Feature by Scottish NHS workers that will appear in the new issue of the Socialist
2018 is the year our NHS will come under more threat and pressure than ever before. I have worked in the health service for 10 years.
I love the job I do caring for my patients. I find it very rewarding but also very tiring and stressful. I go home sometimes feeling I haven’t given the care to my patients that I should have because there just hasn’t been enough staff or time to spend with them.
First minister Nicola Sturgeon, in a speech in parliament recently said she would like to thank everyone in the health service for their hard work. Well, I don’t need her thanks.
What I need – and for the rest of my colleagues – is to be paid enough and to be on the appropriate banding scale for the job we do.
Staff are on their knees having to do two jobs or more, some are visiting food banks. We have seen wards closed and threats of closure in our small community hospitals, staff shortages, long shifts, low staff moral and the list goes on.
At the end of 2017, the NHS was hit with an epidemic of flu and respiratory problems, leading to wards being closed to new admissions all over the country.
The Scottish and Westmister governments have used this as an excuse for the absolute shambles that our hospitals are in today. It’s not just the flu epidemic that has caused chaos, our NHS had been under pressure for weeks, months and years.
Scotland’s A and E units may have performed better than England in December but we still had some of the worst figures on record. Both Nicola Sturgeon and health secretary Shona Robison have apologised to patients. But the NHS is in an unacceptable state.
A result of unprecedeted cuts and underfunding and a refusal of the SNP government to fight Tory austerity.
We all need to get organised within our work places. Join a union if you haven’t already done so and get active in it. The NHS unions must, alongside local communities, take the lead in building a mass campaign to save the NHS from cuts.
A national demonstration and coordinated strike action by unions is a vital and urgent step This is the year that all our colleagues within the NHS have to stand together and help save our NHS.
Build a mass campaign to end the cuts onslaught
In November’s Tory budget of last year, Hammond and co were under pressure from none other than the chief executive of NHS England to provide an immediate cash injection of £4bn. Instead Philip Hammond pledged a mere £350m to deal with the expected winter pressures.
The consequences of this miserly attitude to health funding are now being seen across NHS England, with bed capacity in excess of what the beleaguered service can cope with, waiting times in all areas going up, care not being delivered and further suffering, indeed fatalities, as a result.
Ambulances cannot attend medical emergencies promptly enough, leading to the tragic events in Essex where a patient having had a heart attack was unable to get to hospital and sadly died, 4 hours after requesting emergency attention.
The consequences of underfunding health services are pain, trauma and deaths. Systems fail for want of resources to adequately meet demand, such things can have tragic results for those who then seek to access emergency services. As the winter pressures have hit hard, through flu, falls and general demands on the creaking service, the Tories have responded with a heartfelt apology. As if saying sorry is enough.
In Scotland we are no different. Austerity in healthcare is biting at the bones of the service. Inadequate provision is the order of the day. Alongside Theresa May, Nicola Sturgeon has also had to apologise. And yet NHS Scotland is under strict financial discipline to make savings just as demand for services are expanding.
Health authorities in England were late to stop elective surgeries over the winter period. But NHS Tayside decided months ago to close its theatres to elective surgery across all its surgical sites, an unprecedented move in its history, as it prioritised emergency surgery instead.
But as we go to press, Socialist Party Scotland is aware that even cancer operations have been effected by the moratorium on surgical procedures in NHS Tayside. For many people the parlous state of their health service may not be a surprise, but the lack of action to remedy the situation certainly is.
It is clear that after a winter of crisis we will see a spring of cuts, if not actual closures of service, across NHS Scotland. Plans have been out for consultations that institute radical redesign of services, including greater centralisation of care to cope with chronic shortages of staff, especially in rural areas, alongside massive increases in agency spending on essential medical and nursing services.
The NHS is about to undergo the ravaging of its services that local authorities have experienced under the years of austerity. Budgets do not match demand. Indeed, there are systemic financial pressures on NHS funds that refuse to be lifted by central or devolved government.
The sheer cost of facilities purchased under PFI/PPP deals are a burden all over Scotland. In Lanarkshire where two hospitals were built, financed by private companies who then lease back the buildings to the health authority, over £90m must be found every year for these contracts.
In NHS Tayside PFI contracts in mental health will not be cleared until 2042 at a cost of £14m per year, every bed in the psychiatric services on Tayside is, effectively, privately provided, with companies profiting from their use, and money going to those companies as opposed to being invested in the service.
In the wake of this budgetary crisis nothing is said about lifting the burden of PFI contracts from Scotland’s health service. The SNP seem comfortable with what they call legacy spending, despite these costs bearing down hard on current budgets.
