It was Nigel Lawson, I think, who once opined that the NHS was the nearest thing the British had to a religion. If so the government has treated its priestly acolytes uniquely badly. The average real pay of NHS workers has fallen by over 10% since 2009. No less than 40,000 are paid below the living wage, and many NHS workers have to have second jobs to survive and some even have to use food banks. Effectively NHS staff donate £1.5bn a year in unpaid overtime. The government’s decision to refuse to pay even the 1% cost of living increase recommended by the Pay Review Body for 2014-5 added insult to injury.
Now the government has taken its provocative stance still further. The Health Pay Review Body (PRB) is currently taking submissions on 7-day working in the NHS. Whilst Agenda for Change sets out unsocial hours rates for NHS staff working evenings, weekends and bank holidays, the Department of Health’s submission to the PRB argues that even unsocial hours payments should now be cut through changing the times defined as ‘unsocial’, paying them plain time rates on Saturdays and lowering rates for Sundays and bank holidays.
These are execrable terms and conditions for devoted personnel so gratefully lauded by patients. But this is the public face of what is now being done to the NHS. Spending on the NHS peaked at nearly 8% of GDP in 2009; it’s now just above 7% and is projected to fall to just over 6% by 2021. That represents £30bn less being spent annually on the NHS compared with 2009. For comparison France and Germany spend nearly 10% of their GDP on their health services and the US spends 17%!
Other unwelcome pressures are are now exerting themselves on the NHS. As a result of cuts in local authority social care services because local authority budgets have now been reduced by up to 40%, people either turn to A&E thus increasing the overload so marked in this last winter or are forced to remain an in-patient for longer (bed-blocking). Again, when NHS Direct was closed down – a serious mistake when it made nurses more accessible on the phone – the new 111 service that replaced it does not have call-handlers with the same level of training, so that people are jamming up A&E to get a medical opinion.
Although the 5-year Forward Review document recently promoted by NHS leaders including Simon Stevens, chief executive of NHS England, demanded £2bn extra to meet health needs, hospital trusts faced with relentlessly increasing savings targets continue to reduce these very same services. Thus several trusts are currently targeting district nursing services for significant cuts, yet with more than a third of district nursing staff over 50 years old and with community nursing marked as an essential service to reduce inpatient stays, this is totally counter-productive. Now the government is proposing to implement a mutualisation model for the NHS: this is what existed before the NHS was created in 1948 – a patchwork of provision with no consistency in access to services, care quality or employment arrangements. As the Cabinet Office minister Francis Maude has himself admitted, “mutualisation is a form of privatisation”.