A health service in perpetual crisis

The Prime Minister is determined to avoid describing the current state of the NHS as a crisis however often he is invited to do so. He is following a precedent: arguably, the system has been in crisis for decades, or certainly on the brink of one, without any of his predecessors conceding this to be the case. Over the winter of 1999/2000, the Labour government presided over circumstances not dissimilar to those we are seeing today. The NHS almost ground to a complete halt because of a serious outbreak of flu.

Nearly all non-emergency operations were cancelled and the country at one point was supposedly left with just two intensive-care beds, with patients shuttled hundreds of miles in search of somewhere to stay. In the space of three weeks there were 200,000 emergency hospital admissions, a huge increase in people attending A&E and 250,000 ambulance call-outs, with many parked on forecourts and patients treated on corridors or in tents.

The crisis was so bad that it prompted Labour to end its election pledge to match the previous government’s spending plans in order to demonstrate its new-found prudence and increase funding on the NHS substantially. Now here we are, 30 years on, with more being spent on the NHS than ever before and yet it is again mired in a crisis that dare not speak its name.

Given this history, Mr Sunak understandably wants to avoid the word “crisis”. After all, it has previously been possible to put the NHS back on something like an even keel with more money and better planning – so why not again? Sooner or later, however, this approach will hit a brick wall.

Speaking to Laura Kuenssberg on the BBC yesterday, Mr Sunak was also anxious to duck questions about his own use of private healthcare. In 1987, Mrs Thatcher confirmed at an election press conference that she paid for treatment, exercising “my right as a free citizen to spend my own money in my own way”. The Left was outraged but the country was not and she won a majority of more than 100 at the polls. Voters like their politicians to be straightforward with them. Mr Sunak said the question was “not relevant” but his reticence guarantees it will be asked again and again. Moreover, rather than be defensive, he should revive the idea of tax breaks for private healthcare introduced by Mrs Thatcher but abolished by Labour.

Mr Sunak showed exasperation that the progress being made in the NHS was not being properly recognised. Inroads have been made on waiting lists which grew to record levels during the pandemic lockdowns, more money is being put into care, and there are more doctors and nurses than before the pandemic.

But while such progress is welcome, it will cut little ice with someone waiting hours in agony for an ambulance to turn up without even guaranteeing entry to a hospital ward on arrival. Specific cases and anecdotal stories have come together in a national narrative that has shaken public faith in the NHS. It was suggested recently that up to 500 deaths are being caused each week because of failures to treat sick people on time. Mr Sunak objected to this and said it was “not a figure the NHS recognised”.

In any case, excess deaths recently reached the highest level since the pandemic peak according to the Office for National Statistics, with many people dying at home or outside hospitals. It is difficult to see this as anything other than a consequence of Covid lockdowns. Flu is rife, but the weather is mild and excess deaths were high before the flu season began – surely a legacy of pandemic measures as people presented cancers and other acute conditions for diagnosis too late.

There remains a stunning dearth of beds in the health service. The Government pledged an extra 7,000 for this winter but has not yet reached that number. Part of the issue is that there are an estimated 13,000 patients in hospital deemed fit for release or no longer treatable. Many are elderly who need to be cared for.

Steve Barclay, the Health Secretary, is proposing to spend another £200million buying up beds in care homes to move thousands of patients out of hospital for four weeks until the end of March to ease the capacity shortfall. This initiative is welcome but could be hampered by staff shortages and the bureaucracy surrounding the release of patients from hospital. Numerous different agencies can be involved in devising “care plans”, without which the patients cannot be released. This needs to be streamlined urgently.

Longer term, more fundamental changes need to be addressed, including the future of primary care and the role of the private sector, both of which are being examined by Labour’s Wes Streeting.

Another way of relieving pressure on the NHS would be for the nurses, ambulance staff and doctors to end their industrial action. Talks are taking place in Whitehall today to find common ground for a settlement. Everyone has been feeling the pinch caused by higher living costs and can empathise with those working in healthcare struggling to make ends meet. But if they care about the health service and the people who need to use it, they will call off their strikes.

Longer term, more fundamental changes need to be addressed, including the future of primary care