A young woman with a child in my surgery this week. They are dependent on food banks: she often goes hungry so that her child gets fed. At other times she eats whatever is on offer, sometimes large amounts of unhealthy food.
She has diabetes. Which is now quite out of control. She weeps when she talks about it.
People whose mental health has deteriorated as a result of the bedroom tax; as a result of the housing crisis; as a result of job losses. All in a GP’s week’s work.
Austerity at the same time as cutting social and healthcare, as well as benefits, can kill. We know this because of the effects of austerity in other countries.
Athens cut its health service by 34% and disability rules were made harsher. Suicide rates rose by 20% between 2007 and 2009. HIV and other infectious diseases rose.1,2 There was a 40% increase in infant mortality between 2008 and 2010 and a 47% rise in unmet healthcare needs.3,4
In Italy, suicides rose in those regions where social protection was weak.5
But it does not have to be this way. In Iceland, which experienced perhaps the most profound financial crisis, outcomes were very different. Iceland’s social protection spending rose by 36% including healthcare and debt relief for homeowners.6 Households receiving support rose by 75%. Cardiac health, mental health and hospital admissions did not change.7 People described themselves as happier – there was much social solidarity.8 In 2012
Austerity at the same time as cutting social and healthcare, as well as benefits, can kill.
Adult social care nationally has been cut by 26%: £3.53bn over the last four years. If the trajectory of cuts experienced to date continues over the period to 2019/20, spending must fall by 21% in cash terms or 33% in real terms. At the same time, the number of people over 65 increased by 10% between 2010 and 2014. There is a 5% decrease nationally in the number of people receiving social care services.
Although NHS funding is technically static, it is effectively falling by 5% a year nationally.* Inflation of products and services for the NHS outstrips the national inflation rate.
A consistent picture emerges from research on community care in Lewisham carried out by Healthwatch and the Save Lewisham Hospital Campaign.10
Staff are increasingly stretched, working harder and longer. Despite this, users in social and health community care still generally receive a quality service delivered by caring and attentive staff who listen and involve them in decisions about their care.
Services overall, however, seem to be reducing in most sectors. Lack of access, resulting from a reduction in community care provision, poor co-ordination of services and continuity of care, confusion about where to access services and access information were themes arising in the second stage of this inquiry.
On occasion, as in findings on hospital discharge, services can be unsafe.
It is easy to see a hospital and get angry when it is threatened. It is harder to see threats to a jigsaw of services to an often vulnerable and sometimes silent population.
Investment in public services
Investing in public services during a recession is the most effective intervention to prevent both health and economic meltdown. Social protection can decouple the link between unemployment and suicide.
Investing in health reaps economic rewards. The basic concept is that of a 'multiplier': how many pounds of future economic growth are created for each pound of government spending. The IMF in November 2012 agreed that the health fiscal multiplier is over 1.11
Oxford professor of political economy and sociology David Stuckler suggests that healthcare investment provides a much deeper stimulus to the economy than almost any other kind of government spending.12 In Wales, health spending during 2009/10 shows a multiplier of 1.78 (for every £1 spent by the health board an extra 78p of output was generated).13 Healthcare results in local jobs, less welfare is needed and money earned is spent locally, not locked up in tax havens.
Ideology and corporate greed are at play. Austerity is being used as a shield to shrink the state at scale and pace. Privatisation helps corporations maintain profits by bleeding the statutory sector, and the current government's policies - such as Andrew Lansley's Health and Social Care Act, and the 'any qualified provider' competition rules - open the door to more private sector involvement in the NHS.
My patients suffer – and so do we as clinicians. We have common ground.
References and notes
- Expert report on HIV/Aids outbreak
- Reuters: Basic hygiene at risk in debt-stricken Greek hospitals
- Stuckler and Basu, The Body Economic p109 Penguin Books 2013
- Stuckler and Basu, The Body Economic p111 Penguin Books 2013
- BMJ 2013;347:f4908
- European Commission Eurostat website
- Globalization and Health 2008
- World Happiness Report 2012
- Save Lewisham Hospital Campaign
- L'Humanité 2013
- Stuckler and Basu The Body Economic p83 Penguin Books 2013
- The Economic Impact of NHS Procurement: A Study of the Aneurin Bevan Health Board