Neil Faulkner reports on the chaos and distress on the NHS’s frontline.
29 March 2020.
We are not ‘all in it together’. We are never ‘all in it together’. We live in a class society in which all social experience is shaped by inequalities of wealth and power.
You would not guess so from the cravenness of the Labour leadership and the fawning of the mainstream media. Apparently, in a ‘national crisis’, we are supposed to abandon ‘partisan politics’ and all pull together for the common good.
Apparently, we are expected to rally behind the leadership of Johnson, Cummings, and the Tory Cabinet. Apparently, we should bury the long history of Tory attacks on the NHS, ignore the real causes of the coronavirus disaster, turn a blind eye to the prioritisation of big-business interests, and put out trust in ‘government guidelines’ and official statements from androids like Dominic Raab.
Why should we do this? Why should we not treat them with the contempt they deserve when, despite everything, despite all the horrors now unfolding, not a single leading Tory has told the truth and accepted blame.
And they will not. However deep the crisis gets, however great the peril becomes, however absolute their culpability appears, they will continue to lie and lie and lie.
They lie for their class. They lie to protect the rich, the profiteers, the system, and their own shabby, self-serving, socially worthless careers.
Every health worker knows the truth the Tories do not tell. Every doctor, nurse, and allied health professional knows. But they are silenced by top-down management as surely as if we lived in Stalinist China – threatened with dismissal, just as Chinese health workers are threatened with incarceration, if they tell the truth to the public they serve.
This article if based on first-hand reports from the frontline of the NHS. It tells the truth about what is happening and who is to blame. It reflects the lived experience of working people as the coronavirus crisis unfolds – in contrast to the regime’s barrage of lies, cover-ups, and empty promises.
The NHS: devastated by Tory cuts
At meetings of health staff in the second week in January, management made no mention of COVID-19. When workers raised the issue, they were told it had not been announced as an emergency, so no advance preparations were being made. No discussion. No plans. No preparations. Nothing.
A deadly pandemic – created, incubated, and then allowed to spread out of control by institutionalised state lying and repression inside China – was already set to spread across the world. But the Tories did nothing to prepare a national health service which, in ten years of cuts and privatisation, they had left operating on minimal margins.
Everywhere there were vacancies – not enough doctors, not enough nurses, not enough allied health professionals. Total shortfall: around 100,000.
Where to begin, as we list the Tory policies responsible? Let us mention just two. The Tories’ opportunistic embrace of Brexit – a tawdry peddling of nationalism and racism by politicians devoid of integrity or principle – has cost the NHS 22,000 staff.
Let us remind ourselves of the vacuous slogans under which this was done. The slogans that define the Johnson/Cummings regime. ‘Take Back Control’ and ‘Get Brexit Done’. The political charlatans who rode to power on these childish tabloid slogans have cost us 22,000 health workers.
Or how about the scrapping of bursaries for student nurses, midwives, and allied health professionals in 2017? Let us just recall, in the context of the present health disaster, that decision. Let us reflect on the sheer class-war viciousness of a government of the super-rich that bails out bankers loading working-class students with debt.
How much debt? Around £50,000 a head. The effect? The numbers applying to study nursing and allied professions collapsed by a third.
So the NHS, in the face of coronavirus disaster, had already been brought to the brink by ten years of class-war attacks.
A class war on the NHS
I am going to say that again: class-war attacks. There is no other way to describe what they have done. They have cut and cut and cut the NHS because it is the public service on which working people depend. They used the 2008 financial crisis as the cover for an ideologically-driven programme of run-down and privatisation.
They have always hated the NHS, because it embodies the ideal of collective provision and public service for the general good. They have always hated it because it is the very antithesis of the world of wealth and greed and profit they present.
As a result, the NHS is now on the brink. Opel 4 (‘Black Alert’) has become the working norm across much of the service. Black Alert is when the ambulances are backed up because there are no beds for the patients they are carrying when they reach the hospital. That sort of thing. Black Alert has become normalised in an NHS hit again and again by Tory wrecking-balls.
