The doctor can’t see you now. This is the message half of emergency patients trying to call 999 are expected to receive from at least one major ambulance service, as crews across the country strike. I hear from sources at one of the ten trusts taking industrial action in England and Wales today (21 December) that they are only expecting to reach “half the incidents we usually would”.
The service will decide which patients to prioritise using an informal risk to “life or limb” rule. Those who cannot be seen will either be referred to 111, speak to an emergency doctor, or “the service will simply say: ‘At the present time, we are unable to respond.’”
Control room staff will still be in touch with paramedics on the picket lines, to run them through any cases they may be willing to pick up. But there are fears patients are in more danger than the public realises – with it being “extremely hard to mitigate” the risk of deaths or life-changing injuries.
Ambulance trusts have asked taxi firms to stand by to drive lower-priority 999 patients to hospital. The military has been drafted in to drive ambulances.
This sounds like an apocalyptic scenario, in a week of back-to-back NHS strikes – nurses walked out on 15 and 20 December. But there are parallels with the days before this industrial action began. After all, ambulance services already have an existing relationship with taxi firms, so common has it become for patients to make their own way to hospital in an emergency. And the week before the paramedic strike was the worst ever for ambulance handover delays.
This is the subplot of NHS pay disputes. As outcomes become poorer, patients’ relationship with the NHS is changing. A service still referred to as a “national religion” is losing its flock. There is evidence more people in the UK are turning to private healthcare, but it’s more than that. The health service’s sacred place in the public imagination appears to be falling.
On the extreme end, this can be seen in the rising levels of abuse and aggression towards GPs and their receptionists. Yet there is a quieter collective shift among patients described to me by front-line workers and backroom staff – a loss of faith in the NHS’s ability to help them.
“People have less trust in our ability to do well by them,” said Dr Emma Runswick, a mental health doctor in the north-west of England and deputy chair of council at the British Medical Association doctors’ union, which is balloting its members in January (she expects a majority for junior doctor strike action to take place around March 2023).
“Most patients and family members understand the difficulties that we’re facing,” she continued, “but it is definitely shifting. We’re seeing more and more people take their own journey to hospital, and manage their own conditions… I think the relationship is changing and I don’t think it’s a good thing.”
A record waiting list, currently at seven million, is increasing “the quantity of frustration that people feel towards the NHS”, said an administrative staffer who works in an endoscopy unit in a north-west NHS hospital. His main job at the moment is delaying procedures.
“Our ability to provide care is obviously limited by the backlog. It makes people feel much more cynical towards the NHS and its ability to provide care not only to them, but to their loved ones. It’s very sad.”
Lack of staffing, too, is registering with patients. One in ten health service jobs is vacant. “Shortages are literally an everyday occurrence and it’s not safe for patients – but it’s becoming the norm, and now it feels like no one bats an eyelid that they’re being forced to live with substandard care,” said Sangeeta Laljee, a vascular surgery nurse who has been in the profession for 22 years. “I’m really worried about when I retire, what happens next? When I need healthcare, am I going to get that care?”
Having never considered going on strike before, she was on the picket line outside St Mary’s Hospital in Paddington, London.
Outside St Mary’s, to honks from cars and ambulances driving past, nurses chanted: “What do we want? Patient safety! Who’s it for? You!” Strikers don’t just voice concern for patients as a rhetorical tool. It is morally injurious, as put to me by one paramedic in the south-west, to see people unnecessarily come to harm each day. It is also, as two nurses pointed out to me on the picket line, on their heads if they cause a patient harm. Staff can see people are in danger due to their working conditions, and sense a breach of that contract between UK citizens and “our NHS”.
Polling data bears this out. Satisfaction with the NHS is at its lowest this century, according to the latest research by the British Social Attitudes survey. Waiting times (to see a GP or get a hospital appointment) are the number one reason for dissatisfaction, followed by staff shortages.
Graph by Ben Walker
Satisfaction has fallen “across the board” among all demographics – and almost as much among Tory as Labour voters – said Richard Brown, director of society views at the National Centre for Social Research (which runs the British Social Attitudes survey).
While four in five people say the NHS is facing a funding crisis, there is growing concern about money being wasted, and limited appetite to pay more tax into the system. “Before the pandemic, 26 per cent of people said money is being wasted in 2019. And that’s gone up to 39 per cent,” said Brown.
There are also signs of public curiosity about an alternative funding structure. Although a majority at 54 per cent think the NHS should be primarily funded through taxes, Brown sensed when doing this research that there is “less distaste for the idea that maybe funding sources other than taxation might come into play”.
Ideas about NHS reform are spreading. The shadow health secretary Wes Streeting has argued that the UK cannot keep throwing “ever-increasing amounts of taxpayers’ money into a 20th-century model of care”. The Conservative employment minister Guy Opperman advocated for more employer responsibility over people’s healthcare (in other words, a step towards an insurance-based model). Leaked minutes of a recent meeting of NHS Scotland directors revealed a proposal to start charging wealthy patients.
Yet the public mood is not straightforward for aspiring reformers. Crucially, support for the core founding principles of the NHS remains very high. A strong majority believe in the universal provision of services, and keeping it free at the point of use.
It appears the public believes the NHS “needs more money, and should spend it better at the same time”, reflected Brown. “Our polling suggests a similar number of people think both of those things, and probably some think both at once.”
This may explain the enduring public sympathy for nurses and other NHS staff taking industrial action. Patients are dissatisfied due to staff shortages, and aware of the funding squeeze. After all, NHS staff top the pollster Ipsos’s traditional Christmas list of who’s been “nice” (as opposed to “naughty”) this year for the third consecutive time.
[See also: Nurses don’t strike lightly]