Workers are balloting for industrial action, attending mass demonstrations and preparing to strike. A ferocious tug-o’-war between trade unions and employers is playing out across the country. Though striking RMT members have been accused of ‘ruining Christmas’, the country’s greatest fears should be reserved for the NHS, which will see ambulance workers and nurses walk out before January, when junior doctors in England cast their vote on industrial action. Is there a solution? A leaked briefing from the Department of Health and Social Care suggests that the government believes volunteers could act as a buffer while healthcare staff take action this winter.
The 31-page report reveals that NHS performance is ‘highly likely to deteriorate further’ thanks to the increased demand on the service in the colder months, in combination with staff shortages due to striking workers. The main threats to the health service are described as ‘industrial action, social care provider failure, extreme weather incidents and civil unrest’. Volunteers may help to ‘build resilience’ in the NHS, the briefing suggests. They would, for example, help paramedics, work in hospitals and provide community support.
This isn’t unprecedented: during Covid, volunteers were recruited in swathes to help with the vaccine roll-out. A number of volunteers still work within the NHS, delivering medication, driving ambulances and helping out with ward work. There is a dedicated NHS Volunteer Responders scheme, which is being ‘reshaped to help the NHS support people’s needs, locally and nationally’. This time, it will look to lift the number of volunteers and place this new intake in ‘additional roles’. If they are treated like the current NHS volunteers, these new staff won’t have contracts, and instead their work will be based on ‘mutually agreed expectations’.
NHS England has said that it is ‘exploring options’ to expand its volunteer base. Forty-two integrated care services in England are being engaged in discussions about the creation of these new roles, to ensure these positions are ‘designed and mobilised to meet local priorities’. What we know currently is vague; there will be more details in the government’s internal winter preparedness documents. But even when looking at this plan in the most optimistic light, it’s hard to ignore the problems the NHS currently faces. Will this be enough to get the health service through winter?
Staff numbers are dwindling just when the NHS needs its workers the most
Volunteers aren’t the answer, says Miriam Deakin, director of policy at NHS Providers. Instead, the 133,000 vacancies across the NHS need to be ‘addressed urgently by the government in the form of a fully funded, long-term workforce plan’. The president of the Royal College of Emergency Medicine, Dr Adrian Boyle, appears to agree: ‘What we need is a skilled and trained workforce to try to deal with the problems we’ve got at the moment. It’s not just boots on the ground – it is also about the capability and training of staff.’ Citing the high hospital workloads and difficulties being seen in A&E departments – as I discussed here – Dr Boyle points to the ‘massive supply and demand mismatch’ the health service is straining under: ‘Hospitals are absolutely full at the moment.’
Training up non-clinical staff to work in healthcare environments won’t necessarily be easy. While the vaccine roll-out meant that volunteers were trained to be ‘stewards’ at vaccination centres, it seems like the government is planning to give these new volunteers more responsibilities. If that’s the case, more training means more money (and time) will be spent on preparing non-medical workers for new roles, when their usefulness will be limited if they don’t have a healthcare qualification. And if these volunteers aren’t trained up, the holes left by striking nurses and paramedics will gape as wide as ever.
The best solution is for the NHS to recruit more skilled staff – and ensure that its existing workforce don’t take industrial action. But this is no simple fix: the health service is not a particularly appealing place to work these days and disputes over salary pepper almost every complaint. Junior doctors have highlighted a poor workplace culture which serves to further demoralise them. At the same time, some nurses have claimed their pay is so dismal they’ve had to resort to food banks. Calls for medical school places to increase by 5,000 have been backed by Labour – and by Chancellor Jeremy Hunt, as a leaked email revealed – but as of yet, there has been little movement on this issue.
The Royal College of Nursing has voted for the first time ever in favour of strike action. Junior doctors in NHS England will decide whether to strike at the start of January, while NHS Wales and NHS Scotland plan to ballot for industrial action later next year. One new doctor from Scotland told me that if they have the option to strike, ‘I’d vote for it, no question.’ Would they be happy with their current salary, if they had less unsociable hours on the rota? They would, ‘but that’s even less realistic’. With patient waiting lists reaching record highs of over seven million in October, and 37,837 patients waiting more than 12 hours in A&E before admission last month, it certainly doesn’t seem like there is any capacity to improve staff rotas. And as more junior doctors apply for jobs outside of the UK as a consequence, staff numbers are dwindling just when the NHS needs its workers the most.
But there’s an additional, seasonal issue the health service must deal with, along with an increasingly dissatisfied workforce, backlogs from the pandemic, and hospital bed-blocking. The cold winter months coupled with cost of living concerns mean that levels of certain illnesses – like heart attacks and strokes – could increase. Already, doctors have seen elderly patients, scared by rising costs so much they aren’t heating their homes, turn up in hospital with hypothermia. The leaked government report cited data suggesting that with every degree drop in temperature, for those living in the coldest 10 per cent of homes death rates will rise by 2.8 per cent.
Our health service could be looking at the biggest staff walkout in its history. This is the time the NHS needs its medically-trained workers the most. While volunteers may help to ease administrative and management pressures, they simply cannot take the place of paramedics, nurses and doctors. The government should be working with the health service to retain its valuable staff base – not, at the eleventh hour, trying to create a new one.
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