trikes 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.”