The ongoing crisis is manufactured as a precursor to further privatisation. Don't let the Tories fool you
I am an experienced A&E nurse, working in Oxford, but I am also a patient with oesophageal cancer.
I woke up on Wednesday morning to a Times headline quoting a leaked e-mail from Andrew Weaver, Lead Consultant in Oncology at the Churchill Hospital in Oxford; the hospital where I currently receive treatment. In the email, Dr Weaver states that due to a 40% nurse vacancy rate, his department will no longer be able to safely continue to offer new cancer patients current Chemotherapy treatment; that they will have to delay commencing treatment by a month, and reduce the sessions from 6 to just 4. Obviously, any delay or reduction in treatment will impact on patient outcomes.
Thanks to the leak and subsequent local, and national, media coverage the Trust has now denied that this was the plan, but that it was just part of a consultation.
This rationing of planned and elective care is not new, but it will become much more common. It will not be discussed with the public, or patients, and will happen covertly.
The issues in my Trust are a representation of those occurring within the NHS as a whole, and in Trusts right across England, as a result of the deliberate defunding of the NHS by this Tory Government.
The cost of living, and of housing in Oxford has been more expensive than most parts of London for the past 2 years; yet unlike public sector workers in the capital we don’t receive any ‘weighting’. This results in a significant recruitment and retention crisis, with many NHS staff leaving for jobs in London, where they can earn an extra £5-7000 per annum. A public sector pay cap for 8 years has also seen the value of salaries drop by about 16%, meaning many staff leave to work in service industries which now pay unqualified staff more than those who have spent years at University, and who save lives and impact patient care.
To maintain safety the Trust has shut 90 beds, directly attributable to significant vacancy rates. A ward or unit cannot safely function with a vacant rate higher than about 10%, yet many areas have rates well above this. Another reason for vacancies is the 96% drop in nurse applications from the EU, caused in part by anti-immigration rhetoric, and Tory policy. I work alongside really wonderful, highly skilled staff from Spain, Portugal and Italy, but many are leaving to go home. The new English language level exam required is also responsible for many non-EU staff failing at the recruitment stage; it’s set at a level which has proved too high for those English born.
Our Sustainability and Transformation Plan (STP), which is part of our local ‘footprint’, 5 year forward view, has closed a further 145 beds. The idea is to move more care into the community; the trouble is that local social care is broken. It cannot recruit staff for the same reasons outlined above; as a result, a further 90 beds are ‘blocked’. Nationally, as part of these plans, GP surgeries and walk-in centres are being closed, A&E and maternity units are being downgraded or closed. Between 2010 and 2016 full-time equivalent District Nurses in England fell by 46.4%, and 50% of training courses face being cut this year. This proves the sham of moving care for acute to the community sector.
Also part of the plan for the future NHS is the establishment of Accountable Care Systems (ACS). These were first established in the US by Kaiser Permanente to cut costs by integrating care. Why are we moving to a US-style healthcare model when the Commonwealth Fund (which compares 11 first world healthcare systems, looking 72 indicators, including cost, efficiency and patient outcomes) put the NHS first, and the US last place? The US spends 16.6% GDP, whilst the UK spending has fallen to 7.3%, and is set to fall further. The only way to continue to cut costs is by rationing care, whilst encouraging those that can afford it to take out health insurance or pay for private care. This system will provide a perfect platform for the continued dissolution and sale of services to private companies.
Nationally the NHS has 40,000 nurse vacancies, with over 60,000 further NHS staff vacancies. The solution? Cut the NHS Bursary and introduce annual fees of £9000, which has seen a drop of 28% in student nurse applications to university. The solution? Introduce nurse apprenticeships and a new role, the Nursing Associate (NA). The NA will train over 2 years. They will be used to fill Registered Nurse (RN) vacancies, whilst paid at a lower Band (3/4, rather than Band 5). Their training has been paid for by cutting the postgraduate training budget of RNs by 50%, meaning that it is now impossible to get specialist training in many areas. This will significantly impact the level of care provision for patients, and add to the workload of RNs, who will be expected to mentor and supervise this new role.
Managers and politicians who do not have a clinical background think that a nurse, is a nurse, is a nurse, and that they can move us from area A to area B without any detriment to our patients; but this just is not the case. When we qualify we begin our career with a basic understanding of our role, but we then specialise (as medical staff do). If you work in theatre recovery, intensive care or cardiac services, over time you become an expert. In the past, there were credited courses for most specialities which would give you further qualifications and skills. Nurses have for years run outpatient clinics and performed minor procedures. What you cannot then expect is to move these specialists to help staff another specialist area, without putting both patient and staff at risk. Yet this is something they all try to do.
Our Ambulance service and A&Es are collapsing under the weight of admissions, because patients cannot easily access community-based care, and because those that need admission have no beds to access. 14,000 beds in England have been closed since 2010, and bed occupancy levels are at 95% (the optimal maximum rate is 85%), which means a dangerously increased workload and cross infection rates.
The NHS crisis is something many of us have seen coming for a long time, we have protested, written articles, and shouted at the tops of our lungs that all of these issues would create a situation in which the NHS and staff could be blamed, and seen as failing by this Government, whose agenda has always been to destroy this socialist model.
We cannot continue to allow this Government to destroy the NHS. We must get them out! Join our demonstration on 3rd February!
David Bailey is an NHS worker, photographer, socialist and an activist. He has organised and participated in convoys to Calais with Oxfordshire Refugee Solidarity. He also works with the People's Assembly and Stop the War and is a member of Counterfire.