The Conservatives’ NHS Crisis
- It is embarrassingly easy to show that conscious underfunding and understaffing are causing the ongoing crisis in our healthcare system
- A crisis is happening in our healthcare system
- A&E wards are overwhelmed by the legitimately ill
- Sepia is the ink used by cuttlefish as a defensive mechanism to confuse, allowing them to escape predators and sneak up on prey
- Probably not a great idea to trust Theresa May over the people we trust with our lives
In 1948 the greatest delivery model for medical care that the world had ever seen was established. For the first time in history the population of a country had access to the full range of healthcare then available in a remarkably fair and even fashion, deliberately and with remarkable success crafted to avoid poorer areas being granted poorer services. The NHS was a dramatic improvement in services across the nation —medical care was established as a human right by the weirdo, Nazi-defeating Commies of our greatest generation.
Single payer, universally provided healthcare services continue to outperform private models well into the 21st century at an increasing pace: we needed it, too, what with Midget Gems and the magnificent rise of craft beer. Patient outcomes are consistently better, access to GPs superior, medical errors less likely to occur, doctor per capita ratios better, cost efficiencies dramatically superior — to the extent that the vast majority of wealthy nations on the planet have since attempted to emulate a success that may legitimately be called glorious while looking only a little pretentious. The most glaring exception — the United States of America — has instead attempted to patch in limited public insurance coverage for private provisions, resulting in the most expensive and least efficient healthcare system on the planet. The US experiences the highest total expenditure of resources on medical care by an incomprehensibly large margin, one of the highest public expenditures per head in a desperate rearguard action to rescue millions of people who would otherwise be unable to afford insurance — and millions who still cannot — with completely mediocre results. One in three Americans must forego medical procedures at some point in their lives, which is a travesty in terms of lost productivity due to illness, since such a thing matters so much, and in terms of debilitating and unnecessary suffering that only escalates without treatment.
Why then has the Red Cross declared a ‘humanitarian crisis’ in the UK this winter? Why does the Society for Acute Medicine’s President Mark Holland describe this terminology as ‘not a million miles away from the truth’? Do they not know a crisis is not happening?
A third of all trusts came under intense pressure that compromised patient care, an ‘unbelievably’ high and unprecedented number of hospitals were unable to cope with demand. This is perfectly normal. The fact that this state of emergency is ongoing in hospitals across the country even as the Health Secretary declares the crisis — after having denounced it as ever happening — as having been resolved a week ago is also perfectly normal. It is perfectly normal for 23 hospitals to indicate they simply stopped having the facilities to render the care necessary to save lives — or rather one or two hospitals have a problem according to our beloved Health Secretary Jeremy Hunt, so we can safely ignore the opinions of the people running the hospitals. It is perfectly normal for patients to die after waiting for 35 hours in a corridor. 151 trusts out of 152 failed to meet the four hour A&E wait target, which is as perfectly normal as the fact that this information had to be leaked by a whistleblower. Endure it.
The chief executive of Colchester and Ipswich trusts Nick Hulme said ‘I’ve not seen anything like this in 37 years in the health service’, which we can all agree is perfectly normal. Royal College of Emergency Medicine President Taj Hassan pointed out ‘Going into winter we were in the worst-prepared position that we have ever been’, which is merely medical lingo establishing that all is perfectly normal. He also pointed out it is perfectly normal for one quarter of all A&E wards to be unsafe due to overcrowding and understaffing, or, as Prime Minister Theresa May put it, a ‘small number of incidents of unacceptable practice’. The accounts of front line staff make for harrowing reading — which is a perfectly normal level of demoralising misery for staff and patients, and acceptable. We should put up with it.
It is perfectly normal that more than two million people waited over the target of four hours in accident and emergency departments last year. Waits longer than half a day, seriously being stuck in a waiting room for over 12 hours, have almost trebled amongst the elderly in just two years. It is perfectly normal for 12 out of 13 ambulance trusts which we already knew to be grossly understaffed by hundreds of people fail to meet targets to attend life threatening situations in eight minutes, and that ‘500,000 hours of ambulance crews’ time in England, Wales and Northern Ireland was lost last year waiting for A&E staff to be free to hand over their patients to — a rise of 52% in two years’. It is perfectly normal for surgeries to be cancelled all over the country at an unprecedented scale and scope. It is perfectly normal for patients to be forced to wait in ambulances until beds or wards are opened up. It is perfectly normal for hospitals to deny treatments to the obese and to smokers, betraying the very foundation of what the NHS is. It is perfectly normal for cancer patients to be denied surgery because no specialist beds are free as hospitals desperately try to cope with day-to-day demand. The Royal College of Nursing reports nurses describing ‘serious concerns over the quality of the care they can provide in what for many are the worst conditions they have ever experienced’, which is perfectly normal.
