NHS crises: a wider picture

Leaked figures to the BBC have marked the past January as the worst month for A&E waiting time as an unprecedented number of patients surpassed the 4 hour waiting target since it was set 13 years ago. Figures report that the NHS only managed to reach this criteria for 82% of patients, with a record breaking 60,000 patients in need of emergency care supposedly left waiting between 4 to 12 hours for a hospital bed, and over 780 waiting more than 12 hours. In the first week of 2017 alone, the amount of patients waiting over 12 hours was triple the figure for the whole of the January of the previous year.

A Department of Health spokesperson was quick to respond to the report, cautioning the public about the ‘irresponsibility’ of unverified claims. Rather than dwelling on the irony of this shift in responsibility, I want to zoom out and consider a wider exploration of this National Health Service crisis, its causes and its consequences. The sad reality is that these shocking figures will soon be swallowed amongst and drowned out within a wave of social care crises. The state of the NHS is not breaking news: hospitals have been missing A&E targets regularly over recent years, as well as many other aims and objectives, such as surgery appointments, across the National Health System. Rather, these recently leaked figures add to long lists of tragic statistics that represent real lives ruined by the inabilities of a system in a long-term state of crisis, under pressure from failing social care systems and over-stretched budgets and staff. As Dr. Porter points out, delays in A&E are symptomatic of a bigger social care crisis. This ‘January’ headline is really only the tip of the iceberg in terms of in a wide-reaching downwards spiral of the British welfare system.

Amongst other factors, the strain on NHS emergency departments is due to rising numbers of A&E visitors, in part a consequence of people driven to visit their emergency services as a last resort following a failure of other health care areas to provide adequate aid. For example, there has been a recent steep rise in A&E psychiatric patients seeking emergency treatment, where prevention and mental health support has failed those suffering from psychosis and depression. We urgently need to think of solutions to remedy this, such as increasing the various services that exist online and over the phone to offer medical advice. These services, which mirror a general widespread shift across service industries away from human contact, do offer some relief to strains on the NHS, and can be especially helpful when considering individuals who may find it hard to seek direct medical treatment due to cultural isolation, or who suffer from anxieties that prohibit their confidence in leaving home – hence the strong connection these services have built within the mental health sphere already. However, digitisation of health services is only suitable for a limited variety of advice and treatment, and can only go so far in easing the pressure on health services. Also notable is that leading organisations pioneering online/over-the-phone assistance are charities, such as Samaritans and Childline, demonstrating a responsibility placed in the private sphere as opposed to the state. This removal of government responsibility is further made apparent when considering the emphasis placed on individualism in our society,  where self-responsibility and self-care are increasingly valued and idealised, whilst those deemed over-reliant on the state and public services are vilified as parasitic and lazy.

It is in these terms that headlines regarding the shortcomings of the NHS should be framed. While remedies such as the digitisation of medical care can offer some interim relief both to those seeking assistance and the structures providing them, we need to consider these points of crises as symptomatic of a wider systemic change, indicative of a wider stripping back of formal social care; a rejection of state responsibility for public welfare. The cradle-to-grave welfare state, introduced through several measures in post-war Britain, represented a positive public attitude towards social collectivism. In 2015, Timothy Ash wrote of the increasing nationalist sentiment that is spreading across Europe. He referred to these growing ambitions to gain control of borders and curb immigration as Europe’s walls going back up: 1989 in reverse. It appears that this historical 180° can also be used to describe the arc that attitudes towards the Welfare State has taken.

The top-down deterioration of the welfare state coincides with an increase in individualistic societal values, an erosion of a sense of collectivism. Rather than priding ourselves on a collaborative support system, there is a populous tendency to shame those who are on the receiving end. These public sentiments reflect Margaret Thatcher’s infamous comments that ‘there is no such thing’ as society, and share her outrage that people are ‘casting their problems’ on the government (and a supposedly imagined collectively built society). To condemn those less able to support themselves as a drain on society – whilst refusing to acknowledge the extent and depth of factors affecting these situations – seems to be an unashamed declaration that our society does not value those disadvantaged by health, wealth, and age – and luck. Dehumanising those who require our individual and collective help has both indirectly and directly assisted the demise of the welfare system (and the NHS services within it) thus far.

To find durable solutions for these NHS crises, we would need to address cracks in the vast interdependent welfare system, and strengthen foundations to support not only the architecture underpinning the NHS, but also a nation’s values, working to revert a growing ethos of individualism. From this perspective, it is clear that meagre promises to provide extra funding in vain attempt to ease A&E waiting times will barely scratch the surface, and appropriate care will remain out of reach for millions of people across the country.

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