Last Wednesday, Karen Gale, a nurse in the emergency department of King’s College Hospital in south London, finished her night shift and joined a picket line of about a hundred nurses, trade-union activists and political supporters on the pavement outside. It was rush hour on the first morning of the two-day strike. Red London buses honored him with placards supporting the nurses’ house: “Coping? You’ve got to be kidding”; “Patients are not dying because the nurses are on strike. Nurses are on strike because patients are dying”; “NHS heroes to zero.” Sirens blared as ambulances left the hospital gates. Nurses clapped. Three people played the drums. Gail has worked at King’s, one of London’s largest and busiest hospitals, for eighteen years – a single mother of four children, the last eight in the ER, dealing with her immediate treatment nurse (deep kindness, zero nonsense) is what is needed in life’s worst moments. I asked her for an example of how the hospital is struggling at the moment. “We don’t have enough beds for one,” she replied.
This winter, the Royal College of Nursing, which represents more than three million nurses across the United Kingdom, called for the first mass strike in its hundred-six-year history. (There was a smaller crackdown in Northern Ireland in 2019.) The main reason is pay. Last March, the RCN requested a five per cent wage increase on top of inflation, which stood at 7.5 per cent at the time. So far, in England, the government has only provided a four per cent raise to National Health Service nurses. Gail told me that, if she works her normal shift pattern, her monthly paycheck covers her bills and then runs out after three days. (In December, food prices in the U.K. were 16.8 percent higher than a year earlier.) To stay afloat, she takes extra shifts, sometimes working six nights a week in the ER. His youngest daughter is five years old. “Sometimes I feel very bad,” she said. “Because she says, ‘Mom, are you sleeping with me tonight?’ And I have to say, ‘Mom has to go to work to pay the bills.’ It’s really sad because you are missing a lot.” Taking pee breaks, next to the permanent exhaustion of working the wards, the mood on the picket line was high. The morning was cool and clear. The late-rising sun lit the tops of hospital buildings gold.
“What do we want?” A union representative is called.
“When do you want it?”
The drums rang. The chanting fell silent. Gayle breathed softly: “Let’s hope we get this raise. Oh dear me.”
Britain is a sea of attacks. There’s a web site, StrikeMap.org, where you can scan the country for picket lines – for train drivers, driving instructors, court staff, bus drivers. 49 strikes at Sheffield. Over a hundred around Manchester. This week, paramedics and emergency dispatchers took their fourth stop in a little over a month. Junior doctors are voting on whether to strike in March or not. Teachers are planning a series of walkouts over the next month. The unifying cause of unrest is inflation – over ten per cent in Britain – and, often, dismal changes in working conditions, usually related in some way to the pandemic. But, although the industrial action affecting the NHS shares some of these grievances, it stands in its own category for the risks it poses to patients, the almost universal respect in which Britain’s publicly funded health care system is held. and the fact that the system appears to be crumbling.
The winter crisis in the NHS has been, well, a regular occurrence for a decade or so. For years, from December through February, it has become common to fill the news with dozens of hospitals declaring “black alerts”—in which they are overwhelmed with patients and have to divert new cases elsewhere. On the surface, the past few months have followed a familiar pattern. The country is in the grip of its first major flu outbreak since the pandemic. add to the long tail of covid And a horrific outbreak of strep-A infections last fall, which has killed at least thirty children and worried millions of parents, has stretched the system to capacity.
But a deeper disease is also at work. The integrated structure of the NHS – it employs over 1.2 million people and has an annual budget of over one hundred and fifty billion pounds – makes people in the UK think it is bigger and better-funded than it actually is. The UK has fewer doctors, nurses, hospital beds, MRI units and CT scanners per capita than most of its European neighbours. According to the Health Foundation, a non-partisan research organisation, per capita health spending in the UK was eighteen percent below the European average between 2010 and 2019 – a period that coincided with the country’s Conservative-led austerity programme, which After was Brexit. “The legacy for the NHS is a huge, and potentially immeasurable, investment and support gap,” Tim Gardner, a policy analyst at the foundation, told me. “It’s the chickens coming home.” “The current emergency has its roots in the political choices that have been made over the past decade and more.”
In NHS jargon, the system was “running hot” – with chronic staffing problems, delayed repairs, outdated equipment, family doctors working short hours, and the increased demands of an aging population – for years before the pandemic. Three years later, some parts are still barely working. In 2012, about ninety-five percent of patients in emergency rooms in England were treated within four hours. Now it’s around two-thirds. Last month, the average wait time for an ambulance for someone with a stroke or chest pain was ninety-three minutes—five times the target. More than seven million people in England – an eighth of the population – are on the waiting list for NHS treatment, up from two and a half million a decade ago. Around one in seven people currently living in a hospital bed are well enough to quit but have nowhere to go (usually a care home for the elderly). Every light is blinking red.
Outside King’s, a specialist nurse in the hospital’s cardiology department, who gave her name 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 shit year after year,” she said. “You go through peaks and troughs. Some days you go in and you’re, like, nothing matters. If I stay late, if I don’t have a vacation, I just have to get through the day, patients But pay attention. You just have to crack it. . . . Other days, you wonder, Really, what am I—? Why am I doing this?”
During the pandemic, Sophie was reassigned to work in the ICU. “Tell me it’s safe.” She took time off with anxiety because she was afraid of killing patients. A fellow cardiology nurse stood next to her with a banner that read “Cause of death? Tory Cutts. The ratio of nurses and patients in her department sometimes reached one to ten instead of one to four. In some cases In the U.S., the wait time for atrial-fibrillation ablation—a procedure to restore the heart’s normal rhythm—had increased from three months to a year and a half. I asked Sophie whether it was worth going on strike, to protest, and to make her aware of these problems. There’s no relief. “I don’t think anybody is happy to be here,” she said. “I worry too much about how much work we have to do to get back.”
The NHS turns seventy-five this year. I came across a panglossian article that was published in british medical journal, twenty-five years ago, at the dawn of Tony Blair’s Labor government, was waiting for this moment. “Today, in contrast to 1998, the NHS is almost wait-free,” the forecast reads. “Whether by phone or internet, in hospitals or community health centres, NHS patients and their families can expect respectful, adapted, and even cheerful responses from any NHS staff.” In the real 2023, the NHS is more of an idea than a particularly good healthcare service. It is the institution that makes most people – over sixty per cent – proud to be British, and yet we are somewhat afraid to use it. A recent survey conducted by Times The London study found that two-thirds of respondents found the NHS currently “bad” and eighty percent thought it had gotten worse over the last five years. On a visit to the UK last week, Peter Thiel, the American billionaire software investor and a serial NHS detractor, described the country’s relationship with its health care model as a case of Stockholm syndrome.