There is an ebb and flow in reporting on the NHS as Trump, Syria and Brexit dominate front pages. But the pressure-cooker state of the entire service still worsens. This morning’s latest figures are just a snapshot of deterioration – but every target is missed, for A&E, ambulance response times, for treating psychosis within a week, for cancer waiting times, blocked beds and diagnostic tests.
“Demand” is rising, the government says, as if serious illness were a choice, though the pressure comes from well-predicted rapidly increasing numbers of old, sick people: this February’s A&E figures are, as ever, better than deepest winter January, but worse than February last year, as this crisis ratchets up. Major A&E centres are treating 81.2% of patients within four hours, against a target of 95% that used to be hit before 2010. The government likes to blame frivolous users of A&E, but those are easily triaged to on-site GPs. Serious delays are due to very ill people needing to be admitted with no empty beds: bed occupancy is at dangerous levels, as Chris Hopson of NHS providers warns, where doctors often have to decide “one in one out”, discharging those who still need more care too early.
Take the temperature in virtually every part of the NHS and the wonder is how the heroically overstretched staff keep the wheels on the trolley. Take this week alone: the Royal College of Physicians says 84% of doctors have to cope with staff shortages and gaps in rotas. GPs? Two years after a government promise of 5,000 more GPs, numbers are still falling. They dropped by 400 just in the last three months of last year: as doctors find the workload unmanageable some escape abroad, take earlier retirement or become locums. Too few new doctors want the burden of running a GP partnership, so 92 practices closed last year, tipping hundreds of thousands more patients on to already overloaded neighbouring GP lists.
Today the Royal College of Nursing starts consulting its members on whether to hold a strike ballot, the traditionally most reluctant of unions to take action. But with public sector pay frozen yet again at 1%, when inflation will shortly hit 3%, nurses are departing, like doctors, for less stressful, better-paid work. Recruitment from the EU is plummeting, as predicted.
As everyone firefights, all the preventative services are being cut that might prevent patients needing a crisis bed
As everyone firefights, hand to mouth, all the preventative services are being cut that might help keep patients from needing a crisis bed. The government has lines to take but no answers, and some of those “lines” are fictions. No, the NHS has not had £10bn, as Theresa May keeps claiming: it’s more like £4.5bn over four years, says the Kings Fund.
No, the £2bn given to social care will not ease the beds crisis, for all the exhortations to councils to use every penny of it in releasing bed-blocking patients with new care packages at home. NHS Providers, representing NHS hospitals, mental and community trusts, says councils are using that money to stem the collapse of existing care services and care homes, as the higher minimum wage and rising costs cause multiple closures. Cuts leave at least half a million old people getting no care, who would have done, and that risks falls, neglect and extra hospital visits. The care crisis is seeing 900 care workers a day leaving underpaid and overworked jobs.
Money, you might think, comes last in hospital managers’ priorities. But they are being severely harried and punished by NHS England to rein in ballooning debt by plundering capital funds and selling bits of land to cover running costs, one-offs many say they can’t repeat this year. An NHS England-commissioned report says £10bn is needed to cover this depleted capital: that’s not for grand new projects, but for basics like outworn dialysis machines.
A chair of a leading teaching hospital tells me “heroic assumptions” are being made by most trusts agreeing their “control totals”, their spending limits for this year. Debts will swell again. This year the NHS gets just a 1% increase, next year an unprecedented zero.
One of the Labour’s NHS triumphs was to cut waiting times for operations from 18 months to 18 weeks – but now that totemic 18-week limit has been abandoned. However, that only adds to hospitals’ financial woes as they rely on income from elective surgery, while every extra emergency costs them money.
This is the dismal background to the reorganisation that NHS England head Simon Stevens is attempting, almost undercover. His state of play review of his five-year forward plan passed hardly noticed, announcing a first tranche of England’s 44 STPs, (sustainability and transformation plans) to reconnect local services fragmented by the Lansley 2012 act.
Most observers think it the right way to go, putting the NHS and social care under a united structure with one finance hub, ending destructive and expensive competition and tendering of services. But hardly anyone thinks this can be done with no new money: every STP calls for capital for new beds and units. Virtually all involve closures and mergers stirring a local political outcry.
Jeremy Hunt, who always presented himself as the patient’s ally, rooting out poor quality, wallowing in the Labour disaster at Mid-Staffs, has fallen uncharacteristically quiet. He has nothing much to say about patient safety in A&Es or elderly patients turned out of beds too soon. Not even deaths on trolleys in A&E corridors in Worcester roused his usual righteous ire.
Concern about the NHS has risen high in recent polling: what no one knows is when public anger will reach a political tipping point. May and Hammond stay iron-clad adamant: all this is NHS shroud-waving and there will be no more money. Lack of any opposition helps, but can they really tough it out where Thatcher, Major and Blair all bent in the face of NHS crises?
When will public anger over the NHS reach a political tipping point? | Polly Toynbee
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