|Volume 53 Number 23, August 5, 2023
At an NHS England board meeting in Birmingham on July 27, plans were announced to prepare for the extra strain on the NHS in the coming winter . The new measures of the winter plan are, in the words of NHS England, a "new scheme to encourage local teams to 'overachieve' on performance measures with financial incentives provided for these areas".
Last winter, more than 500 excess deaths a week were estimated to be linked to long waiting times, with a record number of patients spending more than 12 hours in A&E, huge delays in ambulance response times and delays for vital treatment. Because of these facts and the opposition they have faced from medical staff and people, the government and its NHS England have been forced to release plans, which they claim will address the current increase in excess deaths and the winter pressures coming up. Health minister Helen Whately claimed: "Our urgent and emergency care recovery plan, backed by record funding, is already improving performance and ambulance response times. Thanks to that plan, the NHS is getting 800 new ambulances, 5,000 extra hospital beds, and 10,000 virtual ward beds."
Speaking to The Independent  this week Dr Adrian Boyle, president of the Royal College of Emergency Medicine (RCEM) rejected the scale and credibility of these plans when he warned that "at least 11,000 additional staffed beds should be provided at hospitals across the country, while the prime minister has only pledged 5,000". He said that the inadequate provision could see thousands of people die needlessly this year. He continued, "If you just look at the figures, all the indicators of our target performance, 12-hour waits in hospital, are all going the wrong way. If we compare them to what was going on at the same time a year ago, it makes me anxious that we are heading towards a worse winter than we just had." He said that the government was "blithely sailing towards an iceberg", and that if it allows this winter to be as bad as the last, "it will break the very people who keep this broken system creaking along". Dr Boyle concluded to The Independent that he has "little confidence" that the government's new plan will "prevent queues of ambulances outside of hospitals, or the shameful sight of patients waiting for hours on trolleys in the corridors in A&Es [that are] full to bursting".
These days what is becoming clear to more and more people is that the government, with little opposition in Parliament, is driving the NHS health care system into a deeper and deeper crisis causing thousands of excess deaths as people are unable to access vital health care services when and where they need them.
It is well known how Boris Johnson's government in 2019 made many promises as part of its electioneering such as building 40 new hospitals in 2020. As then, so now, it is impossible to give credibility to the government's claims that its "robust new measures ... will boost capacity and resilience across the NHS as well as building on the recent improvements in ambulance response times and A&E performance". Health professionals are rightly saying that extra beds need extra staff which the NHS no longer has. What must be also pointed out is that this announcement is another good pretext for government to grease the hands of the private health companies as they did in the pandemic, when such beds were hardly used at huge costs for these private hospital contracts.
The crisis in the NHS is one that has been caused by long-term corporate driven austerity cuts within the state controlled NHS, and its fragmentation into Trusts and other bodies. Such cuts have been incentivised and hidden in year-on-year "Cost Improvement Programmes (CIPs)" and other ring-fenced mechanisms to "balance the books". This is all designed to drive a corporate focus to health care rather than a focus on human-centred health care provision. It is this that has driven the programme of closures of acute and community health and mental health services and the distancing of these services from local towns and communities and the unacceptable and life-threatening long waits people are now experiencing. It has also driven the crisis of underinvestment in health staff pay, training and retention, and the complete undermining of their well-being especially over recent years.
Further, on top of this restructuring of the NHS, there is the government's scandalous privatisation programme of the most profitable, diagnostic and routine acute services aimed at making people pay for these profits in one way or another, now and in the future. This is a direction that can only be described as one of wrecking the universal public health care system and the human resources who provide these services in favour of their system of paying the rich.
Consequences of the Crisis in the NHS
Marking the 75th anniversary of the NHS on July 5 this year, Health Campaigns Together (HCT), a newspaper representing many health campaigns and trade unions across the country, whilst celebrating the NHS achievements, examined the drastic consequences of the crisis in the health system . HCT pointed out: "People are dying because of political choices. Austerity is responsible for 335,000 excess deaths 2012-2019. A degraded and underfunded NHS could not cope during Covid and is now the cause of up to 500 deaths per week from delays in emergency care alone."
In exposing the "Integrated Care Boards" that the government put in place last year, HCT says that "from July  to February , nearly 2,900 private companies received over £3.9 billion directly from 40 ICBs, as shown by available monthly spending reports". As one among many similar examples, Circle Health, notorious for the failed takeover of Hinchinbrooke Hospital in 2012, is now owned by the US giant Centene Corporation specialising in "health insurance and managed health care". Circle also benefited in profitable contracts from the under-utilisation of private hospital capacity block-booked for Covid in 2020. In September 2022, this US company agreed to pay Texas $165.6 million to settle allegations that the company overcharged the Medicaid  programme for pharmacy benefit management services. Similar large claims were settled earlier with the US government, the state of Washington and at least nine other states. When Centene took its initial 40% stake in Circle back in January 2020, the CEO was Samantha Jones. She was later appointed as Boris Johnson's Chief Operating Officer and has now been appointed as a non-executive director at the Department of Health and Social Care. In this way the government is continuing to import into the NHS the same corruption perpetrated by these US companies to Britain.
Speaking Out to Change the Direction of the NHS
These days what is also becoming clear is that more and more people are speaking out, including the Royal College of Emergency Medicine, health campaigns and especially health staff and their trade unions. They are not going to accept this situation in a modern society where such a crisis in the NHS is being imposed by the powers-that-be. People are continuing to take matters into their own hands and, very importantly, to organise in their communities to defend their hospitals, and their health and mental health services. People are asserting the rights of all to health care and timely access to that health care in and around their communities, towns and cities.
As HCT puts it, the call is for the NHS "to be built back and built stronger" with an "end to feeding the private parasite eating away at the heart of the NHS; reclaim that wasted funding and reinvest it into rebuilding public services and safe staffing".
A modern society requires a thriving health service in order to function. The situation where narrow private interests take pride of place is wrecking the NHS. This must be opposed, with everyone concerned in England, Scotland and Wales continuing their fight alongside health workers who are also in the forefront in the fight to safeguard the future on the NHS. They must set their own agenda to reverse the crisis in the NHS. The demand is for a new direction for a publicly-owned human centred health care system where they decide. In essence, the fight is to change the direction, as part of changing the direction of the economy and the society. By speaking out and taking a stand, people must empower themselves, especially health workers when it comes to the NHS, and recognise that to do so is part of bringing about a new situation. The voice of health workers must be heard!
1. NHS sets out plans for winter with new measures to help speed up discharge for patients and improve care
2. The Independent. A chilling warning from Britain's most senior A&E doctor: Tory winter plan could kill thousands
3. Health Campaigns Together Special issue summer 2023
4. Medicaid is a US government programme that provides some health insurance for adults and children with limited income and resources and who qualify for its aid.