January saw the longest NHS strike in its 75-year history as junior doctors of the British Medical Association walked out for six days in their bid to restore a real-terms pay cut of 26% since 2008. The dispute highlighted the exhausted state of public services across the UK and the underlying cause: long-term failure to invest in services and pay staff adequately.
The Government’s treatment of the NHS undermines its founding principles of universality and high quality. Nominally, the Department of Health and Social Care’s budget has risen every year. But inflation and a growing, ageing population have turned marginal increases in expenditure into real-term cuts.
This has led to an assault on wages, working conditions and health outcomes. With junior doctors reporting nightmares about work, a recruitment and retention crisis is unsurprising. One in seven NHS workers are searching for work elsewhere, rising from one in ten in 2021. The latest figures highlight 121,070 vacancies, predicted to reach 360,000 over the next decade without intervention.
A&E waiting lists are now ten times worse than in 2011. Hospital treatment waiting lists have risen to a record of 7.8 million. We are the sixth largest economy in the world. Yet we now have the second lowest number of hospital beds per capita in the OECD and the sixth lowest number of MRI machines. People are dying sooner than they should because of budgetary decision making – the situation is truly nightmarish.
Inadequate investment in other areas of the economy also contribute to an overloaded NHS. The detrimental effects of poor housing costs the NHS over 1 billion per year. If spread across the whole population, socio-economic inequalities aggregately shorten life expectancy by 1.5 years in England. Cuts to key service areas explain these damning findings – analysis indicates that public spending cuts caused 335,000 excess deaths between 2012 and 2019 across the UK.
The Social Guarantee’s integrated approach centres on the delivery of universal, preventative services to meet human needs. If implemented, it would go far to remove mounting pressure on the NHS. Services that deliver life’s essentials – from caring for physical and mental health, and for the young and old, to providing education, housing, energy and transport – are highly interrelated and must be treated as such.
Investment in these services so that they are universally accessible and of sufficient quality to meet needs is the best way to avoid health problems and life lost due to deprivation. It would mean the NHS can focus on looking after people with unavoidable illnesses.
Without a healthy population and effective healthcare services, society cannot flourish. Modelling from the 99% Organisation shows that continuing on the current trajectory of healthcare expenditure will restrict GDP growth close to zero over the next 50 years. Failing to invest sufficiently in the NHS’s workforce and infrastructure is fiscally irresponsible. Maintaining a healthy population is one good reason to invest in healthcare services; preventing economic decline adds to the case.
A core principle of the Social Guarantee is to ensure fair pay and conditions for services workers. Restoring decent pay for junior doctors is an important step towards resolving the recruitment and retention crisis – and thereby strengthening the NHS.
Workers must be supported to safeguard their rights. Instead, the Government scapegoats unionised NHS staff, falsely attributing the UK’s record-breaking waiting lists to the strikes. Research demonstrates that industrial action has had a minor effect, increasing waiting list length by only 3%. Nonetheless, public support for striking junior doctors remains strong, with an Ispos poll from September showing 53% in support, compared to 31% in opposition. In a more recent Christmas poll, NHS staff were rated top of Ispos’ 2023 ‘Nice List’ for the fourth year in a row.
The NHS and its vision of equal access to healthcare as a human right is of course a major source of pride in the UK. It must be protected at all costs – not least through the organisation and delivery of other essential services. This must start with public investment to enable fair pay and support for the staff upholding it through challenging times.