Gavino Maciocco
The NHS is sick, headlines the Lancet. The roots of the suffering situation of the British Health Service lie in the policies of the Conservative government which for years has reduced investments in the public sector to a minimum, favoring the private sector, prompting patients to turn to private clinics, including through insurance. There are also the pernicious effects of Brexit.
Lyn Brind, a 61-year-old woman, was taken to Queen Elisabeth Hospital in King’s Lynn (Norfolk) due to severe respiratory distress but was kept waiting for over 4 hours outside the Emergency Department (Accident&Emergency – A&E), boarding the ambulance without receiving the necessary assistance. When his turn finally came, it was already too late: 22 minutes later, writes the The Guardian, the patient died. The London newspaper adds that last December 57,000 patients remained waiting for a long time outside the emergency rooms, 6,000 of whom were in critical condition. According to Royal College of Emergency Medicine there would be between 300 and 500 deaths per week in the UK caused by overcrowding and long waiting times in emergency rooms.
“The National Health Service (NHS) is 75 years old and unwell, reads theLancet editorial of last January 28th. Suspected heart attack patients waited for the ambulance five times longer than the 18-minute goal. In 2022, 347,707 patients spent more than 12 hours in emergency departments waiting for a bed, four times as many as in the previous 10 years combined. The excess of deaths in 2022 was the highest in the last 50 years (…) Underlying this rapid deterioration of the situation is the combination of chronic and acute problems. The symptoms had been present since at least 2015, but were misdiagnosed and left untreated. Underinvestment, staff shortages and system mismanagement have been exacerbated by the profound demoralization and burnout of NHS staff, increased demand for services and the winter surge in COVID-19 and flu. The health of the population has been neglected, the stalemate in life expectancy and the enormous difficulties of the social assistance system have been ignored”.
Figure 1. Life expectancy at birth in the UK in 2018-2020 has returned to 2012-2014 levels for males and is similar to 2015-2017 for females.
The roots of the NHS’s plight lie in the policies of the Conservative government which for years has reduced investments in the public sector to a minimum, favoring the private sector, prompting patients to turn to private clinics, including through private insurance. The most impressive fact of the crisis is the progressive impoverishment of the public, health and social workforce, which is at the basis of the unbearable expansion of waiting times (not only those in front of the emergency room: the number of people waiting for treatment or elective surgery as of April 2022 was 6.5 million versus 3.2 million in September 2015). So unbearable as to require the establishment of a commission of inquiry of the House of Commons, which last July made public a report entitled “Workforce: recruitment, training and retention in health and social care” which opens with this categorical statement: “The NHS and the social care sector are facing the most serious staffing crisis in their history”. The Report states that as of September 2021, 99,460 posts were vacant in the NHS and 105,000 in the social sector (managed by the municipal administrations): in particular, in the health sector, 12,000 hospital doctors, 6,000 family doctors and 50,000 nurses and midwives.
And then there are the deleterious effects of Brexit which has raised often insurmountable barriers for foreign health and social workers to access the United Kingdom. The UK has traditionally relied on foreigners to fill medical vacancies, especially family doctors, nurses and social workers, but now the procedures for foreigners seeking visas to work in the UK are, by admission of the parliamentary committee , “lengthy and opaque, complex, difficult and expensive with potential inconsistencies, and in need of regulatory reform to make it proportionate and streamlined to assist in ethical overseas recruitment”. In short, a disaster. The maximum of incongruity (inconsistency) is registered in the enrollment of social personnel: here to obtain the visa it is necessary to have an employment contract with an annual income of no less than 20,840 pounds, when the national average income of these operators is much lower, 17,900 pounds . (See post The lost soul of the NHS).
To all this must be added the problem of the rising cost of living (and related inflation rate) which exploded in 2022 and caused by the increase in the price of energy and other consumer goods. That growth – of 9-10% – in the UK was among the highest in Europe and has sparked a wave of protests and strikes which also affected the health sector, in particular nurses and ambulances.
