Thirty-six years ago I had an interview for a temporary clerical officer job in the local hospital. One question was – ‘Who is the most important person in the health service?’
Thinking on my feet as I sat in the interview I answered – ‘the patient.’
Which is the right answer.
Although this doesn’t appear to be the case today.
While I was recruited to possibly the very lowest rank in the health service all those years ago, those today at the very top appear to have a different view.
Last week the Minister for Health at Stormont, Robin Swann, issued a public consultation on whether new staff recruited to the health service and social services should be compulsorily vaccinated. The Minister both in the consultation and in interviews more or less ruled out vaccination of all staff, considering it relevant, or perhaps only possible, for new and agency staff.
It should be remembered that the Minister and Executive ensured that all health service staff, including office staff with no contact with patients, were offered vaccination last year before patients described as extremely clinically vulnerable – those with suppressed immune systems for example.
When some of these patients were sent the draft of a letter proposing that they ensure all visitors to their homes take a Covid test, the project disappeared when it was returned with a question whether this would also include the visit of district nurses.
The public consultation launched last week mentions that “Trade unions, employees and employers will have a key role in this consultation, but the views of the general public will also be very important.” It also mentioned relatives, and failed to mention patients.
This week the Minister announced he wanted the introduction of a mandatory Covid-19 passport scheme and this has been agreed by all the parties except the DUP. So, while the Minister wants anyone going into a restaurant or pub to demonstrate that they are vaccinated, or not otherwise a risk, he thinks it’s acceptable for nursing staff dealing with the care of vulnerable patients to be excused this requirement.
Part of the reason for the recent increase in Covid is obviously the partially seasonal nature of the virus. In the case of Northern Ireland however it is also due to the relatively lower numbers vaccinated than Scotland, England and Wales, despite having had a head start on them. It currently has a higher number totally unvaccinated and a lower number fully vaccinated with a booster shot.
Not only has this probably led to increased severity of infection – requiring hospitalisation – but also increased the sickness level of health service staff (up to 20% among nurses). Media reports following Freedom of Information requests indicate potentially lower vaccination rates among nursing and social services staff than among the rest of the population.
The trade union UNISON has opposed mandatory vaccination of nurses and called for a voluntary approach of persuasion. The union might appear to be on more solid ground if it did not make the stupid point of asking why health service staff should be singled out. Management might also strengthen its position if it were to at least mention the needs of patients, that their views should be canvassed, and that protocols were in place to ensure that the most vulnerable patients were not unnecessarily exposed to unvaccinated staff. Both might have more of a point if they had followed through on their argument and were to point to a rigorous campaign to get staff to voluntarily vaccinate.
Unfortunately, as argued before, the needs of the NHS bureaucracy have been put before the needs of the people it is supposed to serve; summed up in the mantra that we must ‘protect the NHS.’ Politicians wave the possibility of the closure of Emergency departments; of the health service “about to topple over” if immediate action is not taken; and warnings by senior medical staff that “this phase of the pandemic is now the toughest”.
Just like the Tories in Britain, they point to the crisis they helped create in order to point away from their own culpability. Instead, it becomes an alibi that implicates those subject to a collapsing service who are blamed for not following guidance and advice.
They congratulate the staff on their heroism in order to absolve themselves while making their heroism a continuing requirement of their work; wrap themselves around the NHS brand in order to avoid and deflect away from their role in its failure, and threaten future collapse as a move to pre-emptively protect . . . themselves.
This partially explains Swann’s particular penchant for lavishing praise on NHS staff with ‘proof’ of seriousness by repeated announcements of additional funding. When advertising the gruelling pressure on doctors and nurses dealing with the pandemic, he presents himself as a vicarious fellow sufferer. Identification of the NHS with himself reaches a pinnacle when he says that “I don’t have enough nurses, I don’t have enough doctors.”
Additional funding, as he acknowledges himself, cannot conjure up and deploy staff out of nowhere; its announcement is instead more usefully deployed as a response to internal requests for action by medical staff raising concern at where services are heading. Additional funding cannot immediately increase capacity, especially if it is non-recurring and limited to a one-off injection, but unfortunately long-term planning has not been a strong feature of the NHS.
