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20 December 2022

How can the NHS strikes be resolved?

Nurses and paramedics are fighting poor pay and conditions. Somehow the government needs to find the money to reverse years of underfunding.

By Harry Clarke-Ezzidio

How does the NHS solve the multitude of issues facing its workforce? Over the past week tens of thousands of nurses, paramedics and other medical staff went on strike over pay and conditions.

Amid consistently-high inflation, pay will be the top priority for workers – and by extension unions. Nurses’ pay is worth less in real terms than it was in 2010 and NHS England, after receiving recommendations from the government’s independent public pay board, has offered most staff only a 4 per cent raise.

Recent months have highlighted what impact pay stagflation is having on nurses, who are among the NHS’s most vulnerable and lowest-paid workers. Reports of food banks for staff opening within hospitals and workers calling in sick because they can’t afford to commute are a damning indictment of how poorly compensated some of the health service’s hardest working staff are treated.

Money is not the whole story, however. Medical staff across the NHS are striking over pay and conditions. The latter – and what it encompasses – is often ignored.

There are record backlogs – which were already at an all-time high before the pandemic, and were exacerbated by Covid-19 – in elective care; a record number of job vacancies (132,139, including 46,828 nurses); operations being cancelled because of staff shortages; and bed capacity is inadequate. All these help to explain why workers (especially a record amount of nurses) are leaving the NHS in droves.

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The Chancellor, Jeremy Hunt, announced £6.6bn for the NHS over the next two years in the Autumn Statement, but that will not be enough to cover the funding shortfalls the health service faces, experts warn. So how did the NHS get into such a poor state?

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There are two themes that have characterised the Conservatives’ oversight of the NHS: underfunding and poor planning.

During the Cameron-era austerity yearly real-terms government spending increases on health and social care dropped from an average of 3.7 per cent a year between 1948 and 2010 to 1.4 per cent from 2010. That wasn’t enough for the NHS, or the social care sector, to keep pace with the additional pressures that were put on the health service from a population that was living longer. As a result, staff and resource capacity is insufficient to meet demand. “We saw bed occupancy rates rise very fast, and we saw social care place availability fall substantially through that period,” Anita Charlesworth, director of research at the Health Foundation charity, told Spotlight.

Austerity also brought drastic cuts to council funding. They had the effect of making it harder for councils to maintain care services, so outsourcing became increasingly prevalent and places became more scarce. During the pandemic hospitals struggled to safely discharge older patients, who made up a significant proportion of Covid-19 cases, into residential homes because of a lack of capacity. 

Both underfunding and poor planning, combined with pressures in emergency care, contributed to the NHS running a system where the “urgent undermined the important”, as Charlesworth put it. “What that meant was that there were fewer resources [for] community and primary care, and those other early detection, preventative parts of the health service.” Effectively, as there were so many fires to put out in emergency care, and it was the most obvious example of the NHS being under strain, other services that help to prevent ill health were left to deteriorate.

So while there’s a lot of detail to confirm, the broad strokes of policy solutions seem clear: adequate, sustainable funding, and a more holistic approach to health. The Conservatives will, somehow, have to find funding for both. It seems like Hunt, a former health secretary, at least understands the need for the latter; he has announced £7.5bn of extra funding for social care over the next two years. While it will “almost certainly not be enough”, Charlesworth warned, “the recognition that we’re not going to be able to address NHS problems without a more balanced health care system was important”.

Ultimately though, the NHS’s problems will not be solved without concrete action to convince its current workforce to stay, and to develop and attract highly skilled practitioners from home and abroad. “I’m striking because I don’t know what else to do any more,” a weary Lynda, who’s been a nurse in the NHS for over 25 years, said on a picket line.

“The creation of the NHS was a decision that was made in 1947, for the public good. The decisions to help support [and prolong] that initial choice still exists,” she added. “It’s just that the government’s choosing to ignore them. People still need the NHS. The current state of the NHS is a political choice.”

[See also: Nurses pay is less in real terms than in 2010]