BMA stall at Leytonstone station, London, 12.1.16

BMA stall at Leytonstone station, London, 12.1.16   (Click to enlarge: opens in new window)

Cuts, debt and exhaustion

Health workers under attack!

Jon Dale

Like a tower tottering on the edge of land washed away by the floods, the NHS in England is staring at a massive, growing funding gap. By 2020 this will be £22 billion a year. That’s £387 for each of us, £890 for the average sized household.

This could mean higher tax, new charges for health care, cuts in health workers’ pay, cuts in the current service equivalent to 18%, or a combination of all of these.

Alternatively, we need a life-and-death struggle to oust this government and replace it with one committed to maintaining a national service free to all at the point of use.

The NHS deficit is rapidly worsening. More trusts are falling into debt. Debts are getting bigger.

According to the National Audit Office, 25 trusts were in deficit in 2012/13 but in September 2015 181 trusts reported deficits – 57% more than six months earlier.

Health workers are suffering under the strain. Staff shortages in hospitals, GP surgeries, ambulance and community services mean more work falling on their shoulders.

Working through breaks and after the shift ends, lifting patients without enough support as there’s no time to wait, noticing a patient in bed needing a urine bottle but getting several other urgent jobs on the way and arriving too late – these are daily experiences.

A 2012 NHS staff survey found only 30% felt there were enough staff for them to do their jobs properly.


It’s not surprising sickness among NHS workers is high. The £2.4 billion cost of sick leave is equivalent to about 2.5% of the total NHS budget. Back pain and mental illness are the two biggest causes of sickness absence.

Ward and department leaders are given impossible targets to achieve on their budgets by senior management. They are under huge pressure to make staff work harder and cut sickness absence.

Outside Salford Royal hospital, 12.1.16, photo by Becci Heagney

Outside Salford Royal hospital, 12.1.16, photo by Becci Heagney   (Click to enlarge: opens in new window)

This increases stress levels and can lead to a culture of bullying, sanctioned at director level. A quarter of staff reported to the NHS 2012 Staff Survey they had experienced bullying, harassment or abuse from their line manager or other colleagues. That proportion is now almost certainly higher.

Much is written about the cost of absenteeism to the NHS. Sickness absence policies increasingly crack down hard on health workers unfortunate enough to be ill or injured – even when this is the result of their work. This increases stress and anxiety.

The cost of ‘presenteeism’ though is less researched and publicised. Two thirds of NHS staff admitted to coming to work when unwell in 2012. The cost of staff dragging themselves into work even when they are unwell increases absenteeism and decreases patient satisfaction. Research in 2015 showed the cost of presenteeism to the whole economy is twice that of absenteeism.

Healthier trusts?

Simon Stevens, NHS chief executive, has a plan to improve health workers’ health. He told NHS trusts to provide health checks, yoga and Zumba classes while at work, as well as physiotherapy and talking therapy sessions and healthier food.

Many trusts already offer physiotherapy and talking therapy sessions but these are being hit by budget cuts. Yoga and Zumba sessions are pointless if staff have no time for proper breaks to attend. How many will stay after working 12 or 13 hour shifts?

Better food would be welcome, but privatised catering services often shut cafes outside peak hours leaving sandwiches, ready-made meals and a microwave for night and weekend shifts.

Tory Health Secretary Jeremy Hunt may think junior doctors should work to 10pm and weekends for standard pay but private hospital caterers like Compass and Serco don’t provide a full service at these times.

More staff would improve workers’ health. This requires more to be trained, but the training budget is being cut. Abolishing student nurse bursaries is one aspect of this.

Outside Salford Royal hospital, 12.1.16, photo Becci Heagney

Outside Salford Royal hospital, 12.1.16, photo Becci Heagney   (Click to enlarge: opens in new window)

One reason why the Tories want seven-day working of non-emergency services is that it would mean more work could be carried out with fewer hospital facilities.

Stevens also wants to shift more health care out of hospitals into the community. This would prepare for more hospital closures with profit-making companies taking over more community care, paying staff minimum wages.

Real solutions

Being ill at home rather than in hospital would be many people’s preference – if there was adequate community care. But community care has been hit hard after years of cuts with an 8% real terms fall in gross spending by councils on adult social services from 2009-10 to 2014-15 during which the need for care has increased.

Cancelling all NHS Private Finance Initiative (PFI) payments would save £2 billion a year.

Nationalising the pharmaceutical industry could save £3 billion a year of profits, and enable research to be done to meet patients’ – not shareholders’ – needs. Add sums spent on medical devices – from artificial joints to syringes – and the NHS probably pays out another £2 billion a year in profits.

NHS England expenditure on medicines in 2014-15 was £15.5 billion, up 7.8% from 2013-14 and up 19.4% from 2010-11.

Then there are privatised services rapidly taking over contracts, the cost of administering the market between trusts and clinical commissioning groups, staff agencies and many other profiteers leeching off the NHS.

Democratic socialist planning of a publically owned and run NHS with the full funding needed would end the real threat it now faces to its existence.

The Socialist Party calls for:

  • Abolish the Health and Social Care Act – no cuts, closures or privatisation
  • Support health workers – united action by all health unions to defend our NHS
  • Scrap the Private Finance Initiative and cancel the debt
  • Nationalise pharmaceutical companies and all private health providers
  • Investment not cuts – for a well-funded NHS, free at the point of use
  • Free education and training and living grants for all