Weekly Blog - 2 January 2023 - NHS Crisis

 

NHS crisis

The UK’s National Health Service (NHS) is under intense pressure and facing a major winter crisis.  The British Medical Association has described the situation as “intolerable and unsustainable”.  Doctors surgeries are overwhelmed, hospitals can’t discharge patients because of a lack of care staff in the community, and 13 NHS trusts have declared critical incidents.  Ambulances are queued up outside of hospitals unable to hand over their patients or to go out again to help new casualties.  In particular, Accident and Emergency (A&E) departments are “in a complete state of crisis” according to the Royal College of Emergency Medicine (RCEM).  They say it is the worst winter for A&E waiting times ever recorded, with some waiting up to 4 days in A&E departments.  The RCEM estimates that between 300 – 500 people are dying every week because of delayed emergency care.  In just one case, the BBC reported how a 90-year-old woman who fell and hurt her hip, had to wait more than 30 hours for an ambulance.  "She's in a lot of pain but she's not on death's door, so I think there is a priority listing whereby she's down the priority list", said her son.^[1]

The pressure is partly being driven by winter illnesses like flu and Covid, combined with an aging population in the UK.  In addition, thousands of NHS staff are off sick with Covid.  However, overwhelmingly it is the result of chronic underfunding.  Public services like the NHS have faced massive spending cuts in recent years since the financial crisis in 2008-9 (as indeed they have in many other countries).  Twelve years of cuts and austerity have reduced salaries and service and safety levels drastically, almost to the point of collapse, driving dedicated nurses, doctors and ambulance workers to the extreme measure of strikes.  The crisis has led many to ask whether the system of public healthcare in the UK is fundamentally broken and unsustainable, and a new model needs to be found.  But public services like healthcare; education; pensions; and unemployment, low-income and incapacity payments have a huge proven track record.  They have played a crucial role in massively driving down poverty and inequality in countries all over the world for well over a hundred years.  The UK is the fifth richest country in the world.  It has the resources within the economy to pay for effective public services, funded through progressive taxation which ensures those who can afford it pay the most.  Whether to do so or not is a choice made by governments. 

 

The role public services have played in reducing poverty

Arise’s 4 Shifts Report looks at what the Bible has to teach us, and what the lessons from the past have to show us, about how to have a fair and green economy and society that works for all.  The research clearly shows that if we rewind the clock to the nineteenth century, we find that all governments, everywhere, were taking no more than 7 – 8% of national income as tax, and using it to pay for the police, army and foreign affairs.  Governments saw their job as maintaining law and order at home, and security and national interests abroad.  They saw no role for the state in providing healthcare, education, pensions, unemployment support or incapacity payments for its citizens, and these were entirely left up to private individuals to arrange for themselves.  As a result, the small wealthy upper-class and aristocracy at the top of societies were well provided for, whilst the vast majority of ordinary people endured massive poverty, inequality and little or no healthcare, education or social support.  More than 90% of the population of the world lived in extreme poverty in 1820.

Then as the industrial revolution led to the emergence of a larger middle-class of tradespeople, lawyers, journalists, students, trade union organisers etc., they began to call for more democratic reforms and freedoms, and for better education, healthcare and social provision.  Responding to this pressure, governments throughout Europe, North America, Oceania and Latin America from the late nineteenth century and throughout the first half of the twentieth century, began to take a much larger proportion of national income in tax, anywhere from 30 – 55%, and use it to pay for healthcare, education and a growing amount of social spending.  The modern welfare state was born.  This intensified even further after the Second World War, and spread to Asia and Africa, as new independent governments emerged from the end of colonialism.  In the UK, the NHS was established in 1948 as part of this process.  As a result, levels of extreme poverty and inequality have reduced dramatically around the world, and there is much wider access to good education, healthcare and social support.  Today less than 10% of the population of the world live in extreme poverty, and virtually all governments around the world see it as a part of their role to ensure all their citizens have access to education, healthcare and social protection.

Far from these higher tax levels undermining national economies, such progressive taxation and public service provision has actually gone hand in hand with stronger economic performance.  It has provided a healthy, educated and trained workforce, and public infrastructure, both which are crucial for a thriving private sector.  Indeed, in the post-war decades of the 1950s – 70s the average tax rate for high earners in most developed countries was much higher than it has been in more recent decades since the tax cutting 1980s.  Yet the rates of economic growth were significantly higher during this earlier period.  Around the world today, developing countries (through no fault of their own) have much lower tax rates than developed countries, typically only 10 – 15% of Gross Domestic Product (GDP).  Developing countries correspondingly spend much less on public healthcare, education and social spending, and as a result have much higher levels of poverty, whilst the much higher taxed developed nations are both much more successful in reducing poverty and much more economically successful.  Indeed, fundamental to reducing poverty around the world is supporting developing countries both to develop their own strong and fair national economies, and to develop effective tax systems to provide basic services like health, education and social protection.

 

So what do we make of this as Christians?

As Christians, we know that God is passionately concerned for those living in poverty and for those who are sick.  So much of the Bible speaks about it, as Arise’s Arise Manifesto report reminds us.  God wants us to do all we can to reduce ill health and crushing extreme poverty.  Jesus instructed us to “Heal the sick” (Matt 10: 8), and James tells us, “Religion that God our Father accepts as pure and faultless is this: to look after orphans and widows in their distress” (James 1: 27).  When we look at history, we see that public services provided through progressive taxation has been one of the most effective tools ever invented for caring for the sick and reducing extreme poverty and inequality, both in the past, and right up to our present times.  Indeed, as the Arise Manifesto report observes, it was Christians driven by their faith, who played a crucial role in the early vision for, and shaping of, the modern welfare state.  For these reason’s Taxation and social spending is one of four shifts that Arise has identified in its 4 Shifts Campaign as essential for providing healthy and flourishing economies and societies, which benefit all, not just those at the top.

We don’t need to imagine what new models and a world without public services, and publicly funded healthcare systems like the NHS would look like.  We have already seen that world in the history of developed nations, and in the present reality of many developing nations.  It is a nasty world where the vast majority live in poverty, and suffer from poor health, education, housing, livelihoods, lack of clean water and no safe sanitation.  Far from giving up on the NHS, and other public services and healthcare systems around the world, what is needed is a sustained and significant investment in public services in the UK, and many other countries, to begin to make up for years of neglect.  Public services, targeted at those in greatest need in society, such as healthcare, education, pensions and unemployment, low-income and incapacity payments play a crucial role in modern societies.  Such public services need investment paid for by higher tax levels for earners at the top of the scale, and more taxes focused on capital and unearned inherited wealth rather than income, which don’t discourage healthy economic activity.  There is a clear way forward to address the current NHS winter crisis, and other healthcare crises around the world.  But are governments ready to take it?

 

Find out more

Find out more about why the world needs 4 Shifts to transition to a fair and green global economy in Arise’s 4 Shifts Report, and how this forms part of God’s bigger vision for our world in the Arise Manifesto.

Found this blog online, or sent it by a friend?  Sign up to receive weekly blogs from Arise directly.

 

[1] Pressure on the NHS is unsustainable, medics warn, BBC, (3 Jan 2023), https://www.bbc.co.uk/news/health-64142614