Fortunately we can overcome this perfectly normal never before seen level of suffering in understaffed, underfunded hospitals by scrapping targets of care, as Hunt has winsomely decided to do. He has given no explanation as to why eliminating these targets improves patient care, improves patient access to healthcare, or encourages a more appropriate allocation of resources — as these are the only legitimate reasons for scrapping such targets surely he must have these reasons; who are we to hear them? It does appear to remove an embarrassing quantitative assessment of his failures as health secretary: he has not met A&E waiting time targets since July 2015. If he fails to meet these perfectly reasonable targets, surely the best thing is to do away with them as a benchmark. Perhaps he is correct: perhaps we should wait for more than four hours if we have what we believe could be an emergency, and we should have to wait for longer than 8 minutes for ambulances to arrive if we’re merely having a stroke. The fact that these benchmarks were eminently attainable before his tenure is a symptom of Labour’s failures.
Mr Hunt has spoken of the need for independent assessments — other than those of voluntary charities like the Red Cross evidently. Let us see if we may find some: The Royal College of Paediatricians issued a letter explaining ‘Our NHS is underfunded, underdoctored and overstretched. The ambulances queuing outside emergency departments are a visual testament to the crisis in social care and the NHS. Our hospitals are over-full, with too few qualified staff, and our primary, community, social care and public health services are struggling or failing to cope. Patients are waiting longer on lists, on trolleys, in emergency departments and in their homes for the care they need. Pressures in social care are pushing more people into our hospitals and trapping them there for longer. […] In our recent survey of doctors in training, seven out of ten reported working on a rota with permanent gaps, and over nine out of ten reported gaps in nursing rotas.’
Oddly that seems to exactly contradict what the Government tells us, and it seems oddly in line with demonstrable fact. Let us see if we can journey together and crack this ineffable mystery.
Extensive, deliberate cuts to funding and staffing levels relative to the increasing population and wealth of the country are failing the best system in the world, in addition to the thoroughly bungled attempt at restructuring social and primary care through the Health and Social Care Act 2012, which critics correctly noted would rapidly and inevitably privatise our health services — at a cost to the NHS of over £4.5 billion annually. Our politicians and their appointees are left lying rather brazenly about some rather straightforward facts — even openly lying for a week that there was even a problem — and issuing demonstrable falsehoods in defence of the horror they have wrought through malice or incompetence. The tabloid press routinely works to support them and in doing so dismisses the heads of our trusts, hospitals and ambulance services, dismisses our front line staff — the doctors and nurses who shoulder enormous responsibility, and endure the most oversight and toughest conditions of any in our history — and dismisses very obvious aspects of objective reality.
The most severe problem afflicting the NHS today is severe under spending. Our current Government has spoken of £10 billion extra funding and rather boldly suggests this is more than the NHS has asked for in its five year plan. This is completely untrue: the figure is for six years of spending and ignores billions of pounds of cuts to healthcare services outside of a very narrow category called ‘NHS England’, meaning our healthcare system is, in fact, being deliberately underfunded by billions of pounds under this Parliament. Excluded from this category, for instance, is spending on training and recruiting new NHS staff. We no longer pay student nurses to work for us, even though earning their degrees means literally taking on the burdens and responsibilities of certified nurses. This itself means, at a time when nurses are in critically short reply —an absurd 90% of hospitals are understaffed— nursing applications have fallen by 20% across UK universities this year. By design we will not be getting nurses to replace those we already know ourselves to be short of, as a direct result of the scrapping of bursaries, a problem the Government was warned of repeatedly. They knew and did it anyway.
The Health Secretary has admitted to the falsity of the £10 Bn figure while under Commons scrutiny, and yet the Government continues to make the claim, as recently as a few days ago. The chutzpah of these cuts seem almost designed to be astonishingly ironic — including the slashing of hundreds of millions of pounds put aside to fund mental healthcare facilities for children — at the same time as May has trumpeted £15 million going towards training school staff and companies in mental health support. While newspapers glory in this supposed ‘extra’ money — which is actually an enormous slash to earmarked services — mental health services have disgracefully deteriorated due to chronic underfunding and Government mismanagement, all while the Government vaguely speaks of ambitious projects that consistently fail to materialise. May in particular appears under the bewildering impression that coining terms such as ‘just about managing’ and ‘shared society’ in of itself ameliorates those social ills her negligence worsens. Indeed, this is the second time the Conservatives have proposed an overhaul in the way we address mental health: she has personally chosen to destroy the first and re-appropriated the money. It is not terribly uncharitable to acknowledge as much will be done this time.
