From every previous NHS crisis, the tipping point should have come last week. Prime ministers crumple when people die – as they have in the Royal Worcester’s corridors. When opinion polls send concern about the NHS soaring above everything else at 61%, above immigration at 41% and Brexit at 36%, sirens should wail inside No 10. But no, not yet.
When the Royal College of Surgeons protests at cancer operations cancelled, is that a tipping point? When nearly half of all hospitals declare major alerts for lack of beds, that’s an emergency. There’s no winter flu, no Arctic weather, just pressure from underfunding, like an aneurysm about to burst. But the prime minister is not for turning, not yet.
King’s College hospital is typical – as its clinical director of emergency medicine, Malcolm Tunnicliff, explains. He stands in the middle of a 10-cubicle emergency section where this week he had 17 trollies crammed in, jammed around the nursing station with barely enough room to squeeze past.
Other hospitals call a “divert” – to send away ambulances from their doors. “We never do that, on principle, because every hospital’s in the same boat. We are here for everyone, all the time,” says Tunnicliff. Like so many NHS staff you meet, his natural blend of enthusiasm and determination to cope leaves him perplexed by what’s happening. “The last four weeks are the worst I’ve experienced. We all worry all the time.”
Recently he’s had 6% more patients – with 10% more needing resuscitation – and he can’t fill all his vacancies, leaving him scouring the world for staff because of the government’s failure to train enough people: 19% fewer nurses are in training. “Day after day my staff here go the extra mile, like Duracell bunnies,” he says. But he fears many may leave as a result of the pressure.
The last straw may be the flame-thrower of blame from Westminster, attacking staff and patients and GP opening hours. No, Tunnicliff says, only 4% come here with things GPs should see. The blockage is a lack of beds for skyrocketing numbers of sicker and older patients. Nationally, 13,822 beds have been cut since 2010, losing 5m bed days. The 40% cuts in social care multiply the blocked bed crisis. NHS funding has never had a six-year squeeze like this, falling far behind similar countries in beds, staff and cash per head. Yesterday the axing of 538 staff from the Department of Health looked like panic, while public health is cut by cash-starved councils – storing up worse problems for the future.
Hospitals usually afraid to blow whistles now talk to anyone who’ll listen. I’ve never known normally cautious managers and senior staff show such unguarded urgency to reveal all. But one exception is the Royal Berkshire, where Theresa May’s Maidenhead constituents go in an emergency. They maintain omerta, allow no visit, put up no spokesperson, apparently paralysed with fright: the care quality commission brands it “needs improvement”, not “safe” or “responsive” nor “well-led”. Does May ever visit?
She should listen to Kings College hospital’s chair, Bob Kerslake – another NHS leader who has become extraordinarily outspoken. Here is a man of exceptional experience and wisdom, a former chief executive of Sheffield city council, elevated to permanent secretary of the communities and local government department and on up to head of the home civil service. He’s a maths graduate and chartered account, an exceptionally numerate civil servant. The government’s numbers are “kidology”, he says. As the Kings Fund showed, the NHS got £4.5bn, not £10bn, extra to 2020: and this was its frontloaded year, with far less to come after April, and zero – yes, zero increase – for 2018, the NHS’s 70th anniversary year.
Here’s more kidology, Kerslake says. “Some 98% of trusts signed up to control totals that most know are impossible.” His own trust was told to make a surplus but has a £2m deficit, so they will be punished by losing their sustainability and transformation money, which will leave them with a £30m deficit instead. I asked him to repeat it twice, it was so incredible. Yet next year they are told to make a surplus, yes, a surplus of £26m – fantasy accounting that no one believes is remotely achievable. “And we have used every wheeze, holding off paying bills … using our capital budget so we have nothing for essentials, like replacing worn-out dialysis machines.”
But when he talks to the Treasury, “They give me the line. I don’t know if they believe it.” The line says what May says: “It’s only a winter blip, we gave the NHS more than they asked for, and GP opening hours are to blame.” Chancellor Philip Hammond is immovable: he says that to give more to the NHS’s “bottomless pit” would create a moral hazard. Kerslake says NHS England’s Simon Stevens forthrightness at the Commons public accounts committee last week has “opened the floodgates, letting others speaking out”.
Is May listening? Talk to the hand. No 10 hopes compassion fatigue will stop the flow of drearily identical stories from A&Es as the news moves on. Brexit has the merit of driving the NHS off front pages. Politically, why worry when there’s no opposition? Polls show that even the NHS is regarded as safer in the hands of May than Jeremy Corbyn. She has plenty of her own ignorant and partisan commentariat opining that “money isn’t the problem, it needs reform” – calling for top-ups and private insurance.
But May can’t defy the NHS laws of gravity that force every prime minister to U-turn on underfunding. Margaret Thatcher, John Major and Tony Blair all buckled. This crisis looks set to outdo all those, says Chris Ham, NHS historian and head of the King’s Fund. History shows – and this was proved in the Blair years – that when the NHS reaches roughly EU funding levels, its results soar. When funding falls too far, trolleys pile up in corridors.
What’s the tipping point? Disasters forced on to the Mail’s front page, the only media she cares about (yesterday it ran instead with a Nigerian health tourist mother giving birth to twins at taxpayers’ expense). What else would it take? Nightly news from the A&E war zone, more care homes going bust – and deaths. Until her final hubristic year, Thatcher knew when to swerve – but May’s obstinacy might do for her.
One thing would force her hand – a joint resignation by Simon Stevens and Jim Mackey of NHS Improvement, announcing they can no longer be held legally responsible for the safety of patients. They just might, as a final act of service to rescue the NHS.
• Comments will be opened later this morning
NHS crisis: the one act of self-sacrifice that could rescue our health service | Polly Toynbee
Hiç yorum yok:
Yorum Gönder