ANOTHER VOICE
The reason why more nurses and mean poorer health care doctors
AUBERON WAUGH
An angry letter appeared in the Inde- pendent last Friday signed by chairmen and past chairmen of an organisation called `Junior Doctors' in seven of the 14 regional health authorities of England. Not surpri- singly, it complained of shortage of funds and the closure of hospital wards to achieve savings, adding for good measure that 'catering and domestic staff levels have been drastically reduced, resulting in poor quality food and filthy hospitals. Low salaries make it impossible to recruit vital staff such as nurses, paramedical profes- sionals, medical secretaries and switch- board operators. The existing staff are therefore stretched to breaking point attempting to maintain standards of patient care . . ..
And so it goes on. Last week, we heard much the same sort of noises from the Police Federation, demanding more of everything but especially more men and more money. Like the health service, the police have, on paper, been deluged with both ever since the Conservatives came to power.
A letter from three senior consultants on Tuesday denied the junior doctors' argu- ments point by point and suggested their initiative was politically inspired, but what distinguishes the moan of these doctors from the Caliban-like snarls of the Police Federation is that the doctors evidently believe the Government is lying when it says it has increased expenditure on health by £4.5 billion — 31 per cent over the rate of inflation — in eight years. In repeating the familiar suggestion that an annual two per cent increase in real terms is necessary to maintain existing standards in the face of the geriatric explosion, the doctors claim that the Government achieved this rate only once, and that in two out of the last three years the Government increase in health expenditure has not even matched inflation.
Plainly there is a conflict of testimony here, which responsible newspapers should investigate, rather than simply print the rival claims. What nobody can doubt is that wards and food are filthy, nursing staff are stretched, wards are closing and the over- all number of hospital beds is decreasing. Nor can anyone doubt that hospital doctors genuinely and sincerely believe that all these things have happened as a result of deliberate Government policy to reduce spending on the health service. Against this is the Government's claim that it has increased spending by a horrifying 31 per cent in real terms, hired an additional 63,000 nurses and midwives, added 12,000 to the number of doctors and dentists. What is the truth?
I do not know what source of informa- tion the Young Doctors can have apart from the DHSS Health and Personal Social Services Statistics for England, published annually by HMSO. Figures from this source are available only up to 1984, but if we study the figures between 1974 and 1984 we see that the Health Service em- ploys more and more people every year to service ever fewer hospital beds. In 1974 there were 276,000 nurses and midwives (from now on I shall simply call them nurses) servicing 396,000 hospital beds in England, giving a ratio of 0.7 of a nurse to each bed; in 1984 the number of nurses had increased to 347,000, the number of beds had shrunk to 335,000, giving a ratio of 1.04 nurses to each bed (reducing to 0.97 of a nurse if you allow for shorter hours worked by nurses).
In those ten years the overall figure for NHS employees rose from 674,000 to 817,000 (an increase of 21 per cent), the cost rose from £4bn to £17bn, and the number of beds fell by 60,000 (a reduction of 15 per cent), or by an average of 6,000 beds a year. If we are to divide the ten years under study into the five years of Labour rule (1974-9) and five years of Conservative rule (1979-84) we find that under Labour the numbers of nurses in- creased by 39,000 and beds decreased by 34,000. Under the Conservatives the num- ber of nurses increased by 32,000 and beds reduced by 27,000.
It may well be that the Conservatives' only achievement in the field of health has been to slow down the proliferation of nurses and disappearance of beds, but a study of this more-nurses-means-fewer- beds phenomenon in the longer term re- veals that the process seems inexorable. Some time ago I referred to the 1976 Gammon Report on Public Provision for Medical Care in Great Britain which first advanced the theory of bureaucratic dis- placement, whereby in any Government enterprise non-productive bureaucratic activity progressively displaces productive activity.
Dr Gammon has now brought his 1976 Report up to date (NHS Hospitals Man- power and Beds available 1948-1984, avail- able from 92 Southwark Park Road, SE16). Between 1948 and 1974, NHS staff increased from 350,000 to 800,000 in the whole of Britain (the 1974-84 figures are for England alone) and the number of hospital beds shrank from 544,000 to 491,000. This gives an annual increase of 17,300 employees and an annual loss of 2,000 beds. In the ten years between 1974 and 1984 the number of employees con- tinued to increase by 14,300 a year and the number of beds reduced by 6,100 a year in England alone.
The explanation for everything — the empty wards, closed hospitals, overworked staff and hideously increased 'throughput' of patients is the same. Not only has the number of administrative and clerical staff increased by 34 per cent in the past ten years (from 79,000 to 106,000) but a large and growing proportion of the nurses (who have increased by 71,000, or 26 per cent) are no longer employed nursing, but on administrative duties. The fault is entirely with the organisation of the health service, and not with either Labour or Conserva- tive governments except to the extent that making more funds available accelerates the process of bureaucratic displacement.
Since the process is inexorable, for social and political reasons, the only way to keep any sort of free health service going is to encourage as many people as possible to opt for private health. If Dr Gammon is right, then the Conservative policy of pouring more and more money into the Health Service would seem to be foolish. The Alliance promise to give it even more money is even more foolish. The Labour proposal, of giving it still more money and penalising the private sector, forcing people back on the NHS, is quite frankly insane.
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