It is clear that there is currently insufficient capacity in the NHS in England. This hasn’t happened overnight. It is the result of failure on the part of consecutive Conservative governments to provide enough resources and training places and to carry out the necessary workforce planning. This points to either woeful incompetence from minsters, or worse: a deliberate running down of the NHS.
The most recent figures show that there are more than 133,000 vacancies in the NHS in England, including over 47,000 registered nursing vacancies and over 9,000 medical staff vacancies.
It is a crisis that predates the pandemic; there were over 100,000 vacancies in the NHS in England in September 2019.
This is a crisis of the Conservatives’ own making. Let’s not forget that public satisfaction with the NHS was at its highest in 2010, just after Labour left office.
The devastating impact that the crisis is having on patients and hard-working staff cannot be overstated.
Members of the Royal College of Nursing have told me how stressed and burnt out they are because they do not have enough colleagues working alongside them.
In addition, many nurses are facing great financial hardship.
I have heard of nurses going to food banks, nurses who cannot afford to drive to work and nurses who are leaving the profession to work in chain stores for better pay.
Last month, the Royal College of Nursing voted to take strike action in its fight for fair pay and safe staffing. It is not something they do lightly. Other organisations representing NHS workers are taking strike action too, and more are balloting members.
The impact of staffing shortages on patients is profound, leading to extremely long and unacceptable waiting times.
There are over five million people waiting for over seven million appointments; these are patients waiting often in pain, anxious for treatment, many with more than one condition.
Some patients are paying thousands of pounds for treatment in the private sector because of these delays. The Conservatives have failed them.
Over the past 12 years, rather than provide it with sufficient funding and make sure it has the staff and resources it needs, Conservative-led governments have embarked on two major reorganisations of the NHS.
The Health and Social Care Act 2012 and the Health and Care Act 2022 both served to open up the NHS to the private sector. One way in which the 2022 act does this is through the use of provider collaboratives.
Each of the 42 Integrated Care Boards (ICBs), the new statutory local commissioning bodies that were established under the 2022 act and which replaced Clinical Commissioning Groups, is entitled to delegate their commissioning functions and devolve budgets to non-statutory sub-committees, including provider collaboratives. These are partnership arrangements involving at least two trusts and they can include representation from the private or independent sector. So, we have a situation where representatives of private companies may be part of an organisation spending large amounts of public money.
In addition, the act provides insufficient safeguards against representatives of private companies sitting on decision-making bodies.
The act prohibits the chair of an ICB from approving or appointing someone as a member of any committee or sub-committee that exercises commissioning functions on behalf of that ICB if the chair considers that the appointment could reasonably be regarded as undermining the independence of the health service because of the candidate’s involvement with the private healthcare sector. However, it by no means rules out people with interests in private healthcare from sitting on those sub-committees, and it gives a great deal of power to ICB chairs.
Then there is the issue of whether we will see an increase in outsourcing to the private sector.
The act provides for the revoking of the national tariff and its replacement with a new NHS payment scheme. The national tariff is a set of rules, prices and guidance that governs the payments made by commissioners to secondary healthcare providers, such as hospitals, for the provision of NHS services.
Given the requirement in the Health and Care Act 2022 for NHS England to consult with each relevant provider, including private providers, before publishing the scheme, I am concerned that this may well be a mechanism through which private health companies will have the opportunity to undercut the NHS.
If that happens, I believe that one of the inevitable outcomes would be an erosion of the
scope of Agenda for Change, and we would see healthcare that should be provided by the NHS increasingly being delivered by the private sector.
In that event, NHS staff may then find themselves forced out of jobs that are currently on Agenda for Change rates of pay, pensions and other terms and conditions, with only private-sector jobs with potentially lesser pay and conditions available for them to apply for if they wish to continue working in the health service.
Ahead of my recent debate on NHS staffing levels, I was overwhelmed by the number of stakeholder organisations that contacted me and shared details of how the staffing crisis is impacting on the people they represent.
It is clear that they want to see a credible plan from the government to put things right for staff and patients.
The government is to publish a comprehensive NHS workforce plan next year, and this will include independently verified workforce forecasts of the number of doctors, nurses and other professionals that we will need in five, 10 and 15 years’ time. Such a plan is long overdue.
The NHS is one of this country’s proudest achievements, but it is clearly in crisis.
It is valued as a comprehensive and universal service, publicly owned, paid for through direct taxation and free at the point of use for all who need it.
It should be a source of shame for the Conservative Party that governments since 2010 have failed to plan and provide the workforce that the NHS needs. We need a Labour government that will invest in the NHS staff we so desperately need.Margaret Greenwood is the Labour Member of Parliament for Wirral West.
Before entering parliament, she was a NHS campaigner and founder member of Defend our NHS, a Merseyside-based campaign group which was originally formed in 2011 to oppose the Health and Social Care Bill, and which is committed to a comprehensive, universal, publicly-owned NHS paid for through direct taxation.
She is also a patron of Keep Our NHS Public.Her other roles in parliament have included Shadow Secretary of State for Work and
Pensions, Shadow Employment Minister and Shadow Schools Minister.
