2019 was the year in which members of the Royal College of Nursing (RCN) went on strike for the first time in its 103-year history. More than 15,000 nurses in Northern Ireland took to the picket lines to protest against pay and staffing levels, which they say make hospitals increasingly “unsafe”. And they haven’t stopped since. On Christmas Eve the nurses announced that they’re planning eight more days of strikes before the end of March unless a resolution is reached to improve working conditions.
The NHS has been under intense pressure in 2019, with A&E attendances and emergency admissions up, dangerously high bed occupancy, cancer waiting times growing and 4.3 million people waiting for treatment. The state of the NHS in England is bad enough with nearly 100,000 staff vacancies, of which about 40,000 are nurses. But in Northern Ireland, the situation is worse. Nurses in Northern Ireland are paid up to £4,677 less than counterparts in England and Wales. The nursing vacancy rate in Northern Ireland is 13%, compared with about 11% in England and 6% in Scotland. Shortages of almost every type across of health professionals across the UK are leading to the temporary or permanent closure of A&E units, maternity services and chemotherapy.
As we head into 2020, here’s a rundown of the pressures facing the NHS and the UK government’s pledges to improve the health service.
Financial pressure
Although funding for the Department of Health and Social Care continues to grow, the rate of growth slowed under the period of austerity following the 2008 economic crash. Budgets rose by 1.5% each year on average in the 10 years between 2009/10 to 2018/19, compared to the 3.7% average rises since the NHS was established.
About 47% of NHS trusts — which provide secondary care to patients who’ve been referred there by a GP — were in deficit in 2018/19. The figure was 67% just among acute hospital trusts, which make up the bulk of NHS trusts across England.
Fewer hospital beds as demand grows
The number of hospital beds in general has fallen over the last 30 years, despite rising population and patient numbers, mainly because of advances in medicine. The UK has just 2.6 beds for every 1,000 people, just over a third of the number in, for example, Germany, which has 8.1 beds. The number of mental illness overnight beds dropped by 62% in the 20 years to 2009. The number of hospital beds in England has halved over the last 30 years and is now about 100,000.
Shadow health secretary, Jonathan Ashworth, says it’s partly the reason that more people are turning to private healthcare. “A decade of cutting over 15,000 beds and failures to recruit staff under the Tories is forcing more and more patients out of the public NHS into poor quality private hospitals,” he said. Figures obtained by the Guardian last year show that the number of NHS patients having surgery in private hospitals has nearly trebled in the last decade, rising from about 215,000 in 2009 to nearly 614,000 in 2018.
Staff shortages
Nursing shortages leading to unfilled vacancies have become a serious issue across the UK. There are currently almost 44,000 nursing vacancies in the NHS (12% of the nursing workforce), but this could hit 100,000 in a decade. As the number of appointments is estimated to be rising, latest figures show that the number of GPs fell in 2016 in both England and Scotland. As a result, the Health Foundation charity reported that the NHS is relying on less qualified staff to fill workforce gaps.
Performance
After a decade of much lower-than-average funding growth, the NHS has been unable to meet growing and changing population health needs.
NHS in England are experiencing the worst performance against waiting-time targets since the targets were set. This includes the highest proportion of people waiting more than four hours in A&E departments since 2004, and the highest proportion of people waiting over 18 weeks for non-urgent but essential hospital treatment since 2008. The target for treating cancer patients within 62 days of urgent GP referral hasn’t been met for over 5 years.
In terms of emergency care, the number of cases of patients delayed in ambulances for longer than an hour have almost tripled in a year, from 1,491 in the week up to December 16 2018 to 4,469 in the week up to December 15 this year.
Northern Ireland’s NHS performance lags behind the other UK nations. Not only does it have the highest vacancy rates, it also has the worst record in terms of meeting waiting time targets for cancer, A&E and routine operations.
Looking to the future
UK prime minister Boris Johnson’s 2020 program, announced in mid-December 2019, will put investment in the NHS into law. The government pledged to spend £33.9bn in cash each year by 2023-24. Significantly, it will mean that the government is forced to increase funding.
The NHS Long Term Plan Bill also includes delivering 50,000 more nurses, which was a controversial part of Johnson’s manifesto messaging (Johnson’s claim was misleading because his target includes 19,000 already employed by the NHS). The Conservatives also pledged to modernise the Mental Health Act and improve processes for detention. There is no specific social care bill, but a section of the speech was dedicated to reform and how they want to find a “cross-party” consensus on devising a strategy.
Starting from September 2020, a new universal offer will also be available to all new and continuing degree-level nursing, midwifery and allied health students; all nursing students on courses next September will receive a £5,000 a year grant. Other health promises include 50 million more GP appointments a year.
The real impact of the program, experts say, will be to keep the NHS afloat and to prevent further decline. The pledged investment amounts to 3.4% year-on-year increase in spending. But the Institute for Fiscal Studies (IFS) said that increases of at least 4% a year on average are needed in order to see any improvement in its services.
“This investment will maintain standards at their current level, but the service needs additional real investment to meet the needs of the future and deliver the improvements we all want to see,” the Deputy chief executive of NHS Providers, Saffron Cordery said. In 2020 we can expect an ease on current pressures, but it’s not enough to restore performance against key waiting times standards and transform services to deliver better care.
Image credit: Trades Union Congress