The daughter of Rita Berry (80) had expected that her appointment at the hospital would not take place. But a text message that they had to reckon with never came. Fortunately, because a scan must show whether an operation from five weeks ago went well. Rita Berry kills time with her cane in one of the waiting rooms at Luton Hospital. “This country is not doing well,” she says when asked about yet another health care strike this year. “But the staff here are great, I can’t fault them.”
More than a hundred thousand patients in the United Kingdom are receiving a text message these days that their appointment is cancelled. The medical assistants are on strike for five days, until Tuesday morning, after which the specialists will follow. They think a wage offer from Prime Minister Rishi Sunak of 6 percent is nowhere near enough. The medical assistants and specialists demand 35 percent more wages, because they have lost so much since 2008 due to inflation, cutbacks and higher training costs. Inflation in the United Kingdom is now around 8.7 percent (about 3 percentage points higher than in the Netherlands). Health Minister Steve Barclay lashed out at the specialists this Sunday because they are average earn more than a ton and their pension has recently improved considerably. The nurses have ended their actions. Many thought an offer of a 5 percent wage increase was too low, but in a legally required vote among union members, the turnout was just too low to be allowed to strike again.
Radiologist Oran Roche will probably join in this week too, he says in the inner street of Luton’s old hospital. “Especially out of sympathy for the medical assistants, but also the specialists are having a much more difficult time than in the past. Nowadays everyone starts with a debt of a ton, because the education is not funded. And the workload is enormous. Is the NHS in crisis? Those are big words, but we are having a very difficult time, yes.”
Personnel shortages
Ask a Briton what his country has produced and what makes him proud, he or she will still name the National Health Service (NHS) second only to Fish & Chips. The Dutch Anne Schilder, who has been working as an ENT doctor and researcher in London since 2011, understands that. She is also proud to work in British healthcare. “NHS is a unique health care system worldwide and is accessible to people of all backgrounds, all income levels. That is a huge achievement.”
But the NHS is under great pressure. Waiting lists are breaking records every month, with 7.4 million Britons now waiting for treatment. The UK celebrated the 75th anniversary of the NHS last week, but there were many gloomy reports. The top of the waiting lists is not yet in sight, the government acknowledges, certainly not because of this week’s strikes. In 2022, 170,000 employees will have said goodbye to healthcare due to work pressure and stress. Research institute The King’s Fund recently established that while care is cheap for patients, the UK scores relatively poorly compared to other European countries on health outcomes, such as treatable cancer and preventable mortality.
The daughter of ENT doctor Anne Schilder also works as a junior doctor in England. Of course, salary is important, she says. That is comparable to the physician assistants in the Netherlands: between 35,000 and 68,000 euros on an annual basis. “The strikers are mainly concerned with patient safety and working conditions. If they work a night shift, there are sometimes big gaps in the schedule and the workload is enormous and the safety of patients is at stake.”
Two weeks ago Prime Minister Sunak, together with the NHS leadership, presented a plan to eliminate staff shortages. Training must be faster, better working conditions must ensure that healthcare staff do not leave, and working after retirement must be made easier. With this, the government hopes that in 2036 300,000 more people will be working in the healthcare sector than the more than 1.5 million of today. The Guardian wrote last week that in a large care center in London the need was so great that until 2022 an 80-year-old nurse was working who was not strong enough to do the job. According to the inspection, there was an unsafe situation.
Recently, an analysis by the University of Oxford showed that the NHS is becoming highly dependent on migrants. Last year, 58,000 visas were issued. Luton Hospital also relies heavily on doctors and nurses from India, Pakistan, Sri Lanka and other countries, staff say. “They are very good,” says radiologist Roche in the inner street. But these colleagues often get shorter contracts and are therefore less long in the hospital. “As a result, they need extra guidance every time.”
Research and innovation
Crisis or not, the national healthcare system in the United Kingdom is and will remain unique, says Schilder. “Nowhere in the world is scientific research in healthcare as good as in England. That’s why I’m here too. There is a lot of media noise about the NHS. In day-to-day practice, of course, we still provide very good care and many people are also very satisfied.”
Certainly, this morning she referred children to surgery where they have to wait more than six months, while in the Netherlands that is a maximum of three to four months. But urgent care is given priority and is of a high standard. And the UK is particularly at the forefront of clinical research, data science and innovation, says Schilder. This is because there is one healthcare system for everyone. As a result, a lot of good data research is possible. “It is unique how much data we can use and link. And there is also a lot of funding for research. That is why I am and will stay here.”
A Dutch person who also knows the NHS well has a more negative opinion. “Something has broken with the staff,” says Marcel Levi. He was Director of University College London Hospitals from 2017 to 2021. “The healthcare staff was always willing to go the extra mile, to work an extra shift under poor working conditions, to work even more overtime. But for the first time, the doctors and nurses have had enough.”
The pandemic, Brexit and the increased cost of living have only exacerbated the problems. “There is also hardly any good social care. So for people with debts, alcohol problems, gambling addiction there is little. Everything ends up in the NHS waste pit. In my time I had learned not to say: you can go home tomorrow. At least one in five patients told me: I don’t have a house.”
Also read this report from the end of 2022 when the strike wave started: In the British emergency room, the patients have to stand
Really falling over, that will not happen to the NHS, Levi thinks. “The social and political support in the UK is something phenomenal.” Although financial support under Conservative governments has always been somewhat less than under Labour. According to many analyzes published in recent weeks, the healthcare system was in the best shape at the beginning of this century. Particularly under Tony Blair (prime minister between 1997 and 2007), expenditure grew by approximately 5 percent per year. When the Conservative Party came back to power in 2010, growth leveled off to about 1 percent a year. Levi: “The conservative governments kept their purse strings out of a sort of austerity mindset. Every now and then, yes, if it really didn’t work anymore, if there was another very difficult winter, one or two billion were added. But that was actually just not enough.”
In his time, Levi saw it mainly in the buildings. “Part of them are about to collapse, or the roof is leaking. That is simply not possible anymore.” Walk around the grounds of Luton Hospital and you’ll see what he means: it’s a maze of old buildings. But a new block is also being worked on and buildings are under construction. Radiologist Roche looks around. “This is what the NHS looks like.”
Former Prime Minister Tony Blair, who has his own think tank, recently argued for more investment in the NHS, particularly in technological solutions. Otherwise, more people will resort to private care, he warns a report from his own institute.
In addition to public care, private care has always existed in the UK. You can take out additional insurance for this. The share of private care fluctuates around 10 percent, but the market is growing due to the long waiting lists. 2022 was a record year. Doctors employed by the NHS often also work part-time in a private clinic, where they can earn more. Oran Roche thinks there is a high risk that many specialists trained in the UK will leave the NHS if the situation does not improve. “Because of the huge debts, the workload. Friends and colleagues have already gone to Australia and Canada. They thought temporary, but they are not coming back. Life for a doctor is much better there.”