A few months into my first job in the NHS, some 38 years ago, I watched Prime Minister Jim Callaghan being interviewed, on his return to the UK after an international mid-winter summit in the Caribbean, about the strikes in public services that have come to be known as the winter of discontent. I and pretty well everyone working in the NHS, and most of the population, knew there was a crisis. Callaghan’s dismissive comment were famously reported as “Crisis, what crisis?” They didn’t go down well, he didn’t act, and he went on to lose the impending election.
Today, can it really be that our current prime minister is the only one who doesn’t realise there is an NHS crisis?
The comment by the British Red Cross chief executive that there is a “humanitarian crisis” upped the ante, but at prime minister’s questions Theresa May said he was crying wolf. However, the fact is that, humanitarian or not, crisis means crisis, and if she carries on with her current denial – and inaction – the NHS will soon cease to be able to cope.
There have been three further NHS crises since 1979: in 1987-8, as the NHS ran out of money and failed to cope with the winter pressures it faced; in the early 90s, when the sickest patients were left waiting on trolleys in corridors for days; and in 2006, when the NHS overspent across the board because it couldn’t do the limitless amount the Blair government expected of it. Each crisis began to be sorted only when the government of the day finally accepted there was problem, and that ministers had to play a leading part in solving it. And so will this one.
My own experience taking on and turning round three different “failing” hospitals taught me that failure occurs when those responsible for poor performance can’t or won’t face up to the reality and instead present it as merely “challenging”. This government describes a service that is being financed as requested, struggling to meet surprising “record” demand but “mainly” coping reasonably, as (it thinks) NHS England confirms, and which would cope well if the resources diverted to thoughtless people who aren’t very ill were used to support the truly needy.
The reality is starkly different. Senior NHS staff know it but keep quiet because they risk being sacked if they speak out. Demand is rising steadily, in line with long-term predictions, at up to 5% a year, so there is no justification for any surprise. On the other hand, waits are rising up to 20 times as fast, which should be cause for alarm. NHS England’s most recent quarterly figures for major A&Es show an increase in attendances of under 5% and an increase of over 70% in waits of more than four hour in a year. Astonishingly, that the numbers waiting more than four hours increased by more than the number of patients, so fewer patients were seen within four hours than a year previously. If these rates of decline continue, the NHS will simply keel over.
What capacity exists is increasingly silting up as patients are unable to move from one part of their care to the next because there is no room. Because they are stuck where they don’t need to be, they prevent the next (sicker) group of patients from getting the care they need promptly, a classic downward spiral. To make matters worse, capacity is actually being reduced in social care and the NHS – the result of a financial settlement for this parliament with minimal growth and an assumed £22bn of savings. As his Commons appearance last week revealed, the NHS England chief, Simon Stevens, now realises the settlement was insufficient from the outset.
The capacity shortfall has little to do with the “thoughtless 30%” so excoriated by Jeremy Hunt for turning up unnecessarily at A&E. May’s suggestion, making already overwhelmed GPs work longer hours, completely misses the point, and suggests she does too. It would obviously help a bit if some of the 30% didn’t turn up unnecessarily, but it wouldn’t create capacity where it is currently lacking. The real problems relate to blockages in treating those who are really ill and in immediate need of treatment, and those who need further support in their own home or a care home, to make their discharge from hospital possible. These are the problems May must turn her mind to.
The best report on the NHS in the last 30 years, chaired by Sir Roy Griffiths, memorably said: “If Florence Nightingale were carrying her lamp through the corridors of the NHS today she would almost certainly be searching for the people in charge.” Yet today, three decades on, no one is in charge of the NHS. So much time is spent buck-passing and cost-shifting for problems that require concerted action.
In the meantime, ballooning wait times prejudice safety everywhere, on occasion with disastrous and fatal consequences. This is what “mainly” coping really means. And as the delays increase, so will these consequences.
