By Eoin Dawson
The depth of the crisis in the NHS is difficult to overstate. While bosses have talked of “recovery plans” and politicians of “building back better”, health and social care services have continued to crumble. The reality is that services have stagnated at the limited level of delivery provided during COVID and those who do not require urgent or emergency care sit on ever lengthening waiting lists. The NHS is no longer a universal service, it is an urgent and emergency care service.
This crisis has been intentionally caused by the utter depletion of health service resources. Successive Tory and Stormont governments have frozen wages and cut funding. They have also facilitated a parallel process of privatization, with more private individuals leeching resources from the NHS than ever. Trust bosses have pursued an increasingly bullish and bureaucratic management style, ignoring the advice and warnings of those who know the service best – the workers. These processes have brought the NHS to the brink.
Politicians call for “radical reform” of the NHS. What most mean by this, is speeding towards the end goal; the complete privatisation of health and social care. The Tories claim there is a “black hole” in the budget that cannot suffer fair wages for health and social care workers. They ask “how much it will cost the taxpayer”, but never question whether the wealthiest are paying their fair share. The Tories threaten that a 10% public sector pay rise will result in a £1000 tax bill per household. This economic dishonesty ignores Office of Budget Responsibility figures and the fact that a significant proportion of any pay rise would return to government coffers in tax and national insurance. They also threaten that increased health service wages will fuel inflation, ignoring that wages were largely stagnant, but inflation has run rampant anyway. There is more than enough wealth in society to pay workers a fair wage. The decision to deny NHS workers is a political one.
Investment in fair pay is the first step towards truly radically reforming the NHS. An inflation-busting pay rise is not only affordable, but necessary to stem the tide of workers leaving the service and to reverse this trend by attracting people to take up vacant posts. Further investment is required to increase the number of training spaces, and create additional training pathways which would allow for career progression. Finally, raising bursaries to a real living wage, commensurate with the work done by students on placement, would begin the process of finally filling the thousands of vacant posts that leave existing staff stretched beyond any reasonable limit.
Due to the state the NHS is in, measures such as these will take time to take effect. Therefore emergency measures are needed to make best use of what resources are currently available in health and social care. Such measures should include enhanced rates of pay in areas that are in severe crisis to encourage staff to remain in post rather than leaving for better pay elsewhere. This would also help to address some of the issues created by the increasing use of employment agencies. Enhanced rates could also be used to compensate staff who are redeployed – an increasingly likely prospect given the depth of the crisis in some areas. Should management pursue a redeployment policy, workers and their unions must demand that these decisions are taken democratically by those who understand the service best – the workers. This democratic control would also act as a bulwark against the inevitable attempts to make any temporary closures permanent. Finally, emergency measures should include the curtailment of the private sector and seizure of private sector hospitals and equipment as necessary, without compensation for profiteer owners. This would end the current uncoordinated and unfair delivery of procedures for those who can afford it, while others wait.
"The train is heading over the cliff", declared one Tory MP as the OECD announced that Britain would shortly be back into recession, if it wasn't there already.