Ambulance drivers in the U.K. are slated to strike on January 11 and 23, following a strike in December, when tens of thousands walked out, protesting low pay (the average salary for an ambulance worker is £25,000) and the inability to deliver prompt, safe services to patients. Thousands of nurses also walked off the job to protest similarly abysmal conditions — as they have done in New York, as well, in recent weeks, where the health care workers have been protesting what they have described as “unimaginable” working conditions. The unions representing nurses in the U.K. have also planned additional labor actions over the coming weeks.
The British National Health Service (NHS), which has been at the core of the U.K.’s social compact since the end of WWII, is being brought to its knees. The reasons are multiple: years of underfunding of basic services by the succession of conservative governments that have ruled the U.K. since 2010; the stresses of the COVID pandemic; the exodus of skilled workers in the wake of Brexit; and double-digit inflation that has driven thousands of nurses, ambulance workers, and other health care employees to seek more lucrative jobs in other fields.
Between 2009 and 2019, NHS spending, in real terms, rose only 1.2 percent per year, rendering the service unable to keep up with the needs generated by a growing and rapidly aging population, and with the increased cost of medicines and medical technology. More than 4,000 European doctors left the NHS in the wake of Brexit. Combined, Brexit, COVID burnout and low pay have also led to huge personnel turnovers in the nursing profession. The average pay of a nurse in the U.K. in 2023 is a little shy of £35,000 (about $42,000 USD), with starting pay at roughly £27,000. For hourly workers, the estimated average pay for a U.K. nurse is just shy of £18, or about $24 USD. By contrast, the average hourly salary for a registered nurse in the U.S. is $43 per hour, and nurses can also expect an average of $12,000 a year in overtime pay. That’s not far from double what the U.K. pays its nurses.
Meanwhile, stories abound of elderly people waiting half a day or more for ambulances to arrive to take them to overstretched Accident and Emergency Rooms that no longer have the capacity to promptly admit and process new patients. Even critically ill patients, for whom every minute can be a matter of life or death, often wait hours for help to arrive: the average wait time for ambulance crews to reach heart attack victims is now nearing two hours in some parts of the country. And once the ambulance does pick up a patient and drive them to hospital, they frequently then have to idle at hospital entrances for hours, waiting for a bed to open up so that they can unload their patients.
In large part, hospital beds are at a premium because thousands of patients who are ready to be discharged into the community can’t be sent home because supportive services have been slashed to the bone by recent governments, and so there are no facilities and staff available outside of hospital settings to care for released-but-still-healing patients, especially those who are elderly and have an array of overlapping needs. Peter Neville, a gastroenterologist who has worked in the NHS for more than 30 years, recently tweeted:
Council funding has been cut and social workers are dealing with huge case loads. So there are big delays. And we can’t send the patients safely home until their care package is sorted out. So they wait. And wait.
With hospital beds remaining unnecessarily occupied, it becomes ever harder for medics to admit new patients. As a result, ambulance crews can’t return to the streets to pick up other patients, and the backlog only grows. More than one quarter of all ambulance drop offs at emergency rooms now involve wait times of more than an hour.
Increasingly, critically ill patients are being taken to hospitals by good Samaritan drivers, or by hiring Ubers when ambulances are no-shows. And even when they are successfully dropped off, frequently hospitals no longer have bed spaces for new patients. Palliative care doctor and author Rachel Clarke recently wrote that “patients [are] dying in corridors, in cupboards, on floors and in stranded ambulances.”
In one instance, a man with acute appendicitis wasn’t admitted to hospital, owing to lack of bedspace, but was advised not to leave the premises because his appendix was at imminent risk of rupturing. He slept the night in his car in the hospital parking lot.
The situation in the U.K. is so bad that Adrian Boyle, president of the Royal College of Emergency Medicine, recently estimated that 500 people a week are now dying because of the slow pace of care and the breakdown of the ambulance service. That’s more than the number of people currently dying each week of COVID in the U.K.
For four generations, the NHS has been the single most important institution in the country. It represents a promise of equal access to health care, and not the military, nor the monarchy, nor even the BBC is more fundamental to the country’s sense of self-image and pride. Yet today, in 2023, the NHS is facing arguably the greatest crisis in its nearly eight-decade history.
Prime Minister Rishi Sunak has committed to significantly reducing wait-lists for NHS procedures by 2025, in part through opening up “diagnostic hubs” in nonhospital settings, including sports stadiums. He has also been meeting with health care leaders to try to plot a way forward to hire more staff and increase funding for the ramshackle health care system. Yet this may be a case of too little, too late. There is, at this point, rampant distrust among the voting public of the Conservative government’s willingness — or ability — to salvage the health care system and the broader social compact of which it is a bedrock part.
Three-quarters of the Conservative Party’s own voters from the last general election, in 2019, now tell pollsters they believe the government has mismanaged the NHS, and roughly half of its erstwhile supporters are hostile to the austerity agenda responsible for cuts to basic social services. Nationally, about 60 percent of voters support the nurses and ambulance workers in their strike actions, considerably more than support other strikers, such as postal workers, border patrol officers and teachers. And according to the latest polling, only about one in five voters intend to vote Conservative in the next general elections. It’s a stunning reversal of fortunes for a party that, in late 2019, was returned to power — its fourth election victory in a row — with the largest parliamentary majority in a generation.
Britain’s NHS was once the gold standard for universal health care systems worldwide. These days, it is chronically underfunded, often unable to provide prompt treatment, even of an emergency nature, and losing a discouragingly large number of vital workers. No wonder the nurses and the ambulance crews have decided that strike action is their only viable option.
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