Last Wednesday, Kareen Gayle, a nurse in the emergency department at King’s College Hospital in south London, finished her night shift and joined a picket line of about a hundred nurses, union activists and political supporters on the pavement outside. It was rush hour on the first morning of the two-day strike. Red London bus horns honking in support of nurses’ homemade placards: “Coping? Are you kidding me”; “Patients aren’t dying because nurses are on strike. Nurses are striking because patients are dying”; “NHS heroes to zero.” Leaving hospital gates ambulance siren. The nurses applaud. Three people beat drums. Gayle worked for 18 years at King’s Hospital, one of London’s largest and busiest hospitals – the last 8 in the emergency department. A single mother of four, she has the nurse’s demeanor (deep kindness, zero bullshit) to heal instantly, which is life’s worst moment necessary in a hospital. I asked her for examples of how hospitals are currently struggling. “We don’t have enough beds for one,” she replied.
This winter, the Royal College of Nursing, which represents more than 300,000 nurses across the UK, launched the first mass strike in its 160-year history. (Northern Ireland has seen smaller moves in 2019.) The main reason is pay. In March last year, the RCN asked for a wage increase that was 5 percent above inflation, which was 7.5 percent at the time. So far in England, the government has only given NHS nurses a 4% pay rise. Gail told me that if she worked her usual shift pattern, her monthly salary would be enough to cover her bills and then run out after three days. (In December, food prices in the UK were 16.8 percent higher than a year earlier.) To make ends meet, she works overtime, sometimes six nights a week in the emergency room. Her youngest daughter is five years old. “Sometimes I feel really, really bad,” she said. “Because she said, ‘Mom, are you going to sleep with me tonight?’ I had to say, ‘Mom has to go to work and pay the bills.'” ’ It’s really sad because you’re missing out on so much.” Aside from the perpetual exhaustion of working the wards, skipping breaks when you need to pee, emotions run high on the picket line. The morning was cold and sunny. As the sun set, the roof of the hospital building was illuminated golden.
“What do we want?” a union representative called.
“When will it be?”
The drums sounded. The singing died down. Gale exhales quietly. “Hope we get this raise. Oh my god.”
Britain is a sea of strikes. There’s a website, StrikeMap.org, where you can scan picket lines across the country — train drivers, driving instructors, court workers, bus drivers. Sheffield forty-nine strikes. There are more than a hundred around Manchester. This week, paramedics and emergency dispatchers went on their fourth shutdown in just over a month. Junior doctors are voting on whether to strike in March. Teachers are planning a series of strikes next month. The unifying cause of the turmoil is inflation – more than 10% in the UK – and dismal changes in working conditions, often linked in some way to the pandemic. But while there has been some grievance about industrial action affecting the NHS, it is in a class of its own because of the risks it poses to patients, the near-universal respect for Britain’s publicly funded healthcare system, and the fact that it appears to be collapsing.
Winter crises in the NHS have happened as often as winter in the past decade or so. Over the years, from December to February, the news has been constant with dozens of hospitals declaring “black alerts” — patients overwhelmed and new cases having to be diverted elsewhere. On the surface, the past few months have followed a familiar pattern. The country is in the midst of its first major flu outbreak since the pandemic.add it to the long tail of Coronavirus Last fall, when a horrific spread of strep A infection killed at least 30 children and alarmed millions of parents, the system was stretched to its limits.
But deeper disease is also at play. The unified structure of the NHS – which employs more than 1.2 million people and has an annual budget of more than £150bn – has led Britons to think it is bigger and better funded than it is. The UK has fewer doctors, nurses, hospital beds, MRI machines and CT scanners per capita than most of its European neighbours. According to the Health Foundation, a nonpartisan research group, between 2010 and 2019, per capita spending on health care in the UK was 18% below the European average – a period that coincided with Britain’s Conservative Party-led austerity program followed by Brexit. What’s left over is a huge and likely unbridgeable gap in investment and support for the NHS “It’s the chickens coming back,” Tim Gardner, the foundation’s policy analyst, told me. “The roots of the current emergency lie in political choices made over the past decade-plus.”
In the years leading up to the pandemic, the system had been “running hot”, in NHS parlance – chronic staffing problems, maintenance delays, obsolete equipment, reduced working hours for GPs and the demands of an aging population Increasing. Three years on, some parts are barely working. In 2012, approximately 95% of patients in emergency departments in England were treated within four hours. It’s about two-thirds now. Patients with stroke or chest pain waited an average of 93 minutes for an ambulance last month, five times the target. In England, more than 7 million people (one in eight people) are waiting for NHS treatment, up from 2.5 million a decade ago. Roughly one in seven people currently in a hospital bed is well enough to leave, but has nowhere to go (usually a nursing home). Every light is flashing red.
Outside King’s Hospital, a specialist nurse in the hospital’s cardiology unit, who identified herself as Sophie, held up a sign that read “Rishi the Reaper” — a reference to the country’s new prime minister, Rishi Sunak. Sophie qualified as a nurse in 2016. “It’s the same year after year,” she said. “You go through peaks and valleys. Some days you go in and you’re like, nothing matters. I just have to get through the day and focus on the patients, if I’m late, if I don’t take a break. You just have to keep trying. . . At other times, you wonder, Actually, what am I—? Why am I doing this?”
During the pandemic, Sophie was transferred to work in the intensive care unit, “I’ve never cared for an intubated patient in my life,” she said. “Tell me it’s safe.” She took time off work anxiously for fear of killing a patient. A fellow cardiology nurse stood next to her, holding up a sign that read, “Cause of death? Tory cuts.” The ratio of nurses to patients in their department sometimes reached one to ten instead of one to four. Wait times for atrial fibrillation ablation, a procedure to restore the heart’s normal rhythm, have increased from three months to a year and a half in some cases. I asked Sophie if it was a relief to be on strike, to be able to protest and make these issues known. “I don’t think anyone enjoys coming here,” she said. “I’m concerned about the amount of work we have to go back to.”
The NHS is seventy-five years old this year.I stumbled across an article published in british medical journal, looking forward to this moment twenty-five years ago when Tony Blair’s Labor government came to power. “Today, unlike in 1998, the NHS has little to no waiting,” read the prophecy. “Whether it’s over the phone or the internet, whether in hospital or in a community health centre, NHS patients and their families can expect a dignified, bespoke and even pleasant response from any NHS staff member they encounter.” In true 2023, The NHS is more of an idea than a particularly good medical service. It’s the institution that makes most people (over 60%) proud to be British, but we’re a little scared to use it.A recent poll commissioned by the Commission Second-rate The University of London found that two-thirds of those polled thought the NHS was currently “bad”, with 80% saying it had deteriorated over the past five years. On a visit to Britain last week, US billionaire software investor Peter Thiel and a string of opponents of the NHS described the country’s relationship with its healthcare model as an example of Stockholm Syndrome.