A view of ambulances parked along a street, as ambulance workers strike, amid a dispute with the government over pay, near the NHS London Ambulance Service, in London, on December 21, 2022. Image Credit: REUTERS

London: Prime Minister Rishi Sunak is facing calls from senior Conservatives, including members of his own government, to get a grip of the crisis in Britain’s National Health Service and make a more generous pay offer to end strikes by nurses and ambulance drivers.

The NHS is routinely buffeted by winter pressures, but the creaking system has buckled under intense strain over the past month. A resurgence of COVID-19 and winter flu plus industrial action “- including the first major nurses’ strike in history “- have forced hospitals across the country to declare critical incidents. Seriously ill patients are facing long waits for emergency care. There has also been a steep rise in excess deaths, at home and in hospitals.

The tumult has prompted sharp criticism of the government’s handling of the crisis, with ministers, officials and members of Parliament from inside Sunak’s own Conservative Party among those who voiced concerns to Bloomberg, on condition of anonymity.

One serving minister said it was unconscionable that nurses and ambulance drivers were on strike while there were queues outside accident and emergency departments, and suggested that failure to avert the walkouts should put Health Secretary Steve Barclay’s job under threat. With doctors also threatening to strike, the burden on the health care system looks set to grow.

Another Tory MP said the party could expect to be annihilated at the next election if voters felt it had presided over a health system that left no ambulances available for heart attack patients.

The government said it will address issues including emergency care and delayed discharges at a “recovery forum” at Downing Street on Saturday.

Trade union leaders from various sectors have been invited to talks on Monday in a bid to avert further strikes by NHS, rail and other workers. They want immediate pay improvement amid a cost-of-living crisis, but the government is more willing to talk about public sector pay settlements for 2023-24.

So far, ministers have insisted that compromising on pay this year would be inflationary; instead of cutting a deal they have announced new laws aimed at cracking down on future strikes. A Sunak ally insisted the government had to reject inflation-busting demands from trade unions, and that conceding to one would just make others more hard-line. On health, the government points to Pound500 million of funding earmarked for increasing hospital discharges and preventing so-called bed-blocking “- a major factor in the current emergency care crisis.

Some senior Tories think this approach has failed. They argue Sunak should have made an exception for NHS workers, singling them out for a major pay rise straight away as a thank-you for their work in the pandemic. A policy that rewarded the NHS but held the line against the left-wing rail union leader Mick Lynch could have won the support of the public, eased the health crisis and avoided a significant increase in inflation, one Tory MP said. Former Cabinet minister Robert Buckland told Times Radio on Friday there should be a “bespoke agreement” on nurses’ pay.

Failure to realise the scale of the NHS crisis

Instead of progress and agreement, ministers and officials are learning the hard way what an acute crisis in health care means for families. One government official revealed that Barclay and his team, in post for a matter of months, have been meeting and exchanging letters with the families of people who recently died after receiving inadequate care. The experience has been crushing, the person said.

Against that backdrop, the practical concern across Whitehall is that the nurses’ dispute could spread more widely across health and social care this year. Several government officials say Sunak should appoint a senior civil servant or non-political figure as a chief negotiator to work with pay review bodies and unions to reach a deal for health workers.

Ministers are considering plans in the coming weeks to increase the number of carers, medical training places and make doctor degree apprenticeships more flexible, in an effort to demonstrate they have a long-term plan to improve the NHS. Chancellor of the Exchequer Jeremy Hunt “- a former health secretary “- has advised Sunak that addressing workforce shortages should be the top priority, though it will take years to fix.

Nevertheless, a former Cabinet minister said the government’s approach to the nurses was shambolic, adding that voters were always going to blame the Tories instead of health care workers. Transport Secretary Mark Harper’s arguments for resisting a pay rise for train drivers were proving more effective than Barclay’s approach to the nurses, a government official said.

Several Tories accused Downing Street of failing to realise the scale of the NHS crisis over the Christmas period. At one point a group of officials suggested Sunak should hold an emergency press conference to address the public on the situation, showing he saw it as his top priority and announcing immediate steps to alleviate pressure on A&E departments. This was rejected partly over fears it echoed heavy-handed Covid-era intervention, but also because officials were unable to produce convincing ideas about what could realistically be done to help in the short-term.

Instead, Sunak rushed forward a speech announcing five pledges for 2023. Only one mentioned the NHS, and that focused on cutting waiting lists, a major issue but one separate to the immediate crisis in emergency care.

There was also bewilderment among Tory MPs that “- at a time when the NHS crisis dominated the news cycle for days “- government briefings ahead of the speech focused on a new policy requiring school pupils to study math to the age of 18. One MP complained that math education was not in the top 100 problems facing the UK right now and it risked presenting Sunak as out of touch.