Defend the heath service and support its largest ever strikes

Striking workers marching in London 1 February

By Terry Williams

Following the biggest strike day (Wednesday 1 February) that Britain has seen for a decade, there will be the biggest strikes ever to hit the health service in the week starting on Monday 6 February. Workers are mobilising in defence of public services, against real pay cuts and the attacks on trade union rights.

1 February – biggest strike day for a decade

On 1 February unions representing teachers, civil servants and train drivers ensured that most schools were at least partly closed, slashed rail services and shut down public services such as the British Museum. Large demonstrations took place in many cities. There were reports of 40,000 marching in London, several thousand in Sheffield, Bristol, Manchester and Nottingham, with many protestors expressing a positive and determined mood.

The strikers also took up the Trades Union Congress’ call for a day of action against the Tories’ new anti-union legislation that will restrict the right to strike by imposing so called ‘minimum service’ requirements on a range of sectors, including transport, health and education.

In the two weeks leading up to 1 February, the National Education Union (NEU) had recruited an additional 40,000 new members for its first day of action.

Week beginning 6 February – escalating action

A wide range of unions will be taking industrial action in the week commencing on Monday 6 February. This includes RCN nurses who will begin a third round of strike action in England, Wales and Northern Ireland. Ambulance workers will stage a strike, with the GMB, Unison and Unite coordinating their actions across England and Wales. Chartered Society of Physiotherapy members across England will continue their strike action. UCU University staff at more than 150 universities will also be striking again.

Health care is in crisis

For decades the NHS used to, year on year, improve the provision of health care. That is no longer the case. Life expectancy has declined in England and Wales, avoidable deaths have been rising, NHS waiting lists have shot up and the waiting time for treatment in emergency departments continues to rise. The graphs below, produced by the Financial Times (FT), indicate the damming scale of the crisis that has bought the health service to its knees.

The Royal College of Emergency Medicine (RCEM) has reported that some patients in emergency departments have been waiting to be admitted for up to four days, when it used to be four hours. In January the RCEM estimated that between 300 and 500 people were dying as the consequence of delays in urgent and emergency care each week.

Health outcomes are far poorer in the UK than comparative developed nations. Britain’s avoidable mortality (that is premature deaths that should not occur with timely and effective healthcare) has risen and it has now reached the highest level among its peers (Austria, Canada, Denmark, Germany, Finland, France, Netherlands, Norway, Sweden and Switzerland), other than compared to the US which is even worse. Health Foundation data indicates that UK survival rates for some conditions are very poor. For example in the UK, only 13 per cent of those diagnosed with lung cancer live for at least five years, in comparison with Japan where 33 per cent live for at least five years. Another example: nine per cent of those who suffer the most common type of stroke in the UK died within 30 days, compared with 6.2 per cent in Germany. The UK has lower quality healthcare relative to other countries.

NHS staffing and pay

Levels of staffing in the NHS are inadequate – the RCN reports that only 25% of nursing shifts are fully staffed. Due to both the stress on health workers and their poor pay, many NHS staff are leaving the service, and the rate of departure is accelerating. The number of nurses leaving the NHS in the year to June 2022 was 40,365. That is about 11.5 per cent of the total number of nurses and the highest rate of loss on record.

The resulting high rate of vacancies has placed a very heavy workload on the remaining staff. Additionally health workers have lost pay, year on year, for more than a decade. The pay offers made for 2022-23 have been for further real-terms pay cuts, when inflation is rampant. Some nurses are now having to rely on foodbanks to feed their families – an increasingly common situation across many parts of the public sector.

Tories are starving the NHS of funds

As the graphs below clearly reveal, since the Tories returned to government in 2010, overall government spending (as %age of GDP) and the spending on healthcare have declined. Public sector investment has been cut and drastically slashed in healthcare (Gross fixed capital formation). The graphs below indicate the changes in Britain, in comparison with the peer countries: Austria, Canada, Denmark, Germany, Finland, France, Netherlands, Norway, Sweden, Switzerland and the US.

Investment in Britain’s healthcare infrastructure halved between 2010 and 2013, leaving health workers across the board hamstrung by shortages of beds and other equipment. Britain has an ageing and ailing population so, to maintain previous standards of health care, spending should have risen.

Britain now spends far less per head on healthcare than its European neighbours France or Germany and it has far fewer hospital beds and other equipment. The graphs (from the FT) below show how Britain’s healthcare capital investment has not only declined, but has left its health service trailing significantly behind that of comparable developed nations. On the key indicators: capital spending on healthcare (as %age of GDP), and the numbers (per capita) of hospital beds, MRI scanners and CT scanners, the UK has fallen behind its peer countries (Austria, Canada, Denmark, Germany, Finland, France, Netherlands, Norway, Sweden, Switzerland and the US).

The Health Foundation has reported that, over the past decade, every year, the UK has been spending about 20 per cent less per person on health than similar European countries. UK health spending would have needed to rise by an average of £40bn every year in the past decade to match the per capita health spending across the 14 EU countries the foundation researched. The greater health care expenditure, including capital investment, in these other European countries meant they had higher staffing ratios and a larger number of beds when the Covid pandemic first struck, enabling them to tackle the virus without disrupting other healthcare to the degree it has suffered in the UK’s NHS.

To save the NHS – government priorities must change

The fundamental economic policies that the Tories are pursuing in government are 1) to shift resources from the public sector to the private sector, by cutting services, reducing corporate taxation and privatisation, and 2) within public expenditure the focus of policy is on shifting resources from public services to the military. It is this framework that has to change if there is to be any chance of saving the NHS. Resources need to dramatically shift in the opposite direction, so that the health care crisis, including the NHS staff shortages, can be tackled. Extra investment is needed now.

The Tories are not going to change the government’s fundamental economic priorities and are discussing further attacks on the NHS’s long-standing principle that treatment should be free at the point of delivery. A former health secretary is now calling for the introduction of charges for GP appointments and emergency department visits.

Unfortunately, the Labour leadership is not willing to consider the change in economic policy direction that is necessary. It endorses the overall Tory government framework, including its economic priorities, so it proposes to ‘reform’ the NHS, without addressing the huge shortfall in funding. Labour’s front bench proposes increasing the use of the private sector in healthcare, claiming this is the way to cut NHS waiting lists. Additionally it plans to allow patients to bypass GPs and refer themselves to specialists. The Doctors’ Association UK has described this latter proposal as ‘downright unsafe’.

There is significant opposition within the Labour Party to its leadership’s right-wing pro-private sector orientation. A large part of the party is likely to have agreed with Sharon Graham, Unite general secretary, when she said that ‘Labour’s key message now should be that it will reverse those cuts so the NHS can truly get back on its feet, not that it will drive through yet another round of disruptive reform.’

Support the strikes

Following next week’s strikes, further widespread action is expected, including from FBU fire fighters and emergency staff, and more strikes from rail workers, postal workers, civil servants, teachers, and lecturers. The strike wave is set to continue.

All those who support the public services should actively promote these strikes, alongside the political demands that provide solutions to the current crisis. These demands include: increasing government’s finances through progressive taxation, shifting resources from military spending to public services, real pay increases for workers and the repeal of anti-union laws not more draconian restrictions.