‘Stranded patients’ meetings have become routine. This is where hospital beds are ‘blocked’ because there is no care available for patients in the community.
This, of course, is because the Tories have a) cut the number of beds, and b) slashed social and community care services. The Tories have cut 17,000 NHS beds since 2010 – more than 10% of the total. As for social care, on one estimate, the service will need investment of £8 billion a year for the foreseeable future to make good the terrible damage they have done to community-based services for the sick, the disabled, and the elderly.
Everything in the NHS nowadays is reactive, nothing proactive. There are no resources for proactive, only crisis management in an underfunded, under-resourced, understaffed service that has been pushed to the limit.
In mid January, knowing all this, knowing what terrible damage they had done, and knowing what was coming, knowing that a global pandemic was rising, the Tories did nothing.
We soon found out why. The little group of proto-fascist ‘wierdos and misfits’ around Cummings in Number Ten were busy concocting a Social Darwinist/eugenicist response to coronavirus. It was labelled ‘herd immunity’.
The basic idea was very simple: the disease would strike down mainly the elderly and those with underlying health conditions; this cull of ‘surplus people’ would be the necessary sacrifice to achieve ‘herd immunity’ among the survivors. We would be fewer, but we would be better, fitter, blonder at the end of crisis, presumably emerging from our bunkers to sing in unison the Horst Wessel song.
Then it must have dawned on Johnson that his premiership – the only thing he cares about – would be over if he presided over a hecatomb of dead. So, belatedly, reluctantly, they began to U-turn.
But nothing was done right. Inside the NHS, there is a culture of top-down control, management secrecy, and official cover-up. A good proportion of the overpaid corporate spivs who now run the NHS are not even former clinicians – they are imports from private industry. Even those who are former clinicians tend to be the toadies: you don’t get promoted into senior management in the modern NHS by defending the interests of staff and patients.
Inside the NHS, generally speaking, it is not the people who know who make the decisions – it is not the doctors, nurses, and allied health professionals on the frontline. It is the people who do not know – the imported corporate-style management – who decide.
How do they decide? Let’s take an example: the ongoing scandal of lack of testing kits, lack of ventilators, and lack of PPE (personal projective equipment). This arises from ten years of cuts, ten years of pruning to the bone, ten years of making zero provision for an emergency. And it arises from a month of doing nothing between mid January and mid February – a month during which the virus got a grip, a month during which the NHS got no support in the face of what was coming.
No forward planning. No information. No discussion. Not the slightest sense that a hospital is a community of highly skilled, highly motivated, caring professionals who should form the basis of any rational, intelligent, decision-making process.
But if that were the case, of course, the negligence and incompetence of the Tories would have been laid bare. So the people who know are not allowed to decide.
Then, when things finally began to happen, it was too little, too late – and everyone was still in the dark, the key decisions emerging with all the transparency of a Vatican conclave.
Government guidelines: government lies
NHS staff have been told by senior management that ‘government guidelines’ are that they don’t need full PPE unless they are doing AGP – aerosol generating procedure, where they are putting tubes into people to hook them up to a ventilator. They don’t need PPE to be on a ward, do house visits, move patients around. All they need are masks, short gloves, and plastic pinnies.
Let us be clear. The disease is highly contagious. It is spread in droplets when people breathe, cough, sneeze, dribble. When people are infected, the stuff gets everywhere.
‘Government guidelines’? Just listen to what the frontline workers are saying. Doctors, nurses, and allied health professionals working with coronavirus victims are distraught that they are contracting, carrying, and spreading the disease for the lack of PPE. Some health workers are reduced to wearing black bin-liners.
Health workers know. Johnson, Hancock, Raab, and their ‘expert’ trusties are lying: the ‘government guidelines’ being handed down from above and then peddled by NHS managers are just another cover-up.
Make that a working rule. ‘Government guidelines’ means government lies, and if you want to know what is actually necessary, listen to the health workers.
Same with testing. ‘Government guidelines’ have been to ignore urgent WHO (World Health Organisation) protocols to test, track, and contain. Had the Tories done this from the outset, we would, at the very least, have slowed the spread of the disease and won precious time for the NHS, making it easier to manage the disaster, care for sick, save more lives.
