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British health care crisis escalates with new nurse strikes

The U.K.’s National Health Service is in freefall as key staff stage walkouts over pay, conditions and underinvestment. But the British government holding the purse strings has so far refused to budge.

(CN) — Nurses in the United Kingdom are set for a fresh two-day strike this week, protesting against low pay and poor conditions as an ongoing crisis in the country’s health care system deepens.

The protest by the Royal College of Nursing, a 107-year-old union engaged in its first-ever series of walkouts, is part of an ongoing dispute between the British government and staff in the U.K.’s National Health Service, or NHS. The standoff comes amid a general collapse of health care provision across Britain, with an estimated 1,000 excess deaths a week being attributed to extensive delays in emergency care and a critical lack of capacity.

Nurses have been joined by doctors, paramedics and other medical professionals in their public condemnation of working conditions and falling standards of patient care, primarily attributed to a staffing crisis. There are currently more than 130,000 vacancies in the NHS – a vacancy rate of almost 10%.

Unions argue the primary reason for poor recruitment and retention of staff is low pay. The starting salary for nurses is below the average U.K. wage of 27,756 pounds ($33,854), while many nurses are frequently forced to work shifts of 16 hours or longer to fill gaps in the service. The high-stress conditions have led to an exodus among hospital staff, as large student debts and the impact of leaving the European Union have been cited as reasons for falling recruitment rates.

The effects of the crisis have thus far been stark. Ambulance waiting times have more than doubled for most calls over the past year, and the service has reached record-long waits for both emergency and non-emergency treatment. A total of 7.2 million people are currently awaiting treatment in England – more than 13% of the nation’s population.

There is also an acute shortage of hospital beds, with patients frequently being treated on floors or left in ambulances for hours on end, further reducing emergency capacity. A record number of hospitals have declared critical incidents over winter, indicating overwhelming pressures on their services.

The health care crisis has come to dominate British politics in recent weeks, with Prime Minister Rishi Sunak under intense pressure to meet with representatives of the medical professions. Nurses are seeking a pay rise of 19%, to reverse a decline in real wages since 2010. But Sunak has refused to negotiate with unions, stating that a 5% pay rise offered last year is the only available option, and that any further pay rises will add to inflationary pressures.

However, the government is not in a strong position to take on nursing and health care unions. The ruling Conservative Party is unpopular across the country following a year of economic pain and political instability, and the party is traditionally distrusted when it comes to NHS management. Health care waiting times reached their previous record highs the mid-1990s, towards the tail-end of the last Conservative administration. Sunak has been damaged by the admission that he is a user of private health care rather than the failing public service – a question which he had initially tried to sidestep when interviewed by the BBC.

By contrast, the NHS is widely revered in British society, with nurses among the most trusted workers in the country. Visibly declining standards in the service are a major concern for the general population, with the issue having quickly overtaken economic management in salience. Recent polling by YouGov found that 85% of the public believe the government is managing the NHS poorly, whilst 60% support NHS staff taking industrial action, as worker protests are called in the U.K.

Controversial legislation being pushed through Parliament by the government seeks to introduce minimum service requirements for public services, which would undermine the ability of public health care workers to strike. However, the new law seems more likely to intensify the dispute than resolve it, and it does little to address the underlying causes of rapidly declining patient care.

Among the key reasons for widespread understaffing in the health care system is high demand. An ageing population and backlog of pandemic-era treatment have both added to pressures in the service. But the long-running issue in the U.K. has been a lack of social care provision. In the absence of an effective public or private social care system, hospitals have long been filling up with elderly, disabled and vulnerable patients whose needs would be better met in care homes or other assisted living arrangements. Unable to discharge these patients elsewhere, health care capacity has become increasingly strained.

Social care has proven to be a political headache for the British government over the last decade, with multiple administrations baulking at the cost of reforming the system, and ultimately backing away from doing so. A botched 2017 reform proposal was seen as too politically costly for Theresa May’s government, and the plans were subsequently abandoned. An attempt last year by Boris Johnson’s government to introduce a social care levy into the tax system was similarly reversed after internal opposition.

Sunak now finds himself at the end of the line of failed attempts to stave off a long foreseen crisis, and appears to have little enthusiasm for any new costly interventions in health or social care. Reports of an emerging Cabinet split suggests that Health Secretary Steve Barclay has privately lobbied for more NHS investment, only to be rebuffed by Sunak and Chancellor Jeremy Hunt. Sunak’s weak parliamentary position also gives him little room to maneuver, with his disunited party pulling in two different directions on fiscal policy.

Emphasizing that it is “the politicians who make the decisions,” Royal College of Nursing Chief Secretary Pat Cullen stated that the “route to resolving our pay dispute is through open dialogue, negotiation, honest communication and reasonable debate."

"I remain optimistic that we will soon have meaningful, resolution-focused conversations with government," Cullen said.

Unions are hoping that Sunak’s position on pay is gradually starting to shift under the weight of political pressure, with the Prime Minister last week refusing to rule out an increased pay offer for the first time – though possibly pushed back to the next financial year. But on the broader issue of health and social care investment there is little movement, meaning Britain’s healthcare system looks set to remain critically under-resourced in the medium term, and the NHS is likely to play a major role in the country’s next general election campaign.

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