Jon Dale, retired doctor, Mansfield Socialist Party
Long telephone queues for GP appointments. Agonising waits for ambulances. Hours in pain and discomfort in A&E waiting rooms. Months waiting anxiously for outpatient appointments, tests, treatments, operations.
Everywhere you look, the NHS is struggling to meet local communities’ needs. Years of austerity, inequality and an ageing population mean more health care is needed than ever.
Staffing crisis
NHS staff work long exhausting shifts, often without proper breaks. The Tories blame strikes for record waiting lists, but skeleton staff levels maintaining essential services on strike days were often higher than on non-strike days!
No wonder staff burnout is a growing problem.
New General Medical Council research estimates 96,000 doctors currently practising in the UK say they are ‘very’ or ‘fairly likely’ to move abroad in the next 12 months, especially recently qualified doctors. The most common reasons given were “feeling undervalued professionally”, “demands of role impacting well-being”, and “the current system presents too many barriers to patient care”.
Nearly 43,000 nurses aged under 50 left the profession between 2018 and 2022 (Royal College of Nursing figures). Reasons included inadequate pay, insufficient staffing to ensure patient safety, harassment and discrimination in the workplace, a lack of career progression and unsafe working conditions.
Likewise, Chartered Society of Physiotherapists analysis warns that 15% of physiotherapy staff leave the NHS each year, almost half of them within five years of qualifying.
All health workers face these same pressures. Agency spending to fill some gaps costs £3.2 billion a year, the equivalent of an extra 31,000 full-time nurses.
Making this staffing crisis even worse is NHS England’s £4.5 billion deficit this year.
A leaked email to NHS chief executives in south west London instructed them to consider “agency restrictions/ ban… a non-essential training freeze… consider what services should be stopped or consolidated.”
Labour’s solution? “… Incentivising staff to carry out additional appointments out of hours.” When are staff supposed to rest, spend time with family and friends, recharge their batteries for their next shifts – or even catch up on housework? Burnout looks set to grow if shadow health secretary Wes Streeting pushes this through.
He insulted all NHS workers, saying: “I think what I find frustrating is the poor planning ahead of winter – the fact that we now see not just crises in winter but all year round… There shouldn’t be an assumption that, every time the NHS runs into winter, system leaders can point to the pressures and just say: ‘We need more money right now.’”
Not a word about the desperate shortage of money and staff all year round, or health workers’ superhuman efforts to keep services going despite this! Health trade unions will need to prepare for future industrial action, as there has been under the Tories.
Labour claims it will train and recruit more staff, but without higher pay or improved working conditions to retain existing staff. That would be the quickest way to cut patients’ suffering on waiting lists.
The Socialist Party supports trade union struggle for:
- Restoration of pay to 2010 levels
- £15-an-hour minimum for the lowest paid
- All outsourced workers brought back into the NHS
- Pay increases linked to inflation
- Abolish student fees and restore bursaries, at a living level
- Expand free training for all health professions
- Fully fund the NHS, make the super-rich pay
Cheap labour
There is one way to recruit more staff with the same inadequate budget – pay them less! And that is already happening. A trend in recent years has been to recruit less-qualified staff, not to assist highly trained and experienced professionals but to replace them.
Leicester Health Care Assistants have been on strike. Paid in Band 2, just one penny an hour above the minimum wage, they have performed Band 3 clinical duties for years and are demanding recognition of this. Similar issues exist around the country.
Over 4,000 medical associates have been appointed, mostly in general practice, anaesthetics and surgery. They are science graduates given a two-year training, as opposed to five years as a medical student followed by another 5-12 years training as a junior doctor.
Paid significantly more than junior doctors, but significantly less than consultants and GPs, it’s becoming increasingly hard for junior doctors to find posts as employers take on medical associates instead.
Jobs newly qualified GPs want “are not there for them”, said NHS England’s national director of primary care. No wonder so many are thinking of emigrating.
Incredibly, there are junior doctors facing unemployment. 700 applied for – but could not get – anaesthetic training posts last year. Despite a massive shortage of consultant anaesthetists, registrar training posts have been frozen. After junior doctors’ and consultants’ strikes last year, a new grassroots campaigning organisation, Anaesthetists United, emerged and has rapidly grown within the Royal College of Anaesthetists.
The Fire Brigades Union conference voted to oppose the use of medical associates at its recent conference, highlighting risks to patient safety from deregulation and deskilling.
But Labour’s silence shows they will stick to this Tory path. Their manifesto pledge to recruit “8,500 mental health staff” does not say they will be fully trained mental health specialists.
Unions should demand good training and professional support for associates with a career path for progression, but with clear limits of responsibility. They should not be misused by employers as cheap substitutes for qualified staff.
In 2012 the Thatcherite ‘free market’ Institute of Economic Affairs wrote: “The compulsory licensing of medical professionals should be abolished. Anyone should be at liberty to practice as a doctor or nurse, with patients relying on brand names or competing voluntary associations to ensure quality. Ending current restrictive practices is essential to enable private firms to increase productivity in the sector.”
A BBC investigation in 2022 exposed this practice. For every 2,000 registered patients, the national average is the equivalent of 1.2 full-time GPs. But at Operose-owned practices the average was a little over 0.6 full-time equivalent GPs. Operose employed six times as many Physician Associates as the NHS average.
Operose, a subsidiary of US health giant Centene, sold its 60 practices last year to HCRG Care Group, formerly known as Virgin Care. NHS services are becoming commodities, bought and sold for profit by huge corporations.
The Socialist Party says: Patients before profits! Kick all private companies out of the NHS!
Private hospitals
Despite Labour’s last conference voting that “Under Labour the NHS is not for sale”, this is not in its manifesto. Wes Streeting makes no secret of his intention to continue blurring the lines between public and private health services.
This has been well-received by some. OPD Group donated £48,000 to his office. OPD is “controlled by” Peter Hearn, whose firms help “private healthcare providers recruit healthcare professionals”.
Streeting also accepted £65,000 from John Armitage, a hedge fund manager with over $500 million invested in UnitedHealth, one of the largest private health insurers in the world.
“Labour will use spare capacity in the independent sector to ensure patients are diagnosed and treated more quickly,” says its manifesto. However, the ‘independent’ sector relies on NHS-trained nurses, radiographers, physios, doctors and other health professionals.
Some work part-time in both sectors, so more private hospital work could mean less time in NHS hospitals.
Eye surgery is a warning of what will happen. NHS spending on cataract surgery has doubled in five years, with 60% now paid to the private sector.
The five biggest companies receiving this money have opened 101 more eye clinics in the past five years and now have 126 in England, making over £100 million pre-tax profits in 2022. SpaMedica alone made £72 million.
SpaMedica’s European parent company, Veonet, was sold in 2022 by one private equity fund (Nordic Capital) to another (PAI Partners). PAI “aims to increase the profitability and long-term strategic value of the businesses we own”.
More unnecessary cataract operations are being performed, while sight-threatening conditions go untreated, with NHS hospitals short of surgeons and training opportunities.
Big business is greedily buying into private health care. The largest private hospital group, HCA UK, is owned by the biggest US profit-making hospital corporation.
Spire Healthcare, with 30 hospitals and over 50 clinics, made £136 million operating profit in 2023. It is 30% jointly owned by a South African shipping company and South Africa’s richest family.
Labour will build the private sector further with NHS money.
The Socialist Party says: No NHS funds should be funnelled into profit-making hospitals. Nationalise all private health care facilities and integrate them into the NHS
Private laboratories
Since Blair’s New Labour government 20 years ago, hospital laboratories have been targets for privatisation. The latest contract signed is between Hertfordshire and West Essex NHS and Health Services Laboratories, a subsidiary of Sonic Healthcare.
Sonic Healthcare, Australian-based, made A$328 million from its UK business in the second half of 2023 and global net profit was A$202 million.
Speaking in a House of Lords debate, Lord Carter called for more private providers within the NHS. Lord Carter is chair of Health Service Laboratories – and a Labour peer.
Our health data
In many GP practices it’s becoming impossible to get basic healthcare without completing an online form (by a receptionist if the patient can’t do this).
Millions of UK patients have to use ‘Patient Access’ to book GP appointments, order repeat prescriptions and more. ‘Patient Access’ is owned by EMIS Health, which was bought last year by Bordeaux UK Holdings II Limited, an ‘affiliate’ of Optum UK which is a subsidiary of UnitedHealth Group – one of the USA’s largest health care companies.
Other data companies include ‘Klinik2’, which is now live across 300 NHS GP surgeries, while ‘eConsult3’ is used by 40% and ‘Patchs Health4’ supports over 10 million NHS patients. Private companies then have access to personal data. AI is increasingly used in these systems.
There is tremendous potential for improving patient care with this technology, but only if democratically controlled by health workers and patients’ representatives. Instead, the software is often developed by tech start-up companies, that get taken over by ‘Big Tech’ if successful. The data can then become a source of huge profit.
In 2019 accountancy giant Ernst and Young estimated NHS datasets could be worth as much as £9.6 billion a year.
Google owns physical premises and hardware where the data is held. Other companies like Amazon and Microsoft are cashing in too.
NHS patient data is unique in the world – held within one health care system and stretching back 76 years. GP practices and Trusts are being pushed by NHS England to set up Data Sharing Partnerships to trade our health data with third parties in return for ‘rewards’. These third parties include private companies in pharmaceutical, digital, diagnostics and biotech industries.
An NHS business unit, the Centre for Improving Data Collaboration, provides commercial and legal advice on contract negotiations and forms of reimbursement. It wants profit-seeking companies to be charged no more for data than charities or academic partners concerned with public benefit. The private medicine insurance industry will also profit if it could access this data.
“Drawing on the strength of our National Health Service,” says Labour’s manifesto, “will also maximise our potential to lead the world in clinical trials. This means making the process more efficient and accessible…” Being “pro-business”, Labour will follow the Tories’ and sell personal data behind our backs.
The Socialist Party says: health research should be democratically controlled by elected representatives of health workers, scientists, patients and the wider community
Nationalise pharmaceutical, medical supplies and data industries, without compensation except with proven need!
Society makes us sick
Air pollution is now the second leading risk factor for death worldwide, after high blood pressure and ahead of smoking and poor diet. It affects poor people most, who are also affected by damp mouldy housing.
Poor working conditions lead to poor health. Long hours at work, trying to compensate for low pay, leave no time or energy to prepare healthy meals. A diet of takeaways and ready-made meals contributes to obesity, diabetes and other health problems.
Insecurity, bullying and harassment, advertising and influencing, competition, alcohol abuse and other features of society today all add to a growing mental health ‘pandemic’.
Climate change is increasingly affecting health.
The Socialist Party fights for an end to capitalist causes of ill-health:
- A 32-hour week without loss of pay
- Rebuild school and community sports and leisure facilities lost through cuts
- A massive building programme of well-built and insulated council homes
- Free nationalised public transport
- Nationalisation of big agribusiness, food manufacturing corporations and supermarkets
- For a new mass workers’ party
- A socialist society would enable everyone to live healthier lives – and have the best health care when they need it