But no. The Tories ran down the NHS for ten years, made no provision for a pandemic, and then, when it struck, did nothing for a month as the virus got a grip. So there were no testing kits. Therefore, ‘government guidelines’ were that we should not do mass testing. Not even – not even – of health workers!
Health workers are being reorganised and retrained for new coronavirus roles. They are being sent into danger. They are being denied proper protection and proper equipment. They are not even being tested for the disease themselves, let alone being provided with testing kits for use in the community. There are hospitals where not a single health worker has been tested for the disease.
Around a quarter of all NHS staff are now off work because they have the disease or may have it and are self-isolating. That loads additional pressure onto those still at work, and many now are suffering acute anxiety, stress, and fear – for themselves, their colleagues, their patients, their families.
Tory cuts, Tory negligence:
how many people have they killed today?
This is what frontline health workers are saying:
I am terrified. I am serious considering whether I can keep working as a doctor.
There is a high death rate for medical first-responders. If they don’t have the protective kit, this increases the risk of death. What we are going to have to use is likely not fit for purpose.
I cannot believe or understand why Public Health England has downgraded our PPE advice. This is not seasonal flu. Why are they contradicting international advice? … Doctors are dying in Italy and China. Young people are dying, too… I’m losing faith in the leadership, medical as well as political. They are making it impossible for me to do my job. I feel betrayed. Who is going to look after our patients if we are ill or dead? Hospital staff are being told we cannot be tested if our symptoms are mild. This is unbelievable. If we’re not allowed to be tested, then how will we ever know how many other people – patients – we are infecting?
It’s terrifying. It’s lambs to the slaughter.
It’s terrifying for staff at the moment. Still no access to personal protective equipment or testing.
Rigid command structures make decision-making impossible.
There’s been no guidelines. It’s chaos.
I don’t feel safe. I don’t feel protected.
We are literally making it up as we go along.
It feels as if we are actively harming patients.
Forget lockdown – we are going into meltdown.
The public and media are not aware that today we no longer live in a city [London] with a properly functioning Western health-care system.
How will we protect our patients and staff … I am speechless. It is utterly unconscionable. How can we do this? It is criminal… NHS England was not prepared… We feel completely helpless.
When this is all over, the NHS England Board should resign in their entirety.
Tory policy: don’t test, don’t trace, don’t contain
Richard Horton, Editor of The Lancet, has written:
The UK Government’s Contain–Delay–Mitigate–Research strategy failed. It failed, in part, because ministers didn’t follow WHO’s advice to ‘test, test, test’ every suspected case. They didn’t isolate and quarantine. They didn’t contact trace. These basic principles of public health and infectious disease control were ignored, for reasons that remain opaque.
The lack of testing is the great black hole of ignorance. Some health workers reckon 100,000s have already been infected. They hear rumours about the pop-up mass morgues being constructed and the hiring of refrigerated lorries to cart the corpses away. They worry that this is only the beginning, that the peak could be weeks, even months away.
Imperial College academics estimate that by late June the demand for ICU (critical care) beds may exceed supply by as much 15 times. They also estimate that the NHS may need 30,000 ventilators: the service currently has 8,000. The Brexit Tories ignored a European joint procurement initiative and offers from individual suppliers. All of a piece with the do-nothing response to the crisis.
What will happen? It is highly likely that Tory negligence will lead directly to doctors having to ration access to ICU beds and ventilators on the basis of who is most likely to survive, leaving the rest of die.
Health workers will die and coronavirus patients will die because of Tory cuts and Tory negligence. Probably thousands, maybe tens of thousands.
That is why the cosy consensus at the top – of politicians and lobby correspondents – is a disgrace. We need to understand why this is happening, why it is getting so bad, why it is being so mismanaged.
And in due course, by exposing the truth, we need the political forces responsible to pay the price – so that they cannot return, after the pandemic, to their business-as-usual attacks on our public services and our social well-being.
A time for settling scores is surely coming.
Neil Faulkner is a revolutionary socialist active in Mutiny.