Crisis – what crisis?

Jacky Davis calls out Tory PM Theresa May, busying herself with Brexit, for the latest NHS crisis

The NHS is back in the headlines once again and for all the wrong reasons. Tabloids and broadsheets alike feature stories of patients dying on trolleys and sick children asleep on A&E floors. Normally cautious individuals and organisations speak out publicly about the problems on the front line which are now so bad that the Red Cross has labelled it a ‘humanitarian crisis’. The only people who don’t think there is a problem are the prime minister, busy with her red, white and blue Brexit, and Jeremy Hunt, pocketing the £17 million he has just made from the sale of his business (and yes, that would be the same Jeremy Hunt who scrapped bursaries for nursing students and tried to deny a 1% rise to NHS staff).

Is it really as bad as the Red Cross suggests? We are inured now to the annual ‘winter crisis’ and the corresponding excuse of ‘unprecedented demand,’ so is this year truly that much worse? The short answer is yes. The sad fact is that these days we have an NHS winter crisis all year round, but now superimposed on that are the results of chronic NHS underfunding, cuts in social care and the chaos following Lansley’s Health and Social Care Act. The result is the perfect storm for the NHS, its staff and patients

Firstly funding. Even the NHS CEO Simon Stevens has been driