By Evgenia Filimianova
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Hospitals in Britain have been bracing themselves for the challenges of winter, struggling to cope with staff and funding shortages.

The UK government accepts there are "challenges ahead" but remains confident there is no need to call it a crisis, while healthcare workers speak of an "all-out economic attack" on the public health system. In the midst of debate over spending, privatization and effects of immigration, it appears there is no clear remedy for the UK's open wound that is the National Health Service (NHS).
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According to the most recent Accident & Emergency (A&E) attendances and emergency admissions data, published by NHS England on February 2, the NHS has managed in the context of the worst flu season.

85.3% of patients were seen within 4 hours in all A&E departments in January 2018, compared to 85.1% in December 2017 and 85.1% in January 2017.

This is below the 95% [national target] standard, which was last achieved in July 2015. Having said that, January was still the second-worst month on record for NHS A&E departments.

Healthcare workers remain deeply concerned at the pressure on the system – the reason thousands joined a demonstration on February 3 in the center of London, demanding "more staff, more beds and more staff."

Toby, a junior doctor who has been working in the NHS for the last three years both in London and outside told Sputnik "the people in the country are being valued down by underfunding of the NHS."

"It is quite hard to get people in Norfolk. Most people there are on temporary contracts and there is no continuity of care."
The final destination of the march was Downing Street, home to the Prime Minister Theresa May, whose cabinet has been accused of causing NHS "chaos" and "thousands more people waiting for A&E care and routine treatment every week."
Staff shortages, long queues and delays to treatment are not new to the operation of Britain's healthcare. In January 2017, the British Red Cross referred to huge waiting hours in UK hospitals as a "humanitarian crisis." In response Theresa May said: "I don't accept the description the Red Cross has made of this."

The National Secretary of The People's Assembly Sam Fairbairn however told Sputnik that for the last few years the NHS has been going through a winter crisis.

"We've seen hospitals completely overstretched, people [are] dying in corridors, people have to be treated in ambulances in hospital car parks by nurses because there is no space inside the hospital. It is obvious, from talking to every single healthcare worker that hospitals are at their limit or past it. The government is doing nothing or any kind of serious way to fix the crisis. Instead they are denying the crisis is even happening. So we are organizing a demonstration to say the NHS needs more staff, more beds and more staff."
"Staff morale is greatly impacted by pay cuts of 14 percent in the last seven years. Hence we are trying to close the gap between the pay we should be on and the pay we are on. People are leaving nursing because there are easier jobs to do for the same money. We haven't got enough beds. The demand is increasing far greater than we can deliver. It is worse at winter but it is all year around now. We are now at critical stage, we are in crisis. After nearly 16 years, I am considering leaving the NHS."
Lisa, a nurse who has been with the NHS for over 15 years and works in the south-east of the UK, told Sputnik the government need to believe in the NHS and see the urgency.
Photo: Sputnik, Evgenia Filimianova
The UK Health Secretary Jeremy Hunt has argued with those defining the current state of the NHS as 'crisis.' During a televised interview he said the reality is "in fact the opposite."

"A crisis is when you have adverse circumstances and you don't have a plan to deal with those challenges and that's not the case. We have been planning most of the year now for the challenges of winter. We had a very challenging winter last year as well. But are there highly challenges circumstances on the front line? Absolutely," Jeremy Hunt said.
"Jeremy Hunt lies and he is very good at lying and he probably believes his lies but the evidence isn't supporting what he is saying. It is the government underfunding that is causing the crisis. They have cut the number of hospital beds, so that we now have the lowest level of beds than any western country," a retired NHS worker and health policy academic Sue Kilroe, who has worked for the NHS for over 50 years, told Sputnik.

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The financial pressure on the NHS raises questions about the sustainability of its funding model. The British healthcare is funded mainly through general taxation supplemented by National Insurance contributions, while private health insurance policies are held by 10.6 per cent of the population.

To pay for the NHS, the British government decrease public spending in other areas or increase taxation, which can be unpopular, and particularly difficult during an economic downturn.

The healthcare funding questions has also caused a British-American Twitter spat, casting doubt on how 'special' the relationship really is. Following the NHS march in London, the US president Donald Trump tweeted:
British Health Secretary Jeremy Hunt delivered a sharp comeback.
Prime Minister Theresa May's spokesman also said she was "proud of having an NHS that is free at the point of delivery."

Despite the public display of affection towards the NHS by the Tory leadership, Ms. Kilroe told Sputnik, the UK government is taking us towards the US split system model.

"The US has a private, well-managed system for people with money and a safety net appalling health service for the poor. The UK government are trying to reduce the NHS to be the safety-net system and to grow the private sector to be a for-profit health service. It is a relentless effort to push people [in the UK] to use the private sector instead and it does work to a certain extent. I am privileged, middle-class, well-pensioned woman and I have lots of friends who are private consultants, senior managers and executives of universities and the NHS. They can afford to use to use the private sector for their emergency sector and they do."

A young woman who joined the London march told Sputnik she needed blood transfusions when she got ill and was able to afford the required treatments thanks to the public nature of the health service.
During the Prime Minister's Questions on January 7, Liberal Democrat leader Sir Vince Cable asked Theresa May:

"The Prime Minister knows that one of the key objectives of American trade negotiators in any future deal after Brexit is to secure access for American companies to business in the NHS. Can she give an absolute guarantee that in those negotiations the NHS will be excluded from their scope and can she confirm that in her conversations with President Trump, she has made it absolutely clear to him that the NHS is not for sale?"

May ducked the question, for which she was criticized and later - in an attempt to reassure fellow politicians and the public – Downing Street insisted the NHS will be protected under any future trade deal with the US.
US President Donald Trump gestures as he meets with British Prime Minister Theresa May in the Oval Office of the White House in Washington January 27, 2017. Photo: Reuters, Kevin Lamarque
NHS veteran Ms. Kilroe believes the funding crisis has been politically created by the government because of their desire to privatize.
"The NHS is the most efficient cost-effective healthcare system in the world and the envy of many but over the last 15-20 years there has been an absolute attack on all public services in every western country by neo-liberal economic interests. We have a government that's neo-liberal in its economic thinking and is working relentlessly and effectively to convert our public service into for-profit enterprise. People say it is complicated. It's not. It is simple. It's an all-out economic attack. They are using a classical model: defund, make it fail and that failure is blamed on the service and the public nature of the service. The attempt in the UK is to break the affection of people for its public health service."
Sue Kilroe
So how does the British system compare to healthcare models in other countries?

In 2017 the Commonwealth Fund think-tank has produced the Health Care System Performance Rankings, assessing healthcare systems in 11 countries.
Photo: Commonwealth Fund
And while the NHS was named the best, safest and most affordable healthcare system, it came next to last on healthcare outcomes, a category that measures how successful treatment has been – a significant weakness, also identified in 2014.

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Lack of funding for the NHS and social care system had led to 30,000 excess deaths in 2015, according to researchers reporting their analysis on a substantial increase in mortality in England and Wales in 2015.

"The impact of cuts resulting from the imposition of austerity on the NHS has been profound. Expenditure has failed to keep pace with demand and the situation has been exacerbated by dramatic reductions in the welfare budget of £16.7 billion and in social care spending," said Professor Martin McKee, from the London School of Hygiene & Tropical Medicine.
Photos: Sputnik, Evgenia Filimianova
Mr. Fairbairn believes that a few steps would massively help the NHS:

"The NHS needs an immediate emergency cash injection to solve the funding crisis. We also want to end privatization in the NHS. The government is selling big chunks of our NHS to private companies," he told Sputnik.

But despite cash injections, the NHS continues to face unsustainable, endemic financial problems. The January 2018 report the National Audit Office (NAO) revealed that the NHS received a one-off cash injection totaling £1.8 billion (US $2.202 billion) in a bid to stabilize its finances during 2016-2017.

However, it has mostly been used to "cope with current pressures and has not provided the stable platform intended from which to transform services."

"Repeated short-term funding boosts could turn into the new normal, when the public purse may be better served by a long-term funding settlement that provides a stable platform for sustained improvements," said Amyas Morse, head of the NAO.
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Lack of sufficient funding has crippled the NHS in terms of staff availability. While the NHS in England had 40,000 more clinical staff in 2017 than in 2012, it was short of 42,000 nurses, midwives and therapists, according to Health Education England, who ensure the NHS gets its staff.

HEE also warned the health service workforce, standing at 1.4 million, will need to increase by 190,000 by 2027 unless the rise in illness recedes.
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In a televised interview, the former UKIP leader Nigel Farage has voiced his concern and outlined what he believes are the root causes of the NHS crisis.

"The big problem we've got is a population crisis, caused by government policy on immigration. We were the population of 65 million are now increasing by half a million people every single year. Over ¾ of that directly attributable to immigration over the last few years. The problem is – we just haven't got enough hospitals, doctors an facilities. Another big problem we've got is that the National Health Service has moved to become the International Health Service. We are providing a lot of care for people coming into Britain all over the world. We do need some fundamental reforms. This system that we had was set up in 1948 and actually – surprisingly – for a state-run thing for the first 50 years the public had great faith in it. Right now it is pretty much at breaking point."

One should not forget however, that Mr. Farage's record of NHS-related remarks hasn't been squeaky clean.

Following the Brexit vote in June 2016, Farage said he could not guarantee that the US$463 million that had previously been given to the EU each week would now be used for the NHS – despite the ads by the Leave campaign, stating the opposite.
Immigration from both the European Union and the rest of the world has been cited as one of the concerns when it comes to NHS exploitations.

Earlier this week, the government announced plans to double the immigration health surcharge paid by temporary migrants to the UK. The amount will rise from £200 to £400 per year.

The Department of Health and Social Care (DHSC) estimates that the NHS spends £470 on average per person per year on treating surcharge payers. Projections suggest that the increased charges may provide around £220m extra every year, with this money going to NHS services.

"It is only right that people who come to the UK should contribute to the running of the NHS. The surcharge offers access to health care services that are far more comprehensive and at a much lower cost than many other countries. The income generated goes directly to NHS services, helping to protect and sustain our world-class healthcare system for everyone who uses it," Immigration Minister Caroline Nokes said.

Not everyone agrees that immigration is a reason to be concerned for the NHS.

"Immigrants are the backbone of our NHS. The truth is that immigration contributes more to our economy than takes away from it. The issue with health tourism isn't actually the main issue with the funding crisis. It is just rubbish when people talk like this," a campaigner told Sputnik.

Another activist stressed that the issue of health tourism is overinflated

"It's a very insignificant proportion of the NHS budget and whoever is resident in this country – they are still paying into NHS by paying the VAT.
The NHS is turning 70 on July 5, 2018 and if you ask any Briton, what national institution makes them proud — the National Health Service will probably be one of them. The tribute to free healthcare was paid during the opening ceremony of the London 2012 Olympics - it may have baffled and puzzled some viewers at home and abroad but that's how important the NHS is to Brits.

It is indeed a loved and celebrated institution in Britain, but chances the NHS can be resuscitated quickly and effectively are arguably low.

The views and opinions expressed in the article are those of the speakers and do not necessarily reflect those of Sputnik.
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