Patients are getting nothing for extra NHS spending
Strikes simply highlight that the system isn’t working for anyone and needs reforming
The NHS has a record amount of cash flowing its way, yet potentially has a record-setting catastrophe on its hands – one that will be made far worse by the strikes planned for later this month.
There is no point even pretending any more that the NHS is delivering on its promise of universal access to healthcare. It is now a game of chance – or sheer luck, if you do receive treatment and care in a decent time frame through the NHS.
This week’s data drop from NHS England, once again, shows the scale of the problem. On many metrics, the system is collapsing further, with the waiting list reaching a new record of 7.2m appointments – a figure that the Government admits will only rise further before it starts to go down. The number of people waiting more than a year for surgery is surging, too – now 411,000, more than double the number projected by the NHS and Department of Health at the start of the year.
Even the numbers going in the right direction still hover around frightening highs. The number of people waiting for more than 12 hours in A&E has slightly fallen from last month’s record high of 44,000 down to 38,000; while the waiting time for an ambulance to arrive for a “category two” call is now down to 48 minutes, from over an hour’s wait. Make no mistake: these are emergency calls, with people suffering from life-threatening illness. It is not an inconvenience to wait for the ambulance to show up. It is a matter of life and death.
The personal stories behind these figures are harrowing: people in agony waiting months on end for treatment; people plunged into anxiety, wondering if they’ll be seen in time. This pain, and these risks, are only going to worsen as the month goes on, as nurses and ambulance workers walk out in protest, demanding more pay to return.
Not all strikes are created equal in the public’s mind, and on the face of it, the nurses have their support. Unlike the RMT – which rejected an 8pc pay raise and announced a strike over Christmas instead – polls remain firmly on the side of the nurses. However, that support has fallen somewhat since the summer, with a poll this week showing 54pc support for their upcoming strikes.
Last year the median salary of train drivers was £59,000, nearly double the average salary in the UK. Meanwhile the average baseline salary for nurses is right around the average salary in Britain – and low by international standards. A British nurse’s counterpart in Chile is likely to be on a higher base wage. It’s important to note that for plenty of nurses, these numbers don’t reflect their overall salary, as well-paid locum work can significantly boost their take-home pay. But it is not hard to make the case that nurses, on the whole, are an underpaid profession – and have been for some time.
Yet when the realities of the strike kick in, will the RCN, GMB, Unite and Unison workers be able to retain this support? With nurses striking on Dec 15 and 20, and ambulance workers, including support staff and call handlers, going on strike at select NHS Trusts on Dec 21 and 28, access to treatment is undoubtedly going to fall even further. The back-to-back absence of nurses on Dec 20 and ambulance workers on Dec 21 is going to cause 48 hours of chaos. It is impossible to claim that lives won’t be on the line because of this decision to piggyback walkouts.
The risk for Rishi Sunak’s Government is that its refusal to give nurses the pay raise they are demanding – close to double an inflation-linked pay rise – will be seen as cold and heartless. The risk to the workers on strike, however, could be greater. With ambulances already unable to show up in a timely manner for so many patients, it is a great unknown how people are going to react when rather than being delayed, they are choosing not to show up at all.
And while demands for more cash tend to be popular – and are often successful – it is becoming an increasingly tough sell. Before the pandemic hit, Britain’s health spending was well above the OECD average, something that hadn’t been true throughout the whole of the 2010s. And since Covid, funding has skyrocketed, with NHS England receiving a record level of £152.6bn this financial year. This has been propped up further by the £13bn guaranteed by the nowdefunct National Insurance levy (Government has promised to keep the cash flowing despite the reverse in the tax) and then an additional £3bn announced by Chancellor Jeremy Hunt in his Autumn Statement. Some of that £13bn was supposed to contribute to pay raises for nurses.
In 2020-21, it’s estimated that 44pc of the NHS budget reserved for “hospital and community health settings” was spent on staffing costs – so where is all this new money going? Not, it seems, to the nurses who, on many grounds, have a point about their pay. Nor are there any signs so far that this money is getting patients faster access to front-line services.
Indeed, what these strikes might end up highlighting is not how much more money the Government needs to pledge to the NHS, but rather how badly the record levels of funding it gets now are managed.
The NHS was an underperforming health service long before the pandemic hit. It’s been a black hole for taxpayer cash for decades, churning out lacklustre outcomes for the patients and comparatively poor salaries and working conditions for workers. As the NHS is the monopoly provider of healthcare across Britain, there is nowhere else for the sick or the staff to turn when the system lets them down.
The strikes may be designed to address pay and working conditions, but their walkout may shine light on a harsh truth many within the NHS are still unwilling to admit: the system isn’t working for anyone. And no amount of cash is likely to save it without reform.