We demand the renationalisation of all PFI contracts as a matter of prudent financial management as much as to end the profit for illness these contracts provide to the banks and corporations.
Furthermore, the SNP government’s general view on NHS services and funding appears to be to let the health authorities manage the decline. Senior SNP politicians in Tayside and Angus are well aware of the draconian cuts in mental health services proposed by the health authority, but remain neutral in the face of public pressure to stop the closures.
There is a great temptation for the government to approach the current catastrophe with an air of complacency, blaming pressures on a spike in admissions for flu viruses, but the facts needs to be faced: NHS Scotland is in crisis all year round.
Recruitment to front line services such as GP practices and nursing posts are drying up. Reliance on expensive agency staff has gone up spectacularly in recent years. Add the ongoing issues around price inflation for prescribing drugs, that private drug companies sell at a premium to the NHS, and there is little to suggest that a future of financial security is waiting around the corner.
All of which calls into account the approach of the trade unions. There is too often a poverty of action in response to the pressures staff in the NHS face when they turn to their unions for help.
This is no accident, workplace relations in the NHS are built around the model of social partnership, which implies a mutual understanding from staff and management as to how the service should develop.
This has meant in practical terms that some trade union leaders at all levels in healthcare seem reticent to criticise the cuts agenda, or it consequences to those who need the services under threat, because they have agreed to the financial proposals of health board management.
Campaigns against cuts generally have involved the wider public more than workers within the services under threat. And yet the potential for a mass campaign involving unions like Unison, Unite and others is huge.
NHS workers are facing significant increases in their workload, stress and pressure as the cuts go further, never mind the decade long cuts in pay and attacks on pensions that have left staff feeling undervalued, ignored and helpless.
The strike action by the Dundee hospital porters in 2015 and in England the junior doctors, and then the ancillary workers at Barts Trust hospitals in east London, have shown the way with their determined action.
The continued presence of financial pressure on NHS budgets from the demands of private profi; drug companies charging high prices, agencies applying administration costs to the staffing they provide, or the banks and building companies who profit from PFI/PPP contracts.
The chronic lack of investment in recruitment and retention of a well paid motivated workforce, which has left services under staffed to meet demand. Similarly the current crisis tells us that austerity in healthcare – applied by Tory and SNP politicians in Scotland – will lead only to a worsening situation unless a strategy to reverse the cuts is developed and implemented now.
A mass movement involving the NHS trade unions and communities can and must be built. Building this type of movement can be the start of winning a socialist NHS – one that is fully publicly owned and funded to meet people’s needs, and democratically run by health workers and service users.
Tayside mental health services facing closure
In the face of extreme financial pressure NHS Tayside, planning cuts of £200m-plus in the next 4 years, has embarked upon a massive review of services.
Proposals for the radical redesign of mental health in-patient care have already seen a ward close in Angus, to be relocated 30 miles south in Dundee. Similar threats now face facilities in Perth – 20 miles away from Dundee.
On the 26th of January the health board proposals go before the so called Integrated Joint Board of local authority officers and health service managers.
A consultation exercise has shown massive opposition to the proposals that all acute mental health beds are provided from one site in the Carseview Centre, Dundee.
Facilities in Angus and Perth that only opened in the past five years are to be mothballed, but still paid for under PFI/PPP contracts at over £8m per year until 2042.
For service users and their carers these changes are profoundly problematic, staff similarly face the challenge of relocating to a new hospital with costs involved only covering an interim period of 4 years for those staff who aren’t currently resident in Dundee.
Also within the proposals in a cut in bed provision, so these proposals will also affect services in Dundee itself, a situation of scarcity that increases risk to patients requiring admission but unable to get in.
Since autumn last year Socialist Party Scotland has been involved with the campaign to Keep Our Mental Health Services Local in Perth.
From a successful public meeting a campaign of public work, including a demo outside the hospital whose admission ward is under threat – Murray Royal – and a survey of service users, which delivered a huge No to what the health board wants to do, have highlighted what we knew to be the case, that these ideas are deeply unpopular.
If the closure goes ahead, the responsibility will lie with the health board and the SNP government for carrying out cuts that threaten the health and well being of some of the most vulnerable people in our community.
A socialist policy for the NHS
- Scrap health board plans to axe hundreds of millions from the NHS in 2018
- Scottish Government must provide the money for a fully funded health service for all and end the cuts
- Stop ward closures and centralisation of services to pay for cuts. Invest in GP services now!
- End the attacks on health workers’ pay, terms and conditions, workload and jobs.
- Scrap the PFI/PPP scandal that sees hundreds of million syphoned off to line the pockets of big business
- Nationalise the drugs companies. Health before profit
- For a mass campaign of trade unions and communities to defend and rebuild the NHS