim is to dismantle, then privatise it. 

A recent report by the independent charity The King’s Fund states ‘the UK, compared to other countries, does not spend a particularly high proportion of national wealth on health care… a decade of historically low funding increases has left services facing huge pressures…how much is spent on health care is a political choice.’ 

The NHS now faces real-term funding cuts of between £4 billion and £9.4 billion (NHS Confederation analysis 2022). And funding is not the only problem.                                 

Hospital Discharge queues    There are not enough hospital beds. Bed numbers have been halved in the last ten years.  On top of this, flow of patients in and out of hospitals is hampered by problems freeing up bed-space for patients. According to the IFS, in February this year over 14,000 people well enough to be discharged were still in hospital. 

Nobody wants to stay in hospital for longer than they have to, but patients  –  many of them frail and elderly – cannot be discharged without planned support and a safe place to go. To organise this is the job of Social Services. 

Patient handovers    Our Social Services and Health Services are separate bodies with separate budgets (except in Northern Ireland). Handover of patients from NHS care to Social Services is a complicated, time-consuming and inefficient business, and is further hampered by Social Services’ own funding and staffing issues. 

Combining our health and social services, as in other countries, could save money, streamline processes and  improve efficiency and patient care. Parliamentary and Government debate about this issue grinds on. 

NHS staff crisis    Poor conditions, inadequate equipment and low pay create exhausted NHS staff. Many trained doctors and nurses become so demoralised, they look for jobs abroad. Brexit has made matters worse – our hospitals have lost many European nurses. It is unclear whether recent pay deals for nurses will help to stabilise numbers.

One Buckinghamshire midwife with 20 years experience described how scrapping of nursing bursaries, in 2016, has added to staff shortages – fewer people choose or can afford the cost of training. Mature nursing students with life experience, she said, are especially valuable to nursing, but many are now lost to the profession; they simply cannot pay to train and support a family.

Eighteen-year-olds coming into the profession, she said, are shocked and often unable to cope with the harsh realities of working in hospitals today, so they leave. For every 10 nursing students, the workforce increases by only one.                                 

Our county problem    Buckinghamshire nurses face another issue, she added. The county is in one of the most expensive places to live outside London, but our nurses do not qualify for Outer London weighting to boost their salaries. A nurse in Hemel Hempstead or Watford automatically earns up to £5,000 more than a nurse in Stoke Mandeville or Wycombe.

Too few doctors    We need more doctors. One experienced GP told me that just offering more medical degrees will not solve the issue. A falling away of trainee numbers comes when students complete their degrees and are ready for specialist training – general practice, psychiatry, surgery…. There are too few of these expensive training places for medical students to move on to. So they find other jobs.                                       

Underpaid and overworked    UK doctors earn less than their European equivalents. To date, junior doctors have yet to be convinced by the Government’s response to their pay claims and, according to the BMA, four in ten junior doctors plan to leave the NHS as soon as they can find a  job elsewhere (2022).

The IT challenge    The NHS needs highly skilled IT personnel to support the work of medical staff and make hospitals as efficient as they can be. But the NHS cannot attract and retain top quality IT staff because in the private sector these workers can earn up to double the NHS salary.

I spoke to an NHS Change Manager for Buckinghamshire hospitals. She told me that there are not enough IT staff to support hard-pressed doctors and nursing staff, especially when new time-saving and money-saving processes and technology are introduced. Doctors and nurses cannot possibly be expected to take on complex changes in hospital technology systems unsupported, especially when they are struggling heroically to cope with scarcely manageable workloads.

Most of us still firmly believe in the NHS and its founding principles – universal  health care, free at the point of access. But only a third of us now believe it is giving a good service nationally, a recent IPSOS survey showed. What can be done?

Fit for the future    One of Keir Starmer’s missions for the Labour Party is to build an NHS fit for the future. This, the mission statement explains, will be achieved by reforming health and care services to speed up treatment, by harnessing technology and life sciences to help prevent ill health, and to cut health inequalities. 

Money matters    What about funding? The UK is a relatively low wage and low tax economy compared with other OECD countries. Higher average wages and higher taxes for those who can afford to pay would create more tax revenue. More tax revenue would mean more money available to support the NHS. Bigger budget funding is essential if our  much  loved Health Service is to survive and be fit for purpose.



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