It’s bitterly cold out there. Wrap up! I remarked to a lady outside Dunblane Cathedral yesterday that conditions were very treacherous underfoot. She agreed. She advised me not to have a fall, because there would be nobody to pick me up. I would die of hypothermia waiting for an ambulance, or even if one turned up, I’d languish in it for sixteen hours outside “A & E” (to use an expression as anachronistic as squills, bleeding or cupping). She was voicing a concern that has become very widespread in the community: don’t, whatever you do, fall ill, or fall over, because the health service is in dire straits.
During the 1990s I was Clinical Head of the Department of Emergency Medicine in Middlemore Hospital, South Auckland, New Zealand. The then Health Minister, Bill English, who went on to become New Zealand Prime Minister, visited the department one day, and sat down in my office, not to tell me how to do my job, but to ask me a question. What do you need?
There’s the difference.
I always suspected that the Thursday 8 pm two minutes’ clap held for the NHS during the pandemic was a load of tosh. It might just as well have been George Orwell’s “two minutes’ hate”. The doctors and nurses on the front line were compared to “the few”, who ensured the survival of Great Britain in 1940 during the Battle of Britain. We were encouraged to clap, while members of the government were partying, flagrantly breaking all the Covid rules. They were spending millions giving out PPE contracts to cronies who didn’t know what they were doing. The NHS might have borrowed a line from President Zelenskyy, when Russia invaded Ukraine last February. The Americans offered him a flight to safety, but he said no, I don’t need a ride, I need weapons. The NHS might have said, we don’t need applause, we need resources.
And now that the nurses in England have asked for a pay rise, the government has distanced itself. The nurses’ union has never called for a strike throughout its long history. They clearly don’t want to go on strike now. On the Kuenssberg Show on Sunday their leader Pat Cullen asked to meet with Steve Barclay the Health Secretary in England to work out a deal. If Mr Barclay did not wish to meet Ms Cullen face to face, then the nurses were willing to negotiate with him through ACAS. But Foreign Secretary James Cleverly distanced the government from the row, which is apparently only between the nurses and the NHS. Keep the politics out of health, he said. Nothing to do with us, gov.
But the government in England has never previously been shy of telling health care professionals how to do their job. Five health secretaries ago, Mr Hunt got offside with the junior doctors by telling them how and when they were going to work. Four health secretaries ago, Mr Hancock, of celebrity fame, got offside with the GPs by insisting they go more or less permanently on line. Three health secretaries ago, Sajid Javid got offside with the public when they told them to get vaccinated and not “cower” under Covid. Two health secretaries ago, Thérèse Coffey drew up a masterplan, bullet-pointed “ABCD”, which never got off the back of a fag packet because she was only in post for six weeks. And now, bizarrely Steve Barclay says his door is open, as is Pat Cullen’s, but he doesn’t want to talk about money. There is no sign of a meeting getting scheduled.
Professor Sir Stephen Powis, National Medical Director NHS England, also appeared on the Kuenssberg Show. Ms Kuenssberg asked him if a strike by nurses could cause patients harm, serious harm, could, ultimately, result in fatalities. Sir Stephen gave a politician’s answer. “We are doing all in our power…” I had rather he had said, “Yes.” After all, if the nursing profession withdraws its labour and the health of the nation does not suffer, then what’s the point of nursing? But people who spell out unpalatable truths without qualification tend to get removed from office. Ms Kuenssberg informed us Professor Powis receives his knighthood this week. Once you are the recipient of a gong, it becomes very difficult to voice unpalatable truths.
If the government is not going to sort this problem out, and if the Medical Director is going to restrict his remit to operational matters, then who remains to solve this problem? It raises the issue, what, precisely, is a Health Secretary for? If the Foreign Secretary says his cabinet colleague is not there to micromanage the NHS, then surely he is there to resource it. It cannot have escaped the government’s attention that the NHS is on the brink of collapse. In England, they are trying to reduce waiting times for out-patient appointments from two years to eighteen months. There are huge numbers of job vacancies, partly because there is nobody to recruit, and partly because doctors and nurses are leaving in droves. The hospitals are bursting at the seams. The focus of the log-jam has moved sequentially backwards from the discharge suite, to the ward, “A & E”, the ambulance bay, and now the community, where the elderly lady lies on the kitchen floor all night with a fractured femur. Surely in that context, the Minister of Health needs to sit down with the health care professionals and ask them, what do you need?
English nurses are the lowest paid in Europe. If the nurses can’t survive without recourse to food banks, then there is a problem. The government’s solution to the problem seems to be to introduce new legislation banning the right of members of some professions to go on strike. It doesn’t seem to have occurred to the government that they might not be the solution, they might be the problem.