Is the NHS still lifting “the shadow from millions of homes?” The quote comes from Aneurin Bevan, Minister of Health in the post war Attlee government, speaking during the second reading of the NHS Bill, April 1946, against strong opposition from the Conservative Party – which under Churchill voted against the formation of the NHS on 21 occasions during the Bill’s passage through Parliament. Times change.
“The NHS is safe in our hands”: Margaret Thatcher claimed in 1982, as would any Prime Ministerial candidate today. The evidence suggests otherwise. Unless safe describes the experience of elderly people at the onset of the COVID pandemic in care homes, or stroke and heart-attack victims waiting hours for an ambulance. The shadow has returned.
A wait of over a year for a major ‘elective’ operation? “Well, perhaps you would like to go private?” Or you can sign up for one of those offers of private insurance that come through the letter-box - about 13% of UK adult population have private health insurance, c. 8 million people, a significant increase since COVID. Need some routine dental work? “I’m afraid you are no longer on our list… but we can take you on as a private patient”. Is there anything more revealing about the nature of our society and politics than where the Conservative Party has taken the NHS in the last twelve years?
During the two televised Tory leadership debates the main contenders had hardly mentioned the NHS until audience questions drew out the customary, vague assertions that the NHS is a great national institution and a top priority. No mention at all in the second debate. Given the age distribution of Tory Party members, and their habit of voting, this omission was a little puzzling. It shouldn’t have been. That phrase “the NHS is safe in our hands” died on contenders’ lips because it was obvious to the studio and TV audience that the NHS had been anything but safe in their hands. It had been in their hands for over a decade; it was falling apart.
Amongst David Cameron’s more disastrous misjudgements on forming a coalition government with the Lib.Dems. in 2010 was to make his Shadow Secretary of State for Health, Andrew Lansley, Minister of Health then pay minimal attention as Lansley made his mark by strengthening the magic genie of competition in the health system through his 2011 and 2012 Health and Social Care Bills.
Lansley also, and not unreasonably, wanted GPs to take control of NHS budgets for ‘hospital services’ and community health programmes. This could have been done relatively easily by enhancing the role of doctors within the existing Primary Health Care Trusts (PCTs), giving them control over finances and commissioning decisions. Instead Lansley dismantled the PCTs, creating huge numbers of expensive redundancies – many redundant staff were later re-employed under different job descriptions - and building new structures with confusing lines of authority, including consortia of GPs, at a cost of c. £5 billion to the taxpayer.
Implementing the Lansley plan was a massive distraction for NHS staff at a moment when they should have been focussed on modernising services; a huge opportunity cost, that accelerated the decline of our health service. By April 2012, only two years into the Cameron government, 96% of the 497 delegates at a Royal College of Nursing conference were voting no confidence in the Health Minister. There had already been a 3,000 drop in the number of nurses. In June, the doctors in the British Medical Association called for Lansley’s resignation. In September Cameron realised what a mess Lansley was making and moved him to become Lord Privy Seal and Leader of the House of Commons.
Jeremy Hunt took over and between 2012 and 2018 failed to tackle staff shortages or to resolve the urgent problems in social care. The Nurses Bursary Scheme was scrapped to save the government £800 million, resulting, it is estimated, in a 40% drop in applications and a long term shortage of nurses. Despite health and social care being perennially linked on paper, they remained ‘siloed’ in reality. Local Health and Social Care Committees met but their budgets remained separate with Local Authorities in charge of the vital social care services which were, and are, mostly in private hands. (It took until this July for 42 huge Integrated Care Systems to be put on a full statutory footing after the 2022 Health and Care Act was passed in April). Beds are still being occupied by patients fit to go home awaiting provision of social care. Ambulances stack for hours outside hospitals. Hunt left Britain unprepared for the pandemic in more ways than one.
But has the Opposition better ideas? It seems obvious that ‘bed-blocking’, with all its knock-on effects, can only be resolved when care workers are paid a decent living wage. In an under-reported speech in a January 2022 speech, Sir Keir Starmer presented what he called the Labour Health Contract, breaking the mould in two senses. First he pledged a New Deal for social care workers and a five point plan for the sector. Second, in an attempt to counter the perennial distorting emphasis on hospitals, ( the 40 imaginary, often promised new ones is a perfect example), Starmer spoke extensively about prevention, stopping people getting sick in the first place and moving beyond a ‘National Sickness Service’ towards a National Health Service with an emphasis on health and well-being.
No-one pretends prevention is easy. Behavioural change never is. But it can be achieved. From the Hollywood movies of the 1950s and 60s with everyone puffing away merrily we are down to 14% of adults smoking in the UK today. Government can make significant interventions in improving air quality, more effectively controlling the great corporate pedlars of cholesterol, alcohol and sugar – as Mr. Kellogg has noted - and providing the public with an accurate diagnosis of the real basic problems. For example, it is not that we have an aging population but an aging population bringing to old age a cluster of often preventable disease and disorders. Nor is it families eating cheap, processed, rubbish food; it is widespread poverty and inequality.