So, we are now enjoined to accept renewed restrictions involving Covid-19 passports in order that the NHS not be overwhelmed. Unfortunately, it is abundantly clear that the NHS has already been overwhelmed. While pointing to the crisis and away from themselves we are supposed to listen to the words of politicians and not recall their responsibility and years of inaction.
Years of unprecedented underfunding of the NHS are now presented as a historic problem that attaches to no one in particular today. We are simply reminded that the task now, our task, is to ‘protect the NHS’ in an unprecedented pandemic.
Many socialists get very defensive about criticism of the NHS, as if it were some sort of socialist enterprise in the midst of capitalism. The reasons for this are numerous, including that it is free at the point of delivery, is not run for a profit and is owned by the state.
Except that it is not free, and is funded by a regressive taxation system; many private companies make a lot of money out of it; it is owned and managed by a capitalist state, and having worked in it for 22 years I can confirm that there is nothing democratic about the way it is managed. Like all state ownership, it is bureaucratic and unaccountable, as repeated scandals exposed within it testify.
It is not therefore simply a question of underfunding, and to uncritically defend it because the only alternative is conceived as privatisation is a mistake. Socialism involves different ownership of the productive forces, including those that protect and improve our health, and this democratic workers’ ownership is not a question of a name on a title deed but of how productive forces are organised and developed.
Workers are not ignorant or indifferent to the bureaucratic failings of the NHS because they are the ones who use it, while some better off workers, middle classes, and definitely the richest all use private health care to one degree or another.
It is argued that the pandemic is unprecedented but the longer restrictions continue the more circumstances can no longer bear the description of exceptional. The lower rate of vaccination might go some way to explaining the greater effect of increased incidence of Covid than in other countries, while the later roll-out of booster vaccinations than in other countries might similarly explain renewed restrictions. Nevertheless, it is the declared necessity of protecting the health system that is employed as justification for the new restrictions announced this week.
We have been informed repeatedly about the pressure which health service staff have been put under, and our reliance on them has been reason enough for most people to accept restrictions. That this pressure has been harsh is real enough but this in itself does not permit the demands of the politicians and bureaucrats to go without challenge.
There have been enough first- and second-hand reports that not all NHS staff have been under similar pressure to ask why this organisation cannot more effectively and efficiently deal with Covid and the other demands placed upon it. Some of the reasons we have mentioned above – that the NHS is a bureaucracy in which individual talent and commitment can only have individual effects.
That the NHS is failing is shown by some of the latest statistics from the Northern Ireland health service which show that between the years 2019/20 and 2020/21 total admissions to hospitals fell by 30%; average occupied beds fell by 17.9% and total theatre cases fell from 110,605 to 59,762, a fall of 46%, and 50% on the previous year’s figure.
What these figures show is that it was not simply a question of capacity but the capability to use that capacity and the inability to use it efficiently. A factor in this will no doubt be increased sickness of staff, but the higher rate of unvaccinated staff contributed to this. Other factors will be the inability to institute infection control without reducing capacity with the creation of much-hyped ‘Nightingale Hospitals’ illustrating the problem.
The results of this failure can be seen in increased waiting times; for example in the 112,915 patients waiting to go to hospital at 30 June 2021, up from 97,243 at 30 June 2020, and 88,203 at the same time in 2019; an increase of 28% over the two years. This is an example of only the most obvious and measurable outcome, which most damaging effect is in the impact on health.
The British government has successfully protected itself by using the NHS as a shield because its popularity has facilitated this, which in turn is partially because the only alternative to it is perceived as privatisation, which is widely unpopular. Much of the Left, with its state-centred view of socialism and greater predilection for knowing what it is against rather than what it is for, has put itself in no position but to follow the government, with the add-on of demanding more money.
When the London Olympics opened nearly ten years ago, it was noted that the NHS was part of the show, a tribute to its place in the national psyche. What it wasn’t was a tribute to socialism, no more than was the presence in the show of James Bond and the Queen.