LLast Thursday, I spoke to a doctor at a hospital in the North East of England who works in acute medicine, a general term that covers most conditions that present as emergencies, from heart attacks to kidney failure. I contacted her for all doctors, the medical professionals’ advocacy group created just before the pandemic. “I’ve never seen anything like it,” he told me. “The halls are packed with people on carts, being served. Our A&E department is twice the size it was before the pandemic, but it’s full of people who can’t get beds.”
What had brought his hospital into crisis, he said, was a bad flu season and a sharp rise in respiratory viruses, along with deep systemic problems that had been festering for years. She explained his fears in the seemingly calm tone of someone who regularly deals with matters of life and death, but what she said was full of foreboding, with the sense that a basic foundation of the social contract had collapsed. “I think most people would say that if they were really sick, when they walked through the doors, they would be as safe as possible. It seems that is not the case now… There is too much danger.”
There was one particularly revealing aspect of our conversation. He changed regularly from the state of the National Health Service on the equally dire condition of adult social care run by councils and much of it provided by private providers, and a key issue looming large this winter: the reality of an increasingly aging society and how little is being has done to prepare for it. Low wages, high staff turnover and continued austerity remain the defining features of how we address society’s care needs, and gaps in provision have a particularly tragic result: patients who should be discharged from hospital are stranded there. In addition, if social care is moderately adequate, many older people might not be hospitalized in the first place. Clearly, one crisis is inseparable from the other.
According to For the president of the Royal College of Emergency Medicine, up to 13,000 NHS patients, representing up to 13% of hospital beds, are “medically ready to leave hospital, but have to stay because they have nowhere else to go.” . My medical contact’s estimate of the numbers at his hospital matched that figure, and he also told me that bed blockage due to poor social care was currently his colleagues’ biggest problem: “If that problem were solved, we could handle it”. .” In human terms, moreover, the problem is tragic: “There is a lot of misery in people who are trapped in a room. It certainly delays your recovery. Beyond a certain point, no one gets better in the hospital.”
In recent months, he continued, it has become difficult to even get care packages for people in the advanced stages of terminal illnesses. “In the past, if you saw a patient who had advanced cancer and wanted to go home to die, we can set that up. Now that often can’t happen, because home care just isn’t there.”
Journalists and politicians in England tend to obsess over the huge care bills paid by the richest households, and the proposal financing reforms now delayed to 2025. But what about the state of social care itself? Thanks in part to rising energy costs, a record number of nursing homes are going bankrupt. In the first three months of last year, the Service and Quality Commission reported that more than two million annual hours of home care could not be delivered due to inadequate labor. By the end of the summer, credible figures He suggested that almost 300,000 people in England were waiting for an assessment of their care needs, with 600 people a day joining waiting lists.
The backstory to all of this is depressingly familiar: the reckless austerity pursued by David Cameron, George Osborne and Nick Clegg, and how it was met in the face of growing need. The first time I heard people in local government talk about the cuts in social care that blocked hospital beds eight years ago. More recently, sporadic but inadequate oodles of money have been accompanied by equally sporadic talk of reform, but there is no sense of anyone being able to stem the mounting failures. Over the weekend, there was news of more emergency spending: “hundreds of millions of poundssaid the Sunday Times front page, to buy places in nursing homes and free up NHS beds, on top of the £500m already allocated to a new “download background”. These moves may be welcome, but there is no strategic coherence: they leave the underlying factors behind the crisis intact.
Sunday morning, Laura Kuenssberg asked the prime minister the right question: “Would you do a job as a caretaker for £18,000 a year?” He did not answer. Nearly 50% of the people in the sector win inside 30 pence an hour minimum wage. Brexit simmers in the background, as one of the causes of growing labor shortages in the sector and the trigger for more spillover effects: rising vacancies in other fields are driving people away from the spotlight in ever increasing numbers. In 2021, the adult social care vacancy rate was 5.9%; One year later, reached it 10% Going forward, we will clearly need increasing numbers of people to staff the system of care, but the current number of vacant positions in the sector is around 165,000.
Despite the culpability of Westminster politicians for much of this mess, these issues run the length of the UK and are now receiving different and much belated responses. Despite strong opposition, the SNP government in Scotland is hard centralize the provision in a new national service; in England, job offers lazy talk of a national system that would take shape “in various parliaments”, while Tory ministers tout the Health and Care Act 2022 as a landmark change in “how health and care services work together”. But there’s an argument you hear over and over again from social care experts: that before we get to any big conversation about radical change, the urgency of our current crises must be alleviated by paying people more quickly and putting a shaky system on the ground. on a stable foot. Contrary to what we hear from both Rishi Sunak and Keir Starmer, there is no immediate way out of this mess that doesn’t involve vast amounts of money, spent year after year, and a host of care workers.
There are two viable ways to ensure those things: a growing economy that will generate enough tax revenue, and a genuinely welcoming approach to people from abroad. But we’re not that kind of country anymore, for reasons that hardly need to be mentioned. Encouraged by the same charlatans who now complain about a “broken” Britain, the vote to leave the EU among those over 65 reached 64%. That grim irony is one more element of a winter characterized by chaos and carnage, and a symbolic image that still seems to be overlooked: people nearing the end of their lives, trapped in hospital wards, clinging to a hope. less and less that they can somehow achieve it. house.
