Running on Empty

In the Great Fuel Crisis of Autumn 2021, those queuing at the petrol pumps may have wondered who was to blame.

Could anyone have seen it coming? Could anything have been done to avert it?

With scenes of forecourt chaos receding in the rear-view mirror, we would do well to scan the road ahead for any other looming disasters. And to take note of the warning lights blinking up on the NHS dashboard. Because the consequences of the healthcare tank running dry don’t bear thinking about.

The NHS had around 100,000 vacancies before the start of the pandemic in 2020. A decade of austerity reduced investment in infrastructure, training, and frontline workers’ salaries. During the 10 years to 2020, NHS pay dropped more than three times as much as private sector pay. A vicious cycle was set in motion – as staffing levels fell, unpaid overtime, stress and exhaustion increased. And then Covid-19 hit.

Personal courage

Few could fail to be moved by the efforts of NHS staff, who stepped up at great personal cost to tackle wave after terrifying wave of virus. Certainly, Boris Johnson was effusive in his praise for the “personal courage…of the doctors and nurses…the cleaners, the cooks…physios, radiographers, pharmacists” who put their lives on the line in the pandemic. Yet fast-forward 12 months from the PM’s hospital stay, and those same NHS staff learnt that warm words – and claps – come cheap.

A proposed pay rise so low that it shocked the nation and sparked protests from across the political spectrum was eventually – after more than four months of dither and delay – begrudgingly replaced by an award of 3%. That pay ‘rise’ appeared in pay packets in the same month that staff saw consumer price rises hit 2.3%. Inflation has since topped 4%.

Now the government has announced a new health and social care levy, to ‘tackle the NHS backlog and pay for social care changes’. So maybe we should be feeling optimistic that those in the driving seat have spotted the trouble ahead, and are taking seriously the need for long-term investment in the health service and its staff?

Underneath the bonnet

Perhaps. But lift the bonnet, and those on the frontline are sucking their teeth and shaking their heads at the sums involved. The new tax is expected to raise about £12 billion annually. That’s about 5% of what was spent on health and social care in England alone last year. It’s supposed to rapidly resolve the biggest elective care backlog in history, then sort out social care, including funding a cap on individuals’ lifetime care costs. In reality, it won’t go far.

The other problem is that, in the short term at least, getting patients off waiting lists is mostly down to the same exhausted, depleted NHS staff who have worked relentlessly through the pandemic. The same staff who will fund a chunk of the pot themselves out of wages that are still shrinking in real terms. How many of them will continue to leave for better paid, less stressful jobs elsewhere? Certainly those on the lowest pay points whose pay is below the real Living Wage even after the 3% award may be asking themselves how much they are valued. Without a workforce plan, the government risks a new crisis in health and care.

Reality vs rhetoric

Sooner or later, reality will overtake rhetoric. If instead of refilling the tank for the long and arduous journey ahead, you lob the NHS a half-filled jerry-can siphoned off the van down the road, it will run on fumes for a while. But then it will stall. And it’s not just the NHS team who will suffer. It’s every patient, every loved one who needs care. So let’s start laying the groundwork for a safe and sustainable NHS now, starting with proper investment in the nurses, ambulance drivers, porters, cleaners, midwives, and every other member of the finely-tuned NHS machine that keeps us safe.

This blog was written for NHS Million.