Remember Mavis Skeet? In 2000 the 74-year-old led the news for weeks when her operation for cancer of the oesophagus was cancelled four times, until it became inoperable and she died. Liam Fox, then shadow health secretary, exclaimed: “This is not an isolated case. The NHS is not coping!”
When does a rumbling NHS crisis erupt into a volcanic political eruption? Labour’s miserable failure to “weaponise” the NHS into a winner in Copeland makes it worth looking back.
Mrs Skeet was the tipping point for Labour. The worst flu epidemic in a decade blew away Tony Blair’s pre-election “waiting lists cut” pledge. Instead Labour stuck to a draconian Tory budget, but this one case sent Blair into the TV studios promising to match average EU spending – and Labour did. The best NHS decade followed: 7% annual budget increases saw waiting times plummet, as heart and cancer results improved.
Margaret Thatcher’s eruption came in 1987 with the NHS squeezed dry. Babies died waiting for operations at the Birmingham Children’s Heart hospital. Through gritted teeth, the NHS “safe in our hands”, she bunged it £100m and punished it with the internal market.
In this latest seismological era, political vulcanologists can’t predict exactly when the top will blow. With its lowest ever funding rises, its hardest years are still to come, despite soaring numbers of the old, hospital admissions up by 31%, and 22% more A&E patients since 2010. Staff shortages follow cuts in nurse training and worsening GP and specialist recruitment. Even if extra is found for social care, the National Audit Office suggests it won’t stem the flow of patients into hospitals.
Are things bad enough yet? The British Medical Association reports that 15,000 hospital beds have been cut in the past six years. The Royal College of Surgeons protests at cancer operations being cancelled. Ambulances frequently stack up outside hospitals. Look at all that molten lava bubbling away.
Ahead of next week’s budget, Theresa May pretends the NHS has an extra £10bn – at loggerheads with Simon Stevens, the head of NHS England, who publicly disputes it. What forces a U-turn? Before it was deaths, but already two patients have died on Worcester Royal hospital trolleys, one after a 35-hour wait. Coroners have protested to the health secretary, Jeremy Hunt, after two recent deaths due to lack of intensive care beds: the case of Teresa Dennett, who died from a stroke, and Mary Muldowney, who died after a brain haemorrhage.
The war zone of A&E has featured nightly on BBC news, with a graphic documentary series on the controlled mayhem in barely coping hospitals. When is enough enough? Not quite yet, it seems. The government has been lucky, with no flu epidemic in any recent winters or any Arctic freeze-over. With beds at full capacity, it would only take a mild outbreak to tip over the NHS.
The pressure-cooker is finance: monumental debts swell by millions a month as hospitals receive absurdly frantic threats if they don’t cut back. In December they were told to free beds by cancelling operations, causing longer waiting times and lost revenue from missed operations. Look at King’s College hospital, in south London: its chair, Bob Kerslake, calls official finances “kidology”. Ordered to make a surplus this year, King’s can’t avoid a £2m loss – yet the punishment is a cut in funds, sending its deficit to £30m, and an instruction to make a £26m surplus next year: this is mirage accounting, mirrored everywhere.
So far these debts are Hunt’s and chancellor Philip Hammond’s problem: what do patients care? But if the Treasury really means to recoup the money, plus the £22bn in savings it demands of the NHS by 2020, then Vesuvius will blow. Wards and units will close, staff will be laid off, the chaos will be unprecedented. It can’t happen.
When the government is forced, kicking and screaming, to pay up, who will it blame? It will call the NHS “unsustainable” and “a bottomless pit”. (Hammond already has.) Yet more “reforms” and re-disorganisations will be hurled at it: payment for services, top-up insurance and tax rebates for private payers will resurface. The government will ignore the UK’s fall in the EU spending scale since 2010, and is now sixth out of the G7 countries, with fewer beds, doctors and nurses per capita.
Who has the political heft and credibility to defend it? Fear of Labour’s NHS moral hegemony kept Thatcher, John Major and David Cameron in check. No longer. Labour thought the NHS was its big bazooka in Copeland, where a maternity unit is under threat. But the naked desperation of Labour’s “Babies will die!” leaflets shot the very last bolt in Jeremy Corbyn’s arsenal. Each time he raises the NHS at prime minister’s questions his feeble attempt at “weaponising” sounds pathetically opportunist: May bats him away with balderdash statistics he is too incompetent to refute.
This has never happened before: polls find May more trusted than Corbyn to run the NHS by 45% to 35%. Far worse, Labour’s failure to counter the right’s message has left more people blaming the NHS crisis on migrants and patients’ bad lifestyles than Tory underfunding or rising numbers of older people. As ever the Mail and the rest carry endless NHS tourism or obese wastrel stories – but Labour has always had to fight twice as hard to get a hearing for the facts on the NHS.
Whoever follows Corbyn will now find it ferociously hard to regain that lost NHS ground. By 1997, hammering away in opposition, Labour had made the threadbare NHS the top issue and owned it. Hard-won economic credibility earned it the trust to run the NHS better. Now Ben Page of Ipsos Mori finds the NHS the second issue after Brexit, but Labour doesn’t own it, or anything else: Corbyn falls behind on everything, with every demographic, so even Labour voters prefer May.
Because the NHS crisis has so far exploded in debt rather than closures, most people’s experience is not yet bad enough to reach tipping point. Page says satisfaction is down on 2010, but not rock bottom, with always a long lag in perception. A third would pay more tax for the NHS, but the rest want savings by denying obese people and migrants.
Austerity has entered the nation’s blood stream: Page finds most people still think it necessary – despite the reckless tax cuts ahead. Banging on about “austerity” without specifics gets Labour nowhere. May’s own polling and her Copeland result tell her this – but hubris is her greatest peril. There may be no opposition, but if she and her chancellor really try to squeeze the gargantuan debt out of the NHS, all hell will break loose anyway.
Labour’s failure on the NHS is prolonging this health crisis | Polly Toynbee
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