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From claps to cuts!

My friend’s husband died last week. They had to wait for weeks to get an appointment for palliative care and had already experienced long waits for medical appointments before that. Another friend is desperate to see a GP for foot pain that is preventing her from being able to care for her children and go to work.

Last night a group of friends sat around the table discussing why this is the situation in one of the richest countries in the world. I said that the NHS needs more money to recruit and retain health workers. Around the table were a GP trainee and a nurse. They both agreed that there are not enough people filling available vacancies. One main factor especially for nurses is the government cancelling the bursary few years ago, which resulted in far fewer nurses graduating to fill vacancies. Another reason is Brexit, which resulted in both staff leaving the country and preventing others from coming to fill NHS vacancies.

In the meantime, the capacity of current NHS staff is decreasing though their own illness, caring for sick family or the dangerous burn out. A report to the House of Commons quoted a survey that revealed that “92% of trusts told NHS Providers they had concerns about staff wellbeing, stress and burnout following the pandemic.” The report concludes that “Workforce burnout was described by many as the highest in the history of the NHS and care systems and as such, it is an extraordinarily dangerous risk to the future functioning of both services.” As staff get sick or burn out, they have to take time off, which in turn increases the pressure on those at work and subjects them to more stress and more burnout and the vicious circle continues.

With decreasing capacity of NHS staff, the quality of services decreases. This is already clear in long waiting lists, overburdened GPs with fewer appointments available and therefore opportunities of illnesses being picked up and treated early. Equally it impacts access to much needed services like palliative care.

I remember the Thursdays when people stood outside their houses clapping for NHS staff. Politicians clapped too. However, calling NHS staff heroes and ignoring the pain and demand of their stressful work and the lack of resources is not only unfair but incredibly dangerous.

Globally, many organisations like the OECD, are talking about building resilient health systems. In fact the call was raised after the Ebola crisis in West Africa in 2014, focusing on Africa and other developing countries. However somehow, it was expected not to be relevant to well-established health systems in rich countries. Yet the Covid-19 pandemic revealed the faults of all health systems. In the UK, austerity measures deprived the NHS from the increased resources that it needed every year. The Kings Fund reveals that the NHS budget “rose by 1.4% each year on average (adjusting for inflation) in 10 years between 2009/10 to 2018/19, compared to the 3.7% average rises since the NHS was established.” It is hardly surprising that the NHS was not ready to face a pandemic like Covid-19; and indeed what the staff have had to do is no less than heroic.

As rich countries recover from Covid-19, they face the challenge of restoring normal health services, containing Covid-19 and preparing for a possible next pandemic. All need dedicated extra resources on a sustainable basis.

[Creator: Mark Winter | Copyright: © Mark Winter via CartoonStock]

If anything positive can come out of a pandemic, it is the awareness in Africa of the importance of producing vaccines and other medical supplies on the continent to ensure that their citizens are not at the back of the global queue as is the current situation now. While over 70% of people in UK/EU are fully vaccinated, less than 5% of Africans have been vaccinated. This means that 95% of the African population is not protected. Diversifying production is critical to change this.

While African health systems are scaling up to be ready to deliver COVID-19 vaccines, they also have to provide other services, like treatment for TB and HIV, child vaccination and material care. All these services suffer under Covid-19. The call for building resilient health systems that was made at the Ebola crisis but then faded away must be resurrected if governments are serious about avoiding the chaos and health and economic problems faced during the current pandemic.

Building resilient health systems does not mean increased financing for a year or even five years. It means a fundamental shift in political thinking; a change from spending on healthcare as a bottomless pit that can be depleted if other priorities come up, to an investment in the economy itself. Access to healthcare is a fundamental human right but it is also an essential ingredient for building sustainable economies and enhancing people’s livelihood.

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