Strikes add to the crisis the NHS faces. It’s been the nurses today, ambulance staff next week. Of course they can be resolved, as can all public pay claims, in this case for the cost of some £13bn to match the full 11.1% peak inflation, according to the Institute for Fiscal Studies’ (IFS) Ben Zaranko (though unions don’t really expect this amount). That sum could be raised by equalising tax on earned and unearned income, which might yield as much as £14bn, according to the Tax Justice Network.
But leave that aside for now: one mystery is why the government is failing to do what it can to ease NHS pressures immediately. Ineptitude? Stupidity? Or, as conspiracy theorists would have it, a positive desire to prove the NHS doesn’t work?
It’s especially puzzling when for once, in Jeremy Hunt, there is a chancellor who knows the health service well, having been the longest-serving health secretary. Only two months ago, he was a rebellious chair of the Commons health and social care select committee, producing thorn-in-the-side reports and even a book spelling out what was needed. He can’t hide behind know-nothing rightwing tropes calling for unspecified, but threatening, “reform”: he’s seen never-ending turbulent “reform” with two new acts in the Tory years. Nor can he believe their constant “too many managers” nonsense: the NHS has a disproportionately low number of managers compared with other industries, and similar health systems. Nor can he agree that NHS staff – with GPs under particular attack – are idlers: fewer GPs are seeing more patients.
He knows that a prime blockage is the failure of social care, due to government funds to local authorities being cut, cut and cut again. That results in 13,000 NHS beds blocked by medically fit patients who don’t have social care beds or homecare packages to make it safe to leave hospital. Patients are unable to be admitted to wards from A&E, while ambulances stack up outside, unable to offload patients into overwhelmed emergency departments.
Most serious problems in the NHS will take years to resolve, such as training new doctors and nurses and repairing dilapidations, but this one could be eased quickly – and at a relatively modest cost. The reason that the social care system can’t cope is the vast numbers fleeing this very low-paid and overworked job for which it is impossible to recruit. Address the miserable pay, and social care would quickly get back on its feet: recruiting would be easy if pay matched the demanding nature of the job, but staff are paid at or near the “national living wage”, with even more experienced workers only earning an extra 7p at hour, less than supermarket pay. On Thursday, care workers from Citizens UK were protesting about their low pay outside the London HQ of Barchester Healthcare where the CEO, Pete Calveley, is paid 130 times their social care rate – £2.27m per year.
So says Sally Warren, the King’s Fund’s director of policy, who was until recently director for social care at the Department of Health and Social Care. So she knows the facts and the costings in considerable depth. How much would it cost to pay enough to raise wages to attract the necessary staff? “£2bn would do it, for each of the next two years,” she tells me. “Not tens of billions.” Compare that, she says, to costs in the NHS and to the vast waste of money of fully staffed ambulances queueing for hours, or surgeons twiddling their thumbs in irritation at the lack of beds to take their patients. “£1.5bn a year is wasted in hospital beds occupied by patients who don’t need them.”
The Treasury snubs all spend-now-to-save-later calculations from every department. Those blocked beds, it usually says, would only be filled by other patients who would be put through faster, each one having an expensive procedure: blocked beds are cheaper. Not so, says Warren, as the surgeons have to be paid anyway, even when prevented from operating.
Jeremy Hunt himself, as chair of the committee, demanded £7bn for social care, which is what it would take in the long run to upgrade the entire sector, to train staff well, to give them a career path on the same Agenda for Change scale of NHS staff. That’s Labour’s plan. Social care gets erratic bungs to see it through winter crises – £500m this year – but Warren says it’s always unpredictable and offered at the last minute, so providers dare not raise pay rates, unsure if they can sustain it the following year, so they use it to buy extra shifts.
That £2bn would open up spare beds closed for lack of staff in the 17,000 care providers, more than 80% of which are small outfits, rather than the big private-equity-owned sharks. . It’s not just beds: many sitting in hospitals needlessly await care packages at home, but domiciliary care services are collapsing. Many wait for NHS services in the community, but the number of district nurses halved in the last decade. The IFS this week produced an alarming report on declining productivity in the NHS. One key reason, it said, was the failure to “discharge patients into the community or social care, which further clogs up the system and acts as a drain on staff resources”. Far from integration, there’s a tug of war, or tug of blame, between the NHS and councils. The Association of Directors of Adult Social Services points to discharged patients needing far higher levels of care than before. And 82% of directors are seeing an increase in the need for care due to people being discharged from hospital more quickly, while 46% say they are now having to care for those waiting for NHS treatment.
The 245,821 people waiting for an assessment of their need for care in August has risen by 20% since last November. All in all, that’s the circularity of treatments in NHS and social care: councils see the NHS has at least had a little growth, while they have had a decade of cuts. Whatever the success or failure of attempts to blend them and their budgets, an immediate promise from Jeremy Hunt of £2bn a year for social care from now on would be money very well spent for both sides. But this poacher-turned-gamekeeper now seems to deny what he used to know just two months ago.
Polly Toynbee is a Guardian columnist