Death by a Thousand Cuts

The National Health Service is in crisis. Right wing think tanks and Tories, at home and at Westminster, suggest prescription charges and paying to see the doctor as ‘solutions’. But worse, the very existence of the NHS is under threat.

Emergency Surgery

While the ‘temporary’ withdrawals of emergency surgery at the South West Acute Hospital in Enniskillen and at Daisy Hill Hospital in Newry earlier this year make the headlines and quite rightly attract public attention, even more profound issues are emerging.

The Western Trust, as well as the Department of Health, has a responsibility to set out very clearly its long-term plans for emergency surgery in the south-west and the implications for patients, services and staff. 

We need to see the overall plan for the future of health and care services and discuss it openly and in the round. Drip feeding information and making announcements by instalments is undermining public and staff confidence.

Local healthcare should always be safe, of the highest quality and be professionally delivered – but it must also be accessible. Patient journeys of over an hour to receive emergency treatment falls well outside of that – even on a ‘temporary’ basis.

General Practitioners

As long as GPs remain as private independent contractors there will continue to be the difficulties in recruitment and threats to services that we have been hearing about recently.

GPs becoming NHS employees, instead of private contractors, would improve the service, reduce waiting times and address many of the problems currently faced in primary care – including the closure of GP practices

It would be inconceivable that other health and care professionals like nurses, social workers and hospital doctors would sit outside the NHS rather than be its employees/. Why should GPs be any different?

Community Care

For the thousands of people who receive treatment, care and support in their own home comes the additional health benefits of familiar surroundings, family, dignity, reassurance and a level of control. Yet despite the fundamental nature of community care the service and its centrality to health, well-being, rehabilitation, recuperation and added years, it has always been, and remains, a Cinderella service.

The majority of community-based care is now provided by a plethora of private companies. It is delivered by some of the lowest paid workers in the health and care system and prioritises profit over people.

The community care system is criminally underfunded. Successive Health Ministers and the Department of Health have never accepted it as a valid and vital part of the health and care system and continue to see buildings and technology as the core of the health service

Why is it that twenty five years ago local community care services were receiving international acclaim for their innovation, flexibility, high standard of care and the contribution they were making to patient care, yet today medically fit patients are forced to remain in hospital because no care package is available to them?  .

Decades of Austerity

For decades, services have been cut, wards and departments have been closed, staff have been under-valued and underpaid and waiting lists spiral out of control while private clinics flourish and those with the money to pay go to the top of the queue.

The Scottish Health Department last week drafted a discussion paper which explored the introduction of what it unashamedly referred to as a two-tier NHS.

Of course, the reality is that the ground work for that very scenario has been laid over many years. The privatisation of the lucrative parts of the service is an ongoing process, plans to allow US and other companies to buy NHS services are always on the table and the erosion and underfunding of existing services conditions public opinion to accept anything that looks like a better alternative. grave Health Service free at the point of use, as long as people are willing to fight for it”.

“…there will always be a cradle to the grave Health Service free at the point of use, as long as people are willing to fight for it”


We are not looking at isolated cases of the ‘temporary’ transfer of services. We are witnessing the potential death of the NHS by a thousand cuts. Since its inception in the 1940s there has been an active and relentless campaign by some to undermine the principle of publicly funded health and social care, free at the point of delivery, and replace it with private health insurance, private healthcare and priv

The Assembly

The Assembly should be in session, there should be a Health Minister and there should be plans, proposals and public discussions. But the current crisis has not been caused by the absence of an Executive. It has been building for years and it has been happening on the watch of successive administrations and successive ministers.  It is one of the outcomes of the policies of deregulation, privatisation and the breakup of public services.

World Best

The NHS is indeed in a crisis. It is being undermined, underfunded and cherrypicked for privatisation.

We owe it to the generations of front-line workers and support staff who have developed and delivered one of the best healthcare services in the world to defend it against those who would sell it off to the highest bidder.

For now, a concerted effort will keep the NHS afloat, but only in a socialist society can it be guaranteed to achieve its full potential.

Re-thinking older care

The recent reforms to social care in England should pose serious questions closer to home. Changes and reforms to health and social care all too often get hung up on bricks and mortar at the expense of focussing on the quality of care.

In particular, the dominant perception of care services for older people has become synonymous with institutional care provided by private companies.

That raises a number of fundamental questions, not least of which is whether institutional care is the best option for the care of a growing elderly population

Clearly it is not. If all we can offer an ageing population is to put them in a home then we need to re-evaluate our approach.

Given the opportunity, the majority of people would prefer to be supported in their own home, if that is possible. Once we accept that principle, we need to ensure that not only is that service provided but that it is provided to the highest possible standard in the most innovative, flexible and inclusive manner possible.

To achieve that, NHS staff should do what they do best – provide care. While the fundamental responsibility for resourcing and providing social care rests with the state, there are many additional aspects to supporting people to live in their own homes and communities than can and should be provided by a combination of voluntary and community groups, social enterprises and families.

Issues of social isolation, mobility, access, contact, involvement and the pursuit of interests are all part of the care requirement and need to be planned, structured, funded and delivered as an integral part of the care of older people at home and in the community.

Communities, and all that they comprise, have a social responsibility to older people. A number of European and north American cities have developed Older Aware environments in which entire communities – social, cultural, educational and recreational organisations, voluntary, community and religious groups, businesses and statutory bodies undergo training and awareness and work together to help provide a community which understands, empathises and actively supports older people as active and involved citizens.

Supporting older people to live in their own homes and communities should be a social care priority. It must be resourced and supported with research and best practice and is provided by a workforce which is trained, well-paid, has a clear career path and is encouraged to excel.

Older care in the community must never become a cliché or a soft option. It is neither. Trusts and trust staff must seek to provide not just good care but the best care. We can and should become an exemplar for the design, and delivery of the care of older people – primarily in their own home for as long as that is possible.

Hospitals and the medical model still dominate our health and social care thinking. That cycle, and the vested interests which it serves, needs to be broken.

A wide range of factors impact upon dependency levels as people grow older. Housing, employment, education, lifestyle and diet throughout our lifetime will all have an impact on our level of dependency as we grow older. Investment in our environment, our opportunities and in our awareness and understanding of health and well-being can have a massive impact on the type of older people we will become and the level of dependency we display. Health prevention resources and culture are still not in sync with that reality.

We are still too happy to wait until people become ill and then seek to cure them. Similarly we wait until people become old and dependent before we start to address and plan for their care. We need to rethink almost everything we know about care for older people.

We need to challenge our own assumptions and contest those of health and social care planners and policy makers. We need to recognise and support the fact that people want to remain as long as possible in their own home and their own community.

We must design and deliver services best placed to achieve that. We need to align all the resources of our society and channel them to that end. That approach is not only desirable – it is achievable.