The Guardian view on NHS waiting lists: blame cuts as well as Covid
The worst thing about the NHS’s enormous waiting lists is that they mean millions of people are not getting the care they need in a timely way. Prioritisation systems ensure that most waits for surgery are not dangerous. But many are painful, frustrating and anxious. They are also wasteful, as when people’s bodies aren’t working well – because their hip needs replacing, or because they can’t see due to cataracts, for example – they can’t do the things that they want and need to. Sometimes, delays in treatment mean that conditions become worse.
New evidence about inequality, with the queues for treatment disproportionately longer in poor areas, shows that these disadvantages are not evenly shared across the population. Currently, there are 260,000 people waiting for heart treatment and 62,000 waiting for orthopaedic surgery in England. Analysis from the King’s Fund shows that those in deprived areas of England were nearly twice as likely as those in the wealthiest to wait more than a year. This is further proof that what is going on in Boris Johnson’s Britain is not that poorer people and places are being brought up to the level of richer ones. Instead, the gap between the haves and have-nots is growing, with the inequality-widening effects of the pandemic being felt not only in rates of Covid itself, but also in education, housing, work and other aspects of health.
At his party’s conference, the health secretary, Sajid Javid, acknowledged the difficulties and said that he was determined to tackle both geographical and racial inequalities. Previously, he has said that the number of people waiting for hospital treatment could ultimately top 13 million. But huge uncertainties remain about the level of demand that will emerge as the pandemic recedes. Sir David Nicholson, a former boss of NHS England, warned in the spring that the extent of the backlog was “truly frightening”. His fear, shared by the shadow health secretary Jonathan Ashworth, is that if sufficiently large numbers of people are forced to pay for treatment, confidence in the service overall is eroded. If ministers were to respond by offering tax breaks or vouchers for private healthcare, this could be the “slippery slope to an insurance system”.
This week, Mr Javid dismissed such suggestions and said that the NHS would “manage”. It is important to note than more than two-thirds of those referred are still seen within the 18-week target time. But private providers are seizing the opportunity to expand their market. And a growing number of desperate people are choosing to pay for treatment rather than wait, even when this entails getting into debt. Some delays are not reflected in the national waiting-list figures at all – for example, backlogs or gaps in community services including GP, district nursing and nonacute mental health appointments.
Health economists say that the recent NHS funding increase of £10bn wasn’t enough. Another £7bn would be needed to push waiting lists back to 18 weeks. Ministers blame the pandemic for the problems, and so far appear to be escaping too much public anger, perhaps in part because of the esteem in which the NHS is widely held.
But the reality is that years of underfunding, bungled reorganisations and grossly inadequate workforce planning have stripped the health service back to the bone. And that is why, whatever Mr Javid may wish or pretend, the pandemic should still be viewed as a serious threat to its future.