More context only makes the dishonesty in this claim more transparent. Hunt has suggested that Britain has one of the highest healthcare expenditures of rich nations. This is asinine: we had, just a few years ago, the most efficient healthcare system in the world; we have literally the best healthcare model the world has ever seen for expenditure consistently below the OECD and EU average, and a great many of those nations are not even terribly rich.
Any newspaper or news source telling you differently is engaging in a public relations battle to sew doubt on an extremely straightforward set of numbers.
Since 2009, spending on healthcare has dropped per GDP and per person terms: the longest sustained fall in funding in history. From the period 2009–2013 spending even fell in real terms, astonishingly and despicably, despite Conservative promises to ring fence the NHS. Per any metric you care to use healthcare has consistently been underfunded in the UK during the Conservatives’ tenure.
We are spending less on each person in the country than we did in 2009 — a situation that will only worsen into 2020 given the paltry amount earmarked by May’s Government — which alone demonstrates an enormous deterioration in services. The sustained and worsening decline in funding compared to GDP means the recession is not to blame: this is deliberate policy. While this winter sees crisis, the long term picture is even more dire: 131 Trusts out of 138 are in the red, meaning we are forced to either spend far more next year to catch up, or slash services even more extensively.
So what have the Government and right wing tabloids blamed for this crisis we can simultaneously be safe in the knowledge is not happening?
Oh. It is perfectly normal that in one week this winter 18,000 people admitted by staff — that is, people with serious issues admitted by paramedics and other experts, rather than us filthy, time wasting scroungers deciding for ourselves if we should get something checked out — waited for more than four hours. We are supposed to be so ignorant as to be unable to understand that sick patients bizarrely occupy beds longer than those who are less sick and should be the focus of efforts to improve A&E waiting times: we are to pretend those who end up not being ill enough to become bed bound are the ones using up all the beds. It is also perfectly normal that this information also has to be leaked to the BBC for the public to hear it.
The greatest causes of bed shortages this winter are actually very clear, our medical professionals have have been struggling desperately to inform the Government and the public about this coming disaster, and did you know that the cloud of ink the cuttlefish shoots out to disorientate victims is called sepia? To use it in a sentence: the pretence that patients attending A&E unnecessarily are to blame is a very obvious attempt to avoid responsibility for failing to address problems the Government knew about in advance and did nothing to avoid, and also sepia is the ink used by cuttlefish used to stultify and confuse victims.
There have also been exceptional and unprecedented cuts in social healthcare spending, including a reduction of one third of local authority social care budgets — which have lost £4.6 billion since 2011 — resulting in record levels of bed-blocking, which has now become so bad that the problem barely eased in summer. The problem of a complete lack of paediatric beds was known about for months, we were warned of it repeatedly, vociferously from every wing of our healthcare services which pleaded for more social care funding, higher levels of A&E staffing, more beds, but the symptoms and the underlying causes remained unfixed as we entered winter. Hundreds of thousands of people who had hitherto been able to return to be cared for at home simply no longer have the option — there is no longer money for this care — resulting in their being forced to stay in hospital, hence the need for so much more volunteer assistance from the British Red Cross this year. Delays for otherwise able bodied people who should have gone home to be cared for has increased 40% this year alone — an absolutely astonishing figure directly attributable to a definite cause. Luckily, help is on hand: social care funding will be slashed a further £2.6 billion into 2020. When asked, the medical director for acute care at NHS England Keith Willet ‘would not answer whether the Government was taking reforms to social care of patients returned from hospital seriously’. Perhaps we can take a stab at answering.
Moreover this is happening at the same time as crucial understaffing at A&E wards — fewer than 1 in 6 are adequately staffed; this issue, deteriorating facilities and overwhelming demand, problems identified and warned about literally years ago have reinforced horrendous staff turnover and turned doctors and nurses away by annihilating morale. Luckily, local A&E and other specialist wards are set to be closed across the country by plans introduced by this department of health’s political appointees in response to funding cuts — the same ones who dither about whether this is a crisis and condemned the junior doctors’ strike on the grounds that it risked patient safety, leading to spectacularly absurd headlines about what ‘the NHS’ is saying.
