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For over thirty years, Val Colvin has worked inside the National Health Service. She’s seen a lot of changes. For the last twenty nine years, Val has worked on a Paediatric Intensive Care Unit – first at Myrtle Street, then Alder Hey and now on the new ‘Private Finance Initiative’ site on East Prescot Road. I asked her what it feels like to work inside the NHS today… and she told me. This is unedited. By Val Colvin.

Where do I start? Some days the work is manageable, some days it is not. There is a shortage of staff on a daily basis and you worry about the safety of your patients and how your colleagues are coping, so staff work extra shifts. Budgets are squeezed and staff are asked to work harder. By working extra shifts, we give up our days off, our holidays, miss out on our social life, miss out on family, kids and friends. We frequently miss our breaks and we often don’t have time to pee. 

Our body clock is all over the place with our shift patterns, we work twelve and a half hour shifts, we swap from day to night and back to days on a regular basis. Our mental well-being suffers from stress and anxiety (“have we made a mistake”, “can I do all of my work”, “do I look after patients as well as I should”) and staff are emotional, overwhelmed, irritable, worried, feeling guilty and sometimes have difficulty concentrating. Physically, we are tired, lack energy from poor eating habits, have headaches, muscle tension, sleep problems and burn out. We do all of this to serve our patients.

Why would anyone starting out want a career in nursing? Doctors and medics, from junior to consultantare also feeling the pressure of working in the NHS – Trust Chief Executives are now starting to talk of their problems, while none of these problems or issues are new… they have been happening for years. But NHS staff are now starting to talk openly about it.

The NHS is a complex business.  The Health and Social Care Act 2012 introduced the most wide-ranging and controversial reform to the structure of the NHS since the service was established in 1948. Responsibility and funding for the NHS was split into various groups headed by NHS England and Clinical Commissioning Groups. The Health and Social Care Act 2012 also saw local authorities given new public health responsibilities – meaning they were now responsible for all the social care needs. This covers a huge range of activities (from child protection to end of life care) and social care in England is defined as the provision of social work, personal care, protection or social support services to children and adults in need or at risk or adults with needs arising from illness, disability, old age or poverty. The Government gleams with pride over its Five Year Forward View planwhich “sets out a vision of a better NHS”, and includes Sustainability and Transformation Plans, The Naylor Review, Private Finance Initiatives and Accountable Care Systems.  

However, little do the public know that the NHS is being deliberately run down and privatisation has subtly been taking place… and we are now two years into the Government’s ‘Five Year Forward View’. The NHS has a proud record of evidence-based practice, but this is all but abandoned in the ‘Five Year Forward View’. The new models of care are cost driven and not based on clinical need and requirement for good patient access. There has been a year-on-year underfunding of the health service, with ministers and NHS England ignoring warnings about staffing and budget shortages and many hospitals running at a deficit… exacerbated by the winter crises; easily foreseeable events. The NHS is currently facing the biggest challenge in its existence and we have seen signs of strain on the system in areas such as hospital care, A&E, GP services, Social Care and Mental Health Care for years. These are services the public use day in, day out. The Government would have you believe that the issues are because of the ageing and growing population, lifestyle factors, people visiting A&E for the wrong reasons, higher expectation from the NHS, advancements in technology and medicine, and rising costs. The media suggest poor management of resources and headlines appear every year with some stories written in such a way as to scaremonger and set the public up to believe that privatisation of the NHS is the only way to save and improve our healthcare services. Have a look: ‘NHS Airbnb, ‘Our NHS is dying‘ and ‘11 hour wait for NHS ambulance’, for example. However, there is evidence of Government systematic defunding at work (according to an analysis by The King’s Fundestimates that between the years 2010-2020 the average budget increase will be 1.2% as compared to the long term average of 4% per year since the NHS began).

What’s happening across Merseyside?
Social Care. Based on the Index of Multiple Deprivation 2015, Liverpool was the fourth most deprived out of three hundred and twenty six district or unitary authorities in England. Seventy two percent of council funding comes from Central Government and since 2010 Liverpool City Council has seen a 58% cut in Government funding – and over the next three years will see a further £90m drop in funding. A massive part of social care is taken up by adult social care provision, giving support for people to live with independence and dignity (often older people) and includes people with physical disabilities, learning disabilities, physical and mental illnesses. Where do the council make their cuts? There are warning signs that social care in Liverpool might not exist in 2019… 

Sustainability and transformation plans. Merseyside is paired with Cheshire when it comes to enforcing plans to merge services throughout the area. These plans include merging services at The Royal Liverpool Hospital and Aintree and a “major service review” at Southport and Ormskirk Hospitals. There are also plans to “reconfigure hospital services” across Cheshire and Wirral – including merging of services to women and children (Arrowe Park and Liverpool Women’s Hospitals).  Warrington Hospital is also facing significant challenges with a possible move to the south of the borough. Accountable Care Systems will replace a number of services under these plans, especially in the social care sector, and these are being introduced without adequate public involvement or consultation, no legal framework and without robust evidence to support their use in the NHS.  Liverpool City Council decisively rejected a ‘Cheshire & Merseyside Sustainability and Transformation Plan (STP)’ in November 2016, but since the confirmation of the STP last December, the council has not only failed to oppose the STP and the accountable care system, but has actively colluded with Liverpool Clinical Commissioning Groups in implementing it.  

