Last Wednesday, Kareen Gayle, a nurse in the emergency department of King’s College Hospital, south London, finished her night shift and joined the queue of about a hundred nurses, trade union activists, and political supporters on the road outside. There was a rush on the first morning of the two-day strike. Red London buses honored nurses’ home-made posters: “What can you do? You are laughing”; “The patients are not dying because the nurses are waiting.” Nurses are being beaten because patients are dying”; “NHS Hero to Zero.” Ambulances are coming out of the hospital gates blaring their sirens. The nurses clapped. Three people beat the drums. Gayle has worked at King’s, one of the largest and busiest hospitals in London, for eighteen years – the last eight in the ER. great, zero bullshit) that is needed at the most difficult times in life. I asked him an example of how the hospital was struggling at that time. “We don’t have enough beds, just one,” he replied.
This winter, the Royal College of Nursing, which represents more than 300,000 nurses in the United Kingdom, has called the first major strike in its history of one hundred and six years. (There was a smaller trend in Northern Ireland in 2019.) The main reason is wages. Last March, the RCN asked for a salary increase of 5 percent above inflation, which at the time was 7.5 percent. Meanwhile, in England, the government has given National Health Service nurses a 4 percent bonus. Gayle told me that, if he was working his full-time job, his monthly salary would cover his bills and then he would spend three days. (In December, UK food prices were 16.8 percent higher than a year ago.) To keep up, she takes extra shifts, sometimes working six nights a week in the ER. Her youngest child is five. . He said: “Sometimes I feel like I’m really bad.” “Because he says, ‘Mom, are you sleeping with me tonight?’ And I have to say, ‘Mommy has to go to work to pay the bills.’ It is very sad that you are missing out on so much.” In addition to the constant fatigue of working in the wards, skipping breaks when he needed to urinate, the mood on the picket line was high. The morning was cool and clear. The late rising sun lit up the golden hospital buildings.
“What do we want?” The union representative called.
“When do you want it?”
The drums were beating. The song ended. Gayle sighed quietly: “Let’s believe that we will be promoted.” Oh my God.”
Britain is a sea of boycotts. There’s a website, StrikeMap.org, where you can search the country for transportation lines – train drivers, driving instructors, court workers, bus drivers. Forty-nine strikes in Sheffield. Over a hundred around Manchester. This week, paramedics and emergency dispatchers canceled for the fourth time in just over a month. Junior doctors are voting on whether to strike in March. The teachers are planning several trips next month. The main cause of the chaos is inflation – more than ten in Britain – and, in many cases, disruptive changes in performance, often related to the epidemic. But, although the industries that affect the NHS share some of these complaints, they are in a group of their own, because of the risks they cause to patients, the international respect that the British medical system is supported by the government. and the fact that the system seems to be collapsing.
The winter crisis in the NHS has been as steady as, well, winter for a decade or so. Over the years, it has become common for news to fill up, from December to February, many hospitals announce “black notices” – in which patients are overloaded and have to take new cases elsewhere. On the surface, the past few months have followed a familiar pattern. The country is at risk of the first flu outbreak since the pandemic. Add that to the long tail of COVID DISEASE and the frightening spread of strep-A disease last fall, which killed at least thirty children and scared millions of parents, and the system has been stretched to capacity.
But a deeper disease is also at work. The corporate structure of the NHS—it employs more than 1.2 million people and has an annual budget of more than 150 billion pounds—makes people in Britain think it is bigger and more profitable than it really is. The UK has fewer doctors, nurses, hospital beds, MRI units, and CT scanners per head of population than most of its European neighbours. According to the Health Foundation, a non-partisan research organisation, health spending per capita in Britain fell by eighteen times the European average between 2010 and 2019 – a period that coincided with the Conservative-led national programme, followed by Brexit. . The legacy is a huge, and unsustainable, gap in NHS funding and support. “These are the chickens coming home to roost,” Tim Gardner, policy analyst at the foundation, told me. “The roots of the current emergency lie in the political choices made over the past decade and more.”
In the NHS’s books, the system was “hot” – with staffing problems, delays in renovations, outdated equipment, family doctors working limited hours, and an aging population – for years before the pandemic. After three years, some parts don’t work at all. In 2012, around 95 per cent of patients in emergency rooms in England were treated within four hours. Now it’s about 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 – one in eight of the population – are on NHS waiting lists, up from two and a half million a decade ago. About one in seven people in a hospital bed are now well enough to leave but have nowhere (usually a nursing home) to go. Every light glows red.
Outside King’s, a registered nurse at the hospital, named Sophie, held up a sign that read “Rishi the Reaper” – meaning Rishi Sunak, the country’s new Prime Minister. Sophie qualified as a nurse in 2016. “It’s the same crap every year,” she said. “You go through peaks and valleys. Some days you walk in and you’re like, Nothing. I just need to get through the day, see patients, if I’m going to be late, if I don’t have a break. You just have to mess it up. . . . Some days, you think, Really, what am I—? Why am I doing this?”
During the outbreak, Sophie was also sent to work in the ICU “I have never looked at a diabetic patient in my life,” she said. Tell me it’s okay. He took a break and worried because he was afraid of killing the patients. A fellow cardiology nurse stood next to him holding a sign that read “Cause of death?” Tory Cuts.” The nurse-to-patient ratio in their department was sometimes one to ten, instead of one to four. In some cases, the wait time for atrial-fibrillation ablation—a procedure to restore the heart’s strength—grew from months to months. three to a year and a half. I asked Sophie if there was any relief in going on strike, in being able to protest and raise awareness of these problems. She said: “I don’t think anyone would be happy to be here. I’m worried about how many jobs we have to go back.”
The NHS is turning seventy-five this year. I found the Panglossian article, published in British Medical Journal, twenty-five years ago, at the start of Tony Blair’s Labor government, I look forward to this time. “Today, in contrast to 1998, the NHS is about to wait,” the forecast reads. “Whether over the phone or online, in hospitals or in clinical settings, NHS patients and their families can expect a courteous, personal and friendly response from every NHS worker they come in contact with.” In the real 2023, the NHS is a bigger concept than a good health service. It’s the institution that makes so many people – more than sixty per cent – proud to be British, yet we fear using it. A recent study by a Time Londoners found that two-thirds of respondents found the current NHS “bad” and that eighty per cent thought it had deteriorated in the past five years. During a visit to the UK last week, Peter Thiel, the American billionaire software developer and NHS critic, described the country’s relationship with its health model as a Stockholm syndrome.