Realising that blaming the public is not terribly good PR, Theresa May, Jeremy Hunt and their sycophants have tried to blame a contract negotiated in 2004 by GPs for a lack of access to medical staff that drives unnecessary attendance in A&E; the Daily Mail in particular is on an oddly perverse crusade to blame every problem generated by spending cuts on this contract. Yet the surge in A&E admissions began in 2003, one year before the contract was signed — and in 2013, nine years later, access to after hours care in the UK was amongst the best in the world, as it consistently had been since the contract was signed:
It is almost as if access to GPs is not to blame, and this whole line of argument is nought but sepia spurted from every dread Government orifice. Indeed, it is somewhat confusing why GP opening hours should be blamed for A&E use. The problem is that like every good piece of fiction the suspension of disbelief is necessary. We are not giving the narrative a good enough go: of course we should assume we are too stupid to understand opening times; if a GP is closed in the middle of the day for a couple of hours, we are so intellectually stymied that we cannot figure out what this means, inevitably leading us to panic and misuse accident and emergency wards. We are so fatuous and useless a people that the scribblers writing at the level of ten year old children get to talk down to us about when our GPs are available and accuse us of misusing the services we have built for ourselves. We are so ignorant of the complicated issues of having amongst the very best access to doctors and nurses in the entire world that we get to have a health secretary who openly misused A&E services and the worst home secretary of the modern era scold us like wayward puppies about the ageing population but then refuse to fund our health services in response to it.
It is normal for people to attend A&E unnecessarily. But while wallies who intentionally waste A&E resources and time — like Jeremy Hunt — certainly abound, doctors and nurses, stretched as they are, are not stupid, cruel or evil enough to pretend that we are always the best judges of our ailments: something that seems like it could be an emergency could turn out to be a chronic condition better suited to a GP or other specialists, for instance. It is shameful that a couple of unelected members of the Executive are trying to discourage us from attending A&E: so many of our most vulnerable already suffer and die from treatable ailments because of a culture that makes us embarrassed to use resources that exist for our benefit. The staff there are as happy as we are when potentially iffy symptoms turn out to be something minor or as happy to point us in the right direction if it turns out to require different specialists. We are not a burden — the NHS exists for us.
May’s solution, of course, is to threaten the funding of GPs. This will surely help to resolve the fact that a full third of GP vacancies went unfilled last year resulting in 80% — 80%! — of GPs reporting this risked the safety of the care they could provide. Actually that failure to fill vacancies would be the Government’s fault, so that can’t be the issue.
The Government’s solution will not increase patient access to GP surgeries: access to GP surgeries is already exceptionally high. The problems in A&E are caused by understaffing, bed blocking caused by annihilated social care funding and increasing legitimate demand, and the plan the Conservatives propose is incredibly inefficient, not in demand and absurdly costly. The vast majority of us already know the exceptional effort our GPs, our doctors and our nurses put in so as to see us in a timely manner despite work loads we can see are horrific. And of course May’s 7 day plan includes no provision for extra GPs or nurses despite levying such an incredible extra burden: at this point it becomes completely academic whether bringing aspects of the healthcare system to such obvious dire straits are due to conscious intentions to destroy it or sheer bumbling idiocy. Terrible ideas that experts oppose and evidence eviscerates but which are pushed through inevitably by an inept Government looks to be the theme of 2017.
Then, of course, comes the natural scapegoat of the coward: immigration.
While the PM and Health Secretary will be briefed on this information and must lie to us, Dorries is merely an MP, and will glean what passes for her knowledge from a newspaper like the rest of us. Her ignorance may be forgiven: why expect our elected representatives to take an interest in fact? Meanwhile, of course, we would be unable to afford the public services which make our quality of life so grand without immigrants: they pay more in taxes than they take in public services. Even if every scaremongering story of health tourism were true; even if every penny in NHS care given to immigrants taken in perfidy, their fellow immigrant pays more in taxes than that stolen by nefarious and oft fictional thievery. Immigrants are not a burden on our system: they enrich it. This is particularly true of immigrants from the EU, and we literally depend on immigrants for the NHS, given that they make up more than a tenth of staff. Far from placing pressure on the NHS waiting times are slashed in regions as immigration increases — immigrants are more productive, healthier and more committed to public service than the rest of the population.
But perhaps the Royal College of Paediatricians, the Society for Acute Medicine, the Royal Society of Surgeons, the Royal College of Nursing, GPs, the Royal College of Emergency Medicine, the British Red Cross, every ambulance and hospital trust in the country, the nurses and doctors we interact with and who are desperate to make their voices heard, and basic statistical evidence are being unfair in trying to warn us about funding and staffing. Perhaps they are merely filled with the greedy desire for the facilities and professionals necessary to treat us without inadvertently causing death or injury, or with the paltry state of being mathematical models that edify us about information. Perhaps you would be right to trust the Government — which already lied about this even happening — over them.
Oh, and if you are in any position to question the Government on any of these points in a public forum, it could lose you your job.