The Naylor Review is at the centre of the controversy and sets out recommendations on how the Government can fund NHS reforms by selling land it no longer needs and buildings that are expensive to maintain… some of the buildings labelled as “surplus” were in fact forced to close through cuts and staff shortages. We are constantly told that old hospitals are “unfit for purpose and will continue to deteriorate”, as the Government strip NHS assets (land and buildings) and then ‘Private Finance Initiatives (PFI’s)’ come to the rescue.  

In Liverpool, PFI’s are taking over. Alder Hey is a PFI hospital costing £237m which was borrowed and now paid back out of patient care funds, as the Government has given no extra funds to help pay what effectively is a mortgage. The Royal Liverpool Hospital is currently waiting to move into a new £335m PFI hospital – but Carillion, the builders, have gone bust… so, on top of previous delays, there are now more. There are also plans to replace Liverpool Women’s Hospital with a new public-funded hospital just one mile down the road, right next door to The Royal – but there is currently a massive opposition in the area to stop this as it could mean a reduction of maternity services. The group ‘Save Liverpool Women’s Hospital is fighting all plans to move the women’s one mile across the city.  

What does this all mean for you?
Remember the headlines screaming out about long waits in A&E, hospitals not being able to cope… closure of local services
including walk-in centres and GP surgeries, in order to centralise services with A&E’s and hospital services merging have put a massive strain on the NHS. Hospitals will not cope and more people will die from lack of treatment. These NHS reforms will not mean increased choice for patients, they ill mean a two-tier system in the NHS. It is a myth to think that the private sector is more efficient and cost-effective than the public sector – the private sector has one goal: to make money for shareholders.

The future of the NHS
Recruitment of nurses is an issue with fewer training programmes and no bursaries. Nurses are leaving the service in their droves, ten thousand EU nurses since ‘Brexit’, because they feel their future is not safe. This results in nurse vacancies being unfilled and the NHS continues to ‘haemorrhage nurses‘. Privatisation of services mostly goes unnoticed, too. Yes, we all see on social media about companies such as Virgin Care, Circle Health and Care UK taking over services and we all put the big red angry face on our status, but do the public fully understand the impact that it has had? Remember, these private companies use the NHS logo on all products – if they were to use their own logos on signs, the public would be more aware of how much money is being taken out of the NHS. Bu they do their dirty work very well. There is also more reliance on enhanced self-care, with adverts promoting pay for Skype apps and unproven technology to avoid hospital admission. But, no need to worry (!), an Americanised system of insurance will soon be on the way to rescue us – f you’ve never seen ‘Sicko’, by Michael Moorethen it’s time to watch it: this is the health system coming to the UK soon.

What can we do?
In the aftermath of war and national bankruptcy, it was a Labour Government that found the resources to create a National Health Service. It is our job to keep it going for future generations. How can you help? You can complain – not to the staff, but to PALS and the Chief Executive of the hospital you are visiting. Ask if there is a patient questionnaire you can fill in and educate yourself on the impact of the ‘Five Year Forward View’ plan. Email your MP and your Councillors and ask what they are doing to support the NHS… after all, they work for us. You can also join campaign groups: Keep Our NHS Public, Socialist Health Association, Save Liverpool Women’s Hospital. Join a union that openly campaigns for the NHS, such as UNISON or Unite.  What else? Join The Labour Party, who will fight to save the NHS for generations to come, and campaign for the NHS Reinstatement Bill, to stop STP’s, to stop PFI’s and to stop the selling off of NHS assets, alongside stopping cuts in social care; and campaign to reinstate bursaries and to stop ‘Pay Cap’.

Our NHS is seventy years old in 2018. It is tired and run down, not from old age, but from neglect from those holding and tightening the purse strings: the Government.  Remember, the NHS is our NHS – we own it and we pay for it through National Insurance and taxes. It’s not a free service paid for by a magical money tree, it is paid for by the public so that at the point of use it is free to all… and that’s the way it should remain.

Image courtesy Aneurin Bevan