Rebuild our health service – invest, democratise, kick out the profiteers!

An enormous expansion of health service facilities, resources and staff would be required to ensure a high quality of care and safety continues as we work and live with Covid-19.
Health workers must be at the fore in shaping rebuilding of our health service

by Pat Lawlor, NIPSA Belfast Health branch (personal capacity)

The current evidence that the Covid-19 pandemic is beginning to plateau will be welcomed by all people across Northern Ireland, especially by health workers who have put their lives on the line on a daily basis. However, the consensus of professional and scientific opinion has cautioned Westminster and the Northern Ireland Executive against complacency, as more viral waves are likely. It is acknowledged by all Chief Medical Officers across the UK that Covid-19 remains within communities and the vast majority of people have no immunity, which is likely to remain the case until a vaccine is available. 

Unfortunately but unsurprisingly, the Assembly Executive has followed the Tories’ drive to rapidly reopen the economy, succumbing to the pressure from big business to increasingly relax lockdown restrictions as a matter of urgency in the interests of profit. Putting lives at risk, the unspoken message from a negligent Assembly Executive is that lockdown is over in all but words.

Covid-19 only added to an existing crisis

It is in this context that Health Minister Robin Swann has proposed a phased return to normal services across our health service through the recent launch of the Department of Health’s document Rebuilding Health and Social Care Services – Strategic Framework. An enormous expansion of health service facilities, resources and staff would be required to ensure a high quality of care and safety continues as we work and live with Covid-19. Major problems face the Health Minister and the Assembly Executive if they believe they can successfully and safely reopen health care services without such investment. Prior to the pandemic, our health service was already in serious crisis, now exacerbated by the pandemic. Looming front and centre will be pressing and immediate unresolved issues – a staffing crisis due to low pay, massive underinvestment, crippled and crisis-ridden service provision and creeping privatisation.

It was only six months ago that 20,000 health workers across Northern Ireland were engaged in strikes and other industrial action. This represented the frustration and anger of all health workers at a decade or more of pay-cuts and inadequate investment.  The battle lines were drawn between workers and the Assembly Executive, with overwhelming public support for the strikes. A negotiated compromise settlement was made with a partial victory on pay for some staff, with agreement on addressing the other issues in further meetings. However, many health workers believed the deal was struck too soon by the heads of the unions and a more comprehensive victory could have been won. This argument was won in NIPSA, whose members refused to back the deal.

Three months later, with chronic staffing and service issues unresolved and cuts to unsocial hours payments imposed on increasingly demoralised staff, our health service was thrown into the Covid-19 pandemic completely unprepared. However, health workers across all areas stepped up – despite inadequate protection, resources or support – to ensure public health and social care services were provided as best as possible. These are the key outstanding problems for the Health Minister as he pushes to return our health services to some sense of normality, while revelations on the Department of Health’s mishandling of the pandemic are increasing every day.

Political and private sector failure

The resignations of nine board members of the Regulation & Quality Improvement Authority (RQIA) has sent shock waves through the health and social care sector. The RQIA, the watchdog responsible for monitoring the quality of health and social care services, has raised serious concerns over the preparation of care homes by the Department of Health for the Covid crisis. It must be remembered that over 50% of all deaths have occurred in care home settings, and many families are demanding answers as to why the mortality rate was so high. The RQIA has accused the Department of Health of cutting across inspections and redeploying senior staff away from monitoring care homes immediately prior to the surge hitting the North. 

On top of this, new revelations are coming to light that health workers may have been put at risk as Health Trusts have used a private contractor to fit-test staff for PPE masks. A review of fit-testing results carried out by this external contractor over the last six months have identified cases which did not meet the designated standard. Management have said they will be contacting those staff affected. This will cause a lot of fear and anxiety among all health staff who have been wearing PPE when looking after Covid-positive patients. And it’s far from the only example of external contractors failing to live up to their promises. In some testing centres outsourced to private firms, up to 30% of tests were shown to be false negatives, as they were not carried out properly by trained health professionals. Private firms always cut corners in the interests of profit. And yet, the Stormont Executive is united in wanting to see a greater role for the private sector in our health service.

Unequal impact of Covid-19 and economic crisis on health

The Department of Health’s document outlines the urgent need to reopen our health services, giving examples of the impact of Covid-19 on health needs and social inequalities. As of March, there were “307,000 people on outpatient waiting lists, 94,000 waiting for inpatient and day cases and 131,000 people waiting for diagnostic tests.” Frightening references are made to the potential tsunami of mental and social care issues that will surface post-lockdown.  

References are made to how the impact of the global economic crash will further exacerbate poverty and deprivation. The unequal impact of Covid-19 on deprived areas versus more affluent areas has been exposed with a recent report from NI Statistics and Research Agency (NISRA). The Covid-19-related age-standardised mortality rate (ASMR) worked out at 48.2 per 100,000 population for Northern Ireland as whole.  However, the ASMR was “highest for the 20% most deprived areas, at 60.5 deaths per 100,000 population.” The document has exposed a potential “stalling of any growth in life expectancy” or even “flattening in the wake of Covid-19 as a result of expected growth in unemployment, economic insecurity and homelessness.” This is a damning indictment of the Northern Ireland Executive, who have not addressed wealth inequalities, rising poverty and the lack of opportunities for young people. They have had no problems pandering to big business and multinationals on corporation tax, rent and rates relief.

Swann’s ‘new’ strategy more of the same – cuts and privatisation

However, despite this, the Minister’s proposals fail to realise the need, underlined by the pandemic, to rebuild a comprehensive, accessible and fully public health service which meets the needs of everyone in Northern Ireland, free at the point of use. In reality, when you cut through the rhetoric and look past the immediate plans to phase in essential services and potential preparations for a second wave, the warnings for our health service are clear. The Department aims to use the crisis created by Covid-19 to implement long-planned ‘reforms’ to our health service by stealth, with minimal engagement with unions or service users. These include cuts (under the guise of centralisation), outsourcing and privatisation.

Throughout the pandemic, senior management in health have used the public health emergency and legislation to enforce changes to staff terms and conditions for redeployment and retraining etc. When a staff member queried her redeployment, citing her contract was for a specific department, a senior manager stated, “because of Covid-19, there is no such thing as a permanent contract anymore!” This may have been the approach of an uninformed and arrogant manager. However, it may also be an indication of the Department of Health’s intent to use Covid-19 as the rock to break up established terms, conditions, roles and responsibilities.

Health workers and unions must shape rebuilding

Our health service is in uncharted territory and faces a prolonged pandemic. It will require appropriate reorganisation and restructuring, with appropriate investment to ensure a high standard of services with guaranteed safety for staff and patients. It is essential, now more than ever, for health workers and their unions to ensure they oversee the reopening and direction of our health service. We know best what services are needed and how they can be safely provided. We cannot allow the Department of Health to wield unaccountable authority, to escalate or attempt to justify health cuts and privatisation under the guise of tackling Covid-19. We have a unique opportunity to shape a transformation of our health services in the interests of patients and staff, although this will require battles with the politicians at Stormont and Westminster. 

Socialists in health demand:

  • Fully public, comprehensive and accessible health and social care for all, free at the point of use
  • Democratic control of health and social care provision by staff and service users
  • Reversal of all privatisation – kick out the profiteers!
  • Real pay-rises and a living wage for all, including student trainees
  • End racism in the NHS and end all migrant charges
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