National Health Service (NHS) doctors Moosa Qureshi, James Haddock, and Chris Day could hardly have expected the level of support they received when they launched an online fundraising campaign to help a trainee paediatrician, Hadiza Bawa-Garba, in the U.K. The campaign sought to launch a legal challenge to the decision by Britain’s General Medical Council to remove Dr. Bawa-Garba permanently from the medical register over her role in the death of a six-year-old, Jack Adcock, in February 2011. Adcock, who had Down’s Syndrome, was admitted to a hospital in Leicester with diarrhoea, breathlessness and vomiting. He died hours later from sepsis. Dr. Bawa-Garba, who was solely in charge of the emergency department that day, was convicted of manslaughter by gross negligence by a high court in late January.
Over £350,000 has been raised through the campaign, launched following the high court decision in favour of the GMC. The amount was well over the target, with hundreds of people, many medical professionals themselves, and from as far as New Zealand, pledging amounts right up to several hundred. The case of Dr. Bawa-Garba has struck a nerve within the British medical community like few others, reflecting widespread concerns over the state of the NHS, which was established in 1948, and the support mechanisms for doctors and nurses working in extremely stressful environments.
‘Underfunded, overstretched’
While many accept that errors were made on Dr. Bawa-Garba’s part, doctors have been swift to point to the challenging circumstances in which she operated. After returning from maternity leave, Dr. Bawa-Garba had taken on the roles of “three or four doctors in the absence of her supervising clinical consultant,” wrote the three doctors behind the online campaign to support her. They noted that a subsequent investigation at the hospital had pointed to systemic failings and changes had been advised at the hospital level. “Everyone agrees that the system is underfunded and overstretched. What happened to Dr. Bawa-Garba could have happened to any other junior doctor,” says Kailash Chand, honorary vice president of the British Medical Association and a long-standing NHS campaigner.
The Bawa-Garba ruling came at the end of a particularly difficult couple of months for the NHS, which has been facing repeated winter crises in recent years. In early January, the NHS cancelled non-urgent planned surgeries and outpatient appointments at hospitals till the end of the month to ease pressure on the system. Scenes of ambulances queuing outside hospitals, and patients waiting for hours on trolleys in hospital corridors, led to accusations from the Labour Party that the NHS was in the midst of its worst winter on record. One doctor attracted much attention for apologising on social media for the “third world conditions” confronted by patients at his hospital due to overcrowding. Prime Minister Theresa May was forced into the defensive, insisting that the NHS was not in crisis.
The root of the crisis is complex, though funding is undoubtedly at the heart of it. Funding has failed to keep up with the needs of a system pressurised by an expanding and ageing population, and advancing medical technology. Adding to this are the cuts that have been made to social care budgets across the country. In Britain, where the elderly and infirm are heavily dependent on state support mechanisms, the NHS has had to pick up much of the slack. There are recruitment problems too: tens of hundreds of posts remain unfilled, while hospital trusts fail to recruit the necessary staff. Options previously relied on, including recruiting staff from abroad even on a temporary basis, have become much more difficult. For three months in a row, Britain has hit its monthly cap for tier-2 visas. This is a development which many believe falls particularly hard on the NHS, where salaries fall below the higher minimum thresholds that kick in once the cap has been reached. “This government turns doctors away, in a failed effort to meet its net migration target,” warned the Labour Party’s Diane Abbott last week.
While the government has repeatedly insisted that it is spending more than ever before on the NHS, medical organisations have argued that the increases are well below the rate needed to maintain standards. The government increased NHS funding in last year’s budget, but NHS England warned that the funds did not plug the gap, and would have to trigger a debate on what was and wasn’t possible, and choices would inevitably have to be made. Dr. Chand estimates that while the NHS budget rose at a rate of roughly 4% a year between 1961 and 2010, the increase has been 2% or less since the Conservative government came to office in 2010. “There itself is a shortfall of around £20 billion,” says Dr. Chand, who believes the government is ideologically opposed to the NHS as it currently exists.
Role in politics
The pressures on the NHS have unsurprisingly led to it playing an increasingly pivotal role in British politics, such as during the run-up to the Brexit referendum when the Leave campaign pledged to channel £350 million a week in extra funding towards the NHS. Since then it has continued to come into play: whether in pro-Remain critiques of unfulfilled promises, or in the power struggle within the Conservative Party, as Foreign Secretary Boris Johnson attempted to portray himself as the one fighting the NHS corner, much to the ire of his cabinet colleagues. There is also concern over the extent to which NHS services, some of which are already contracted out, could be opened up to foreign firms (particularly from the U.S.) in any post-Brexit free trade agreements.
For all the pressures, Britons by and large remain deeply committed to the NHS. This was highlighted when they indignantly reacted to U.S. President Donald Trump’s attempts to use a march in London that focussed on urging the government to step up funding for the NHS as an argument that universal state health care was “going broke and not working”. Even the government was forced into a rare criticism of the President. A recent survey of the public, conducted by a right-of-centre think tank, on attitudes towards nationalisation and the role of the government, found a clear majority in favour of more funding for the NHS. Among its most passionate defenders is Stephen Hawking, who emphasised how he would not have survived without it, and how the NHS, for all its flaws, is the hallmark of a “humane, civilised” system.
“This is a unique system, whatever its flaws. Universal healthcare, free at the point of provision, is a fundamental human right and the U.K. is perhaps the only country in the world that has truly tried to meet that requirement,” says Dr. Chand. “It’s really under threat. And if we aren’t careful, we could lose the NHS in the next five years.”
vidya.ram@thehindu.co.in
