The Guardian view on the NHS: the worst winter?
The pressure on the NHS, and the UK’s wider health and care system (including services delivered by councils), has been so intense for so long that the public has got used to it. Even before the pandemic, staff and hospital bed shortages were leading to serious problems. Underfunding throughout the 2010s meant that the service was increasingly ill-equipped to cope with the rising prevalence of chronic illnesses and demographic pressures. In November 2019, several months before Covid-19 hit, NHS England was described by senior leaders as being “on its knees”, “in a downward spiral”. Calls by ministers to “protect the NHS” during the pandemic were an explicit instruction to the public to limit demand, in the hope that a meltdown could be prevented.
It worked, in the sense that people did stop seeking treatment for nonurgent conditions. Up to a point, this made sense: in a pandemic, some resources should be reallocated on a temporary basis. But the release of pentup demand over the course of this year has created a vast backlog. The waiting list of 5.8 million people in England is the longest since records began in 2007, and the other nations of the UK face their own problems. In Scotland, 600,000 people are waiting for treatment, with a similar number in Wales and about 350,000 in Northern Ireland, where more than half of patients wait more than a year for a first consultant appointment.
Some health bosses are now warning that the service lacks the capacity to shrink this enormous queue for treatment. Last week, Matthew Taylor, chief executive of the NHS Confederation, which represents organisations that provide and commission services, said that “many hospitals are only able to cope now with people coming through emergency departments”. But evidence shows that all over the country, hospitals are failing to cope even with these: in recent weeks, several deaths have been linked to long ambulance waiting times, or waiting times to be admitted to an A&E unit from an ambulance. The Association of Ambulance Chief Executives estimates that about 12,000 patients each year could be experiencing “severe harm” as a consequence of delayed handovers.
The government’s approach to mounting evidence of life-threatening resource shortages is a predictable combination of denial and deflection. While the health secretary, Sajid Javid, said in a recent appearance before the health select committee that the coming winter would be “extra tough”, and that a manifesto promise of 6,000 new GPs would be broken, he has also denied that current pressures are “unsustainable”. And he has wrongly, and rashly, pointed the finger of blame at GPs, appearing to join in a newspaper campaign aimed at shifting responsibility for A&E pressures, and shaming them into offering more face-toface appointments (from 80% before the pandemic, the proportion of patients seen in person has fallen to 60%).
Dr Richard Vautrey, the outgoing chair of the British Medical Association’s GPs committee, believes that statements by NHS England have also fuelled “anti-GP rhetoric”. The service’s new chief executive, Amanda Pritchard, chose not to address this in her first big speech, focusing instead on the vaccine programme and appearing to suggest that staffing concerns would be met by a workforce plan next spring. Given the severity of the situation, with desperate bosses urging the payment of bonuses to care workers to dissuade them from quitting, what Ms Pritchard described as her “optimism” ought to be tempered. Too much negativity can be unhelpful, undermining morale and confidence. But when the NHS is struggling in such serious ways, as the ambulance crisis indicates, the last thing it needs is for the health secretary to turn on staff groups, or for the head of NHS England to imitate the prime minister’s boosterism.