England, Wales and Scotland section of International Socialist Alternative

Is the NHS facing breaking point?

What does “breaking point” in our NHS actually look like?

After more than a decade of real terms funding cut, it has become normal to hear claims that the NHS has, or is, reaching “breaking point”. Here in my home city, Leicester, we heard reports from back in December 2019 of patients waiting in the back of ambulances for up to six hours because of a lack of capacity. As of November 2019, there were already 4.4million people on the NHS waiting list – a 5.7% increase on the previous year!

Add a pandemic into the mix, and it was always clear that the NHS could crumble.

It has also been common to hear how the NHS is reaching breaking point because of understaffing. Before the pandemic, there was more than 100,000 vacant posts in the NHS, with more than 40,000 of these in nursing. These problems were driven by the hostile environment nurtured by the government; the cuts to the nurses’ bursary; the loss of increments for NHS workers, and the fact that many NHS staff have seen a real-terms pay cut of up to 20% over the last 11 years!

However, the fact that the NHS still exists, despite all these unbearable pressures – the fact that it is still providing services – for some, seems to stand in contradiction to these claims. Indeed, the persistence of the NHS is something which the government has actively tried to claim credit for, in their claims to have “protected the NHS” throughout the pandemic for example.

But breaking point was never going to be a single event, like a ship capsizing. Breaking point was always going to be a process and what we have seen over the last 18 months is a serious acceleration of that process.

Breaking point in the NHS was the many hundreds of NHS workers who died because they did not have access to adequate PPE; breaking point was patients being denied life-saving treatment because of a complete lack of capacity due to decades of cutting beds and selling land. Breaking point is the number of health workers now living with Post Traumatic Stress Disorder due to the experiences of the last year.

In the wider picture, breaking point was the more than 150,000 people now dead due to covid – the highest per capita figure in the world, despite the fact that we are the sixth richest economy in the world!

And how do the government respond to all this? Is it to reward our NHS workers? To pay them what they deserve? No. It is to offer a pathetic 1% pay increase – in reality, a real-terms pay cut – to those who have spent the last year putting themselves in harms way to protect us.

And how do they respond to the structural problems that our NHS has faced, particularly over the last 18 months? Do they plough money into the public sector, which is responsible for both the vaccine and its successful roll out? Again, no! The government responds with more privatisation! The Tories’ new Health and Care Bill, which had its second reading in Parliament on Wednesday, poses a serious danger to the NHS as a public owned organisation. The Bill divides the NHS in England into 42 different ‘integrated care systems’, each with its own tight budget with the principal aim of driving down the costs of health care. While the Bill is promoted as reducing privatisation in the NHS, the reality is the opposite. Private companies are even being allowed to sit on the integrated care system boards in each area – thus partially running the NHS.

And we need to understand the development of this bill in the context of the last 18 months because the purpose of privatisation could not be any clearer. Profits for the few, misery for the many. Just look at the disaster of test and trace: £38 billion squandered on a vitally important service, which should have saved lives! Apparently having learned nothing from this failure, late last month the Tories went ahead and awarded Serco yet another contract, this one worth £322 million, to run more test and trace centres!

But we should be clear that this is not just about incompetence. The government isn’t simply making mistakes when it hands swathes of our services to profiteers, who have no idea and no experience of how to run them. This government’s pandemic response, and its approach to our NHS in general, is dripping in ideology. A decent pay rise for NHS workers would cost a fraction of the money wasted on test and trace. It would also pay for the student nurse bursary more than 50 times over. But this government is not interested in policies which would benefit ordinary people. They are using this pandemic to hand our services over to their mates in the private sector.

A reckoning over this government’s continued mishandling of the pandemic is already overdue. The national day of action on July 3, with protests taking place at 70 different locations across the UK, showed widespread support for NHS workers and opposition to privatisation. We need to build on this momentum.

This means building support in our communities, in our workplaces, in our trade unions, to mobilise people to fight back against this government and this system. Back in January, education workers provided a glimpse of the latent power of organised workers when they forced the government to retreat from their deadly reopening of schools, saving lives in the process. This was a direct result of pressure from below which pushed trade union leaders into action. Similar pressure will need to be mounted on the leaders of health unions when the government does finally announce its pay offer!

To those who say it is no longer possible to maintain the NHS, I say this: 73 years ago, despite a war-ravaged economy with huge debt, we created the world’s first universal health service. This was not handed down to us from on high, like some claim. It was the result of the enormous sacrifices that ordinary working-class people made during the war, and the insistence of these people that the old conditions would no longer be tolerated.

Much is different today, but I think we are living at a similar historic crossroads.

One thing that most people agree on is that we cannot go back to normal… normal was the problem. After all this, we must not allow a return to pay cuts, to underfunding our services, to scapegoating the most vulnerable in society while the billionaires make record profits. We need to build a society where good publicly funded services is a priority. Where zero-hour contracts and fire and re-hire practices are banned. Where workers are not victimised for organising in trade unions. But to get there, we will need to struggle. We know that we have the type of money for this kind of society because the global billionaire class has made out like bandits during this pandemic.

It will be a turbulent road ahead. We will lose some of the battles – but even losses will be important for us as they will sharpen our ability to fight back. We will learn how to fight effectively in the process of struggle.

But fight we must, because there is a future to win!


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