With vax mandates looming and industrial action on the table, the UK’s overstretched National Health Service could be in for a winter of even more discontent.
In April 2020, at the peak of the UK’s first wave of the pandemic, Boris Johnson called the NHS the UK’s greatest national asset. That national asset, having already been seriously devalued by the now disgraced Matt Hancock, is now under the stewardship of Savid Javid, a former senior banker at JP Morgan Chase and Deutsche Bank who strongly supports the privatisation of public services. After replacing Hancock as health secretary, Javid wants to shake things up even more at the NHS, even as the Tory’s latest root-and-branch reform, the Health & Care Bill, awaits its third reading in parliament.
To do much of the shaking, Javid has called on General Sir Gordon Messenger, a former vice chief of the UK’s defence staff. Messenger is expected to bring military discipline to NHS management. Those who don’t yield, by quickly bringing down patient waiting times, will be ruthlessly dispatched. In other words, a banker who made a name for himself structuring emerging market synthetic CDOs for JP Morgan Chase and later Deutsche Bank has appointed a
military general with extensive experience of commanding the commando in Iraq and Afghanistan to restore order to the UK’s rapidly faltering National Health Service. What could possibly go wrong?
Conflict Stirs in the Trenches
Meanwhile, on the organisation’s front lines the once-lionised nurses and care workers are agitating for a meaningful pay rise. After all the sacrifices they’ve made and hazards they’ve faced over the past 19 months, it seems like a reasonable request. But all the government will offer is a measly 3%. Given that the consumer price index in the UK is currently 3.2% and is expected to reach as high as 4.8% in coming months, said “rise” is actually a cut in real terms.
But that is not the worst part. The worst part is that nurses and care workers will be part funding their own pay rise thanks to the government’s recent hike in national insurance payments. As the Guardian reports, “a nurse or midwife on an average salary will see their tax bill soar by £310, care home workers will have to pay at least £140 more and ambulance staff will be hit with a £420 increase. On average, 1.4 million NHS staff will each have to fork out £315 more a year.”
Unsurprisingly, the nurses are not happy and are now contemplating industrial action. The biggest union, the Royal College of Nursing, says that 92% of its 450,000 members oppose the 3% pay rise. Those members, who represent roughly two-thirds of the country’s nurses, will soon be voting in a ballot on whether to participate in industrial action. If the vote passes, the choice will be between either working to rule, which means finishing on time, not staying behind hours after the shift ends or doing extra shifts when a hospital is short of staff, or going on strike. Either way, the di1sruption to an organisation that is already massively understaffed will be huge.
Three other public sector unions — Unite, Unison and the GMB — have also said that between 80-90% of their NHS members have rejected the government’s offer. Both Unite and the GMB are also preparing to hold a strike ballot.
This is the second time this year that NHS staff have threatened to strike. The first was in March after the government made an even more desultory offer, of a 1% rise. At that time consumer price inflation in the UK was 0.7%. It has since risen to 3.2% and UK inflation expectations are at a 13-year high. This is putting huge pressure on low-income public workers, many of whom are demanding a commensurate pay rise. The government has so far refused to give in, arguing that public finances are under unprecedented strain.
But so too is the NHS. If nurses do decide to strike in sufficient enough numbers, they should have plenty of leverage, albeit at the risk of losing some public support. Waiting lists for elective procedures are already through the roof, having hit yet another record high of 5.6 million in September. According to the Institute for Fiscal Studies, in a worse-case scenario they could more than double in the next year.
A Second Health Crisis
In September, the Office for National Statistics warned that the country is now facing a second health crisis, as a result of delayed treatment, fewer consultations and reduced immunity. Through the summer the country saw almost 5,000 excess deaths that were not caused by covid. This is highly unusual for the summer, said health experts consulted by The Telegraph. Although excess deaths are common during winter months, when a combination of cold weather and seasonal infections pile added pressure on the NHS, summer generally sees a lull:
Data from Public Health England (PHE) shows that during that period [between July and September] there were 2,103 extra death registrations with ischemic heart disease, 1,552 with heart failure, as well as an extra 760 deaths with cerebrovascular diseases such as stroke and aneurysm and 3,915 with other circulatory diseases.
Acute and chronic respiratory infections were also up with 3,416 more mentions on death certificates than expected since the start of July, while there have been 1,234 extra urinary system disease deaths, 324 with cirrhosis and liver disease and 1,905 with diabetes. Alarmingly, many of these conditions saw the biggest drops in diagnosis in 2020, as the NHS struggled to cope with the pandemic.
Cancer care is also on the rails in some health authorities. Cancer patients at a hospital in Nottingham are being forced to miss vital treatment due to a chronic lack of nurses. Thanks to a nationwide shortfall of specialist cancer nurses in the UK, more than half a million people with cancer are either missing out on support or not receiving enough, according to Macmillan Cancer Support.
Like many national health systems, including Canada, New Zealand and the US, the NHS faces a growing shortage of nurses and other medical staff. This is due to a slew of reasons including low pay, burnout and fears of contracting covid. A combination of factors, from Brexit to tougher migration rules, has also depleted its huge foreign workforce. There is also a vicious circle at work: the more stretched and overloaded the workforce becomes, the greater the number of nurses suffering burnout, and the more depleted, stretched and overloaded the workforce becomes.
According to the King’s Fund, an English health charity, NHS hospitals, mental health services and community providers are reporting a shortage of nearly 84,000 full-time equivalent (FTE) staff. That’s the equivalent of 6% of the NHS’s total workforce. The groups most affected include nurses, whose vacancy rate is currently 10% (equivalent to 39,000 workers), midwives and health visitors.
Workforce shortages are not new in the NHS, says Anita Charlesworth, the Director of Research and the REAL Centre (Research and Economic Analysis for the Long term) at the Health Foundation.
[T]hey are a recurring and enduring feature of the health service over the last 70 years. The reasons for such shortages are complex. A historical reliance on international recruitment may be part of the story. A bias in the UK to focus on the exchequer cost of training doctors and nurses (which is expensive), but not the cost associated with the failure to train enough staff is another factor. More broadly, workforce shortages are totemic of the short-termism that dominates national policymaking. This isn’t a health-specific issue – on skills, infrastructure and climate change, governments of all persuasions repeatedly end up focusing on the urgent at the expense of the important.
In 2017, a House of Lords Select Committee argued that the absence of any comprehensive national long-term strategy to secure the appropriately skilled, well-trained and committed workforce that the health and care system will need over the next 10–15 years represents “the biggest internal threat to the sustainability of the NHS”.
That was three years before Covid upended the healthcare system. Since then, rather than take a more considered, long-term approach to staff recruitment, training and retaining, the NHS has doubled down on its use of temporary staff, many of whom are on the equivalent of zero-work contracts. As a recent article (h/t Lambert) in Tribune Mag reports, this has allowed the organisation to use precarity as a weapon against worker organising:
The NHS continues to fill staff shortages by spending almost £1.5 billion a year on temporary staff, including bank and agency workers to cope with shortages. Temporary staff supplied by agencies cost on average twenty percent more than those from the NHS’s own banks, despite doing the exact same job, but in the year 2017/18, spending on bank staff was higher than for agency for the first time in several years – a £528 million reduction in agency spend.
If the NHS was to fill its current temporary vacancies with workers from both the staff bank and agencies by offering them permanent contracts that encompassed flexibility, and full employment rights instead of outsourcing, it could free up £480 million to reinvest.
Bank contracts also pose problems in the form of the expectations placed on those working under them. Put simply, we know that we are not meant to be seen as full employees. This means that the NHS as an employer can take a neoliberal approach to how it delegates its hours for bank workers.
Next Up: Vaccine Mandates
The government is now planning to heap even further pressure on the NHS by mandating vaccination for all frontline workers. It already imposed a “no jab, no job” rule for care home staff in September. Workers in the sector have until November 11 to get double jabbed. Anyone who doesn’t comply will be legally barred from work. As in the US, the result is likely to be a sharp increase in staff shortages in the care home sector and a further deterioration in the quality of care. Care home bosses are already warning of an even worse winter crisis than last year’s.
The government wants to do exactly the same with the NHS’ frontline staff, despite the weak — and fast-waning — efficacy of the current batch of vaccines against the Delta strain, the likelihood that many of the unvaccinated workers have already had natural infection and the extremely high uptake of the vaccine among NHS workers. According to the latest weekly figures for England, 1.32 million have had a first jab (92%) and 1.27 million (89%) have had a second. That still leaves 8% of England’s NHS workforce — roughly 114,000 workers — unvaccinated. Any frontline workers who refuse to take the jab will either lose their jobs or be redeployed.
The mandate, which is likely to come into effect in late October or early November, has stirred strong opposition from public sector unions. While strongly urging its members to take the vaccine, the Royal College of Nursing expressed serious misgivings about the government’s plan:
“The RCN has significant concerns that mandating vaccines will further marginalise those who are currently vaccine hesitant and put further pressure on a hugely depleted workforce by forcing people out of employment.
“Staff vaccination should not be used as part of staff contracts, it should not be a condition of employment or part of employment contracts, linked to terms and conditions of employment or to pay.
“The RCN do not believe that this approach is effective in improving uptake of vaccination in staff.”
It’s unclear just how many of the NHS’ unjabbed frontline workers will bow to the government’s pressure and how many will simply leave their jobs. For many, finding new work in healthcare outside the NHS is unlikely to be easy. But thousands of healthcare workers will no doubt refuse to yield, as has already happened in the US, France and other countries. And that will leave an already underfunded, overstretched, understaffed NHS facing an even bigger shortfall of nurses just as winter dawns.