Climate of Fear in the NHS

Saturday 8 October 2011

“The last chance to save the NHS” is how it has been billed. This Sunday thousands from across the country are expected to descend on London to launch a headline-grabbing demonstration against the coalition government’s proposed healthcare reforms.

Led by the anti-austerity group UK Uncut, the protesters plan to temporarily close down the iconic Westminster Bridge just days before a crucial parliamentary debate on the controversial Health and Social Care Bill. If the Bill is passed into law, campaigners say, it will open the NHS up to corporate interests, damage the standard of service and lead to the destruction of an equal and universal healthcare system.

But in the build up to the demonstration, an investigation by The Big Issue in the North has discovered frontline NHS staff across England are already enduring cutbacks that could be putting patient care at risk, with some surgeries being delayed due to tight budgets.

Speaking on the condition of anonymity, Dr Stephen Smith (not his real name), said at one hospital in the south west of England staffing was at a “dangerous level” after the ratio of nurses to patients in each ward had been reduced.

“There is a climate of fear and a feeling that everyone’s budgets are under heavy attack,” he said. “Working in A&E for example there are signs up saying ‘how can we save money’, with people asked to give suggestions. But the amount that’s having to be saved each month is just crazy, and consequently rotas are being designed with less doctors in them because it’s cheaper. Which clearly puts patients at risk.”

Smith added that he believed the Health and Social Care Bill would send things in a “very bad direction”.

“There isn’t anybody I know in the medical profession that thinks it’s a good idea. Everyone has said that this is going to destroy the NHS and is just an attempt at backdoor privatisation. The only people who are pro it are the GPs who are going to make money out of it,” he said.

Jacqui Moore (not her real name), a specialist practitioner who is also a union representative at a hospital in the north west of the country, described increased levels of stress due to a string of job cuts.

“I see alot of staff going off with stress at the moment. The minute you start cutting staff everybody else is just expected to work harder and a lot of staff react to that. They just can’t cope with it. Just about every person I deal with seems to have either been off with stress or has just come back after a period of stress-related illness. Everybody is feeling the pressure.

“I think it’s just symptomatic of what’s going on in the health service as a whole. The whole agenda is very cost driven, and every decision that seems to be made is a financial one, rather than one that’s got patient care at the end of it.”

Shortly after coming to power in May 2010, the coalition government gave an assurance that its cuts agenda would not impact upon frontline services. And in April this year the government launched a “listening exercise” to address concerns about the scale of its NHS reforms.

Launching the initiative, prime minister David Cameron said the government wanted to “safeguard the NHS for future generations”, but added that it was only through “modernisation that we can protect the NHS and ensure the country has a truly world-class health service.”

Months after the listening exercise, however, the British Medical Association (BMA), which represents around 141,000 doctors and medical students in the UK, called for the Health and Social Care Bill to be “withdrawn or at the very least significantly amended.”

“The clear view of BMA Council is that the Health and Social Care Bill remains deeply flawed,” said Dr Hamish Meldrum, the council’s chairman. “The BMA will continue to publicly and vigorously highlight the concerns of doctors and patients, particularly to peers who have a real opportunity to protect the NHS by addressing the damage that could be done by many aspects of these reforms.”

One long-serving nurse at a hospital in south London, Mike Davey, told The Big Issue in the North the fear is that the standard of service – and ultimately patient care – will be severely compromised by the changes.

“There’s a nervous anticipation and a lot of staff are very concerned. It’s having a negative impact on morale,” he said. “This particular government is putting thumb screws on to the managers, the executives and the trust boards so they have to pretty much market test everything – which means services being privatised out.

“We’re told a private company can do things cheaper and better than our own in-house services. But previous experience, since the Thatcher government in the 80s brought in mass privatisation, has led us to see that this is not actually the case.”

At a hospital on the outskirts of Manchester, some surgeries may have already been rationed due to budget shortages.

According to Oldham and Saddleworth MP Debbie Abbrahams, a 33-year-old man in her constituency had an operation to fix his cataracts delayed because his sight was classed as "impaired" as opposed to "blind". The man, an engineer by trade, cannot work due to his condition and will have to wait until his vision worsens before he can undergo immediate surgery.

"Delays to simple and relatively inexpensive operations, like those for cataracts, can severely affect a person's life,” Abbrahams said. “I am very concerned about this situation as I have had several constituents come to me asking for help because they cannot get their cataracts treated in a reasonable time. Along with Michael Meacher and other Greater Manchester MPs I am asking Oldham's Primary Care Trust for clear answers about why this and other basic operations are being hit so hard by this government's ideologically driven cuts."

On 11 October the Health and Social Care Bill will be debated at length in the House of Lords. The Lords can propose amendments to the Bill, with some Liberal Democrat peers, led by Baroness Shirley Williams, expected to rebel against it. Writing in the Observer last month, Williams said that she had “huge concerns”, adding: “The battle is far from over.”

For Ben Jackson, a spokesman for UK Uncut, this Sunday’s protest will be crucial.

“It all depends on what they [the Lords] hear from the public,” he said. “So we need to take drastic action to make it clear that this isn’t going to be something we’re just going to lie down and take. This is something we really care about. It’s an emergency for the NHS."

This article first appeared in issue #896 of The Big Issue in the North magazine.

About the Bill

The Health and Social Care Bill was introduced into parliament on 19 January 2011. It was approved by the House of Commons on 7 September and is currently at the debate stage in the House of Lords.

Key measures contained in the bill include proposals to:

  • Abolish Primary Care Trusts (PCTs) – which manage the provision of care services in a specific area – and replace them with consortiums of GPs. The consortiums will have control of an £80bn budget for the treatment of patients.
  • Establish a new organisation called HealthWatch England, which will be tasked with promoting greater democracy and accountability in the NHS. It will have the power to propose investigations into poor services and ensure that feedback from patients is taken in to account.
  • Turn all hospitals in England into semi-independent foundation trusts by 2014. This will allow hospitals to earn money by treating private patients and place them in direct competition with one another for patients. It was Tony Blair who originally introduced this concept in 2003. Around half of all hospitals in England already have this status.

The British Medical Association says its three main concerns about the bill are that it:

  • Is centred around an inappropriate and misguided reliance on market forces.
  • Will have unintended, knock-on impacts with longer-term consequences such as the impact on public health and medical education and training.
  • Will lead to over complexity and greater bureaucracy.
A Department of Health spokesperson said: "Our revised plans both safeguard the future of our NHS, and ensure it is more efficient and more accountable. The fundamentals of our plans - more control for patients, more power to doctors and nurses, and less bureaucracy in the NHS - are as strong today as they have ever been. Because we believe passionately in the NHS, funding will increase by £12.5 billion over the next four years, a sign of our commitment to protecting it for the future, so there is no excuse to cut back on services that patients need."