What to do
First of all – says the Lancet – the field must be cleared of some political trends and positions which, far from being the solution to the problem, would further aggravate the situation. Between these the idea that the current model of the NHS is unsustainable and you need a radical change and a further push towards the private sector, with additional payments and higher contributions from users, as former health secretary Sajid Javid recently revealed. This view is deeply flawed, notes the Lancet. With the right approach, the NHS is sustainable and must maintain the principle of providing free care in times of need, which is the foundation of a just society. Another idea that the Lancet rejects is the one it identifies in poor productivity of the health system the cause of the crisis: this is a gross misunderstanding of the purpose of healthcare, which is not a factory, judged by crude efficiency metrics, but a service based on care, compassion and quality. Keep focusing about doing relatively more with relatively less it is dangerous and obviously harmful.
In the short term – according to the Lancet – there are two remedies. First, the government must recognize that the NHS is in crisis, which it must address with urgent and unprecedented action to inject new resources. Secondly, the government needs to give a clear message to NHS staff about wages, the new recruitment plan and improved working conditions. In turn, the NHS has to admit that it has a huge cultural problem at home: the pervasiveness of racism, sexism, bullying, harassment and conflict. Toxic work culture is an often cited reason for leaving the NHS and has a negative impact on patient care. In the longer term, investment in public health and prevention needs to be stepped up as the main way to reduce demand on the NHS. The government must abandon short-term cash injections and use tax-based finance to achieve sustained and predictable increases in its resources. In this way, the NHS can jump start with investment in staff, facilities and technology. The NHS must engage in the rapid development of innovation and the adoption of new working models which should not be blocked by traditional views on roles and responsibilities. Anything is better than the current model of social work, which monetizes vulnerability, enriches a few providers and leaves more than a quarter of social work staff living in poverty. The negligent management of the NHS – concludes the Lancet editorial – has brought the services to their knees. Contrary to popular narrative there are initiatives that can be taken quickly and successfully. Last but not least, to value and remoralise NHS staff who have a responsibility to protect the health of the nation hit by an unprecedented economic crisis that is deepening inequalities and plunging thousands of people into poverty and precariousness.
Gordon Brown intervenes in defense of the NHS and its original valueshistoric Labor figure, Economy Minister 1997-2007 and Prime Minister 2008-2010, with an article on the Guardian of last January 23, where we read, among other things:
“As Economy Minister at the time I said that Labour’s refinancing of the NHS – an average annual increase of 6.3% in real terms between 2000 and 2010 – should be reviewed every 
decade. This did not happen under the Conservatives and the consequences are visible to all of us. But the pressures facing the NHS reinforce the need for full NHS funding and show why this is preferable to European-style social insurance or private insurance.
The reasons are clear. No one knows in advance which of us or any of our family members will need medical procedures or hospitalisations, the costs of which could run into hundreds of thousands of pounds. A system that guarantees comprehensive coverage paid for by general taxation and which spreads the costs across the population is the best insurance policy we could imagine – and indeed, if properly funded, it is bound to be the best in the world.
Such a national insurance system is better equipped to cope with even greater pressures resulting from further advances in medical knowledge. As DNA gives private insurers more information about each person’s susceptibility to disease, companies will be reluctant to cover the population most at risk, unless at exorbitant costs. It is this new reality, resulting from welcome scientific breakthroughs, that makes risk pooling and cost sharing across the UK even more important.
Even in these circumstances, conservatives may, as a matter of ideology, prefer an inefficiently functioning private sector to a well-functioning public service. Indeed, neoliberals seem to find more joy in one person who subscribes to Bupa (the most important UK insurance company, ed) than in 60 million people who use the national health service. But what we know from the growing pressures of health inequalities, from the groundbreaking work of Michael Marmot, should shift our focus away from this ideological sideshow of tariffs and private insurance to the need to address poverty and the other social determinants of ill health. . It is by attacking and eradicating the causes of disease that we will do the most to reduce waiting lists and pressure on the hospital sector.”