One thing is sure: we need a new set of hands to restore the safety of our health service and to lift the shadow over millions of homes that again hangs over us.
See TheArticle 20.07/2022
At 16.30 on 3 August 2021 the massive ship Ever Given weighed anchor at the port of Felixstowe. 200,000 gross tonnage and the length of four football fields, she is one of the world’s thirteen largest container ships owned by a subsidiary of a Japanese shipbuilding company and chartered by Evergreen Maritime shipping based in Taiwan. Ever Given’s voyage had been eventful and became internationally renowned after running aground and blocking the Suez Canal.
She had stubbornly refused to budge and clear the ship-jam: as a result over 300 vessels, including five other container ships, 41 bulk carriers and 24 crude oil tankers, got stuck at both ends of the canal for the over six days it took to re-float her. Once refloated, she was impounded by the Egyptian government and held for three months in Ismaila until compensation was sorted out and paid.
As the Ever Given drew into Felixstowe onlookers came out to see the maritime prodigy. One man though, Julian Wong, was more interested in seeing the crew on board. The Port Chaplain for East Anglia and Haven Ports, who worked for Stella Maris UK, the British branch of an international charity caring for seafarers and those on fishing boats around the world, he had seen plenty of giant container ships. His concern was the crew - who were not permitted to go ashore. Early in the morning after the Ever Given had docked, he went to offer support and brought chocolates for all on board. The captain and first officer sent back a thank-you message with a selfie. The ship was gone the next day, an average turn-around time.
Spending months at sea without setting foot on land is a common experience for the seafarers who come to Britain, many from Asian countries. Bigger ships, smaller crews, more exhausting work. Though some of the most acute welfare needs are found in more modest fishing vessels. The International Labour Organisation’s (ILO) 2006 Maritime Labour Convention, ratified by 97 States by 2021, “aims to provide minimum living and working conditions for seafarers that are globally applicable and uniformly enforced, including granting seafarers shore leave”. ‘Aims’ is the operative word. Shore-leave, a critical matter for health and wellbeing, depends on ships’ Masters who have complete control over who can come on board and whether crew can disembark but are themselves under pressure from the shipping companies focussed on profitability and ever faster turn-around times. During the global COVID pandemic hundreds of thousands of seafarers were not allowed to leave their ships at all. Much mental illness resulted. Vital medical needs were more than usually difficult to obtain.
Nine big shipping lines joined in three alliances dominate global container traffic. In 2021 the profits of these shipping lines amounted to £157 billion. Prior to COVID, according to Nick Glynne on Radio 4, managing director of the retail company Buy It Direct, shipping companies were charging c. £2,000 to transport a standard 40 foot container from China. At the peak of COVID infections the charge was anything between £16,000 and £20,000. Shipping a fridge from China pre-COVID, for example, cost the retailer £10. This rose to £100 during COVID whilst the shipping companies’ costs rose c. 15%. Negotiations by the International Transport Workers Federation on the minimum wage for seafarers resulted in an increase: from £6,114 to £6,316 per annum taking effect from January 2023.
Yet, it took P&O ferries’ callous dismissal of its largely British workforce, in order to substitute cheap and non-unionised foreign labour, for the plight of seafarers to gain public attention. The ‘M’ in RMT stands for Maritime but a Filipino seaman is unlikely to be able to join a union during a two day stop in a British port even if he is allowed to disembark within the port precincts.
Stella Maris has 1,000 chaplains and volunteer ship visitors in over 300 ports in 54 countries. Reporting on the last three years work, they list their top three priorities: responding to the impact of COVID, supporting victims of abuse at work, and responding to ‘ship abandonment’, that is the practice of dumping seafarers thousands of miles from home when things go wrong. (Leaving an abandoned ship can be breach of contract - if stranded crew can get home, they may lose their pay).
The problems for seafarers caused by the war in Ukraine have been little reported. Stella Maris provides very tangible emergency help irrespective of nationality. In Odessa, with the help of the Stella Maris Crisis Support Fund, Father Alex Smerechynsky and his assistant Rostik Inzhestoikov care for families of seafarers fleeing Ukraine. Father Edward Pracz, Stella Maris chaplain for the Polish Baltic Sea port of Gdynia located on the western coast of Gdańsk Bay, has converted a retreat centre into a home for some 50 women and children, families of Ukrainian seafarers.
Breaking the isolation of shipboard life is a routine element in Stella Maris’ work. Every year they provide internet access to seafarers and thousands of free sim-cards to contact their families after long periods at sea. There is also a more intangible aspect of their work, making visible the invisible work force of sea-borne international trade – four billion tons of goods transported by sea at the turn of the century increasing to 11 billion today. These are the men and women who literally keep the global economy moving.
In the last couple of weeks, anyone enjoying the sunshine on the Suffolk beach of Dunwich, perhaps thinking it should win the Today Programme favourite beach competition, could see on the horizon two bulky container ships stacking to go into Felixstowe. Giant vessels piled high with the typical 40 foot containers like a floating Lego housing estate. No romance of the restless sea there, just a couple of dozen crew members confined, isolated and separated for months from their families, seemingly close, definitely essential, invisible.