Abstract
In 2010, the UK embarked on a self-imposed programme of contractionary measures signalling the beginning of a so-called “age of austerity” for the country. It was argued that budgetary cuts were the most appropriate means of eliminating deficits and decreasing national debt as percentage of General Domestic Product (GDP). Although the budget for the National Health Service (NHS) was not reduced, a below-the-average increase in funding, and cuts in other areas of public spending, particularly in social care and welfare spending, impacted significantly on the NHS. One of the areas where the impact of austerity was most dramatically felt was in Accidents and Emergency Departments (A&E). A number of economic and statistical reports and quantitative studies have explored and documented the effects of austerity in healthcare in the UK, but there is a paucity of research looking at the effects of austerity from the standpoint of the healthcare professionals. In this paper, we report findings from a qualitative study with healthcare professionals working in A&E departments in England. The study findings are presented thematically in three sections. The main theme that runs through all three sections is the perceptions of austerity as shaping the functioning of A&E departments, of healthcare professions and of professionals themselves. The first section discusses the rising demand for services and resources, and the changed demographic of A&E patients—altering the meaning of A&E from ‘Accidents and Emergencies’ to the Department for ‘Anything and Everything’. The second section in this study’s findings, explores how austerity policies are perceived to affect the character of healthcare in A&E. It discusses how an increased focus on the procedures, time-keeping and the operationalisation of healthcare is considered to detract from values such as empathy in interactions with patients. In the third section, the effects of austerity on the morale and motivations of healthcare professionals themselves are presented. Here, the concepts of moral distress and burnout are used in the analysis of the experiences and feelings of being devalued. From these accounts and insights, we analyse austerity as a catalyst or mechanism for a significant shift in the practice and function of the NHS–in particular, a shift in what is counted, measured and valued at departmental, professional and personal levels in A&E.
Highlights
Since 2010, many European countries have introduced austerity measures
Austerity policies have affected the socio-economic landscape of healthcare provision in the UK at the systemic, professional level and at the personal level of healthcare professionals; and nowhere was this change more noticeable than the waiting rooms of A&E departments around the country
This paper has shown that despite claims that problems in A&E should not be attributed to austerity cuts, an emphasis on what is measured, counted or valued reveals a different narrative among healthcare professionals working in A&E departments in England
Summary
Since 2010, many European countries have introduced austerity measures. These were ostensibly to address budget deficits caused by the 2008 stock market crash and subsequent nationalisation of private debt. A number of economists have argued that austerity policies hindered rather than aided recovery [4,5,6,7], and international institutions, such as the UN, have described austerity more as a political choice rather than an economic necessity [8, 9] While this debate is ongoing, economic analyses and statistics illustrate the effects reductions in public spending have had in many European societies, including the UK [10,11,12,13,14]. These retrospective and prospective economic and statistical analyses are important in projecting and demonstrating the consequences of financial cuts. They cannot capture the full picture of austerity, as they often lack insight into the everyday meaning and experience of austerity for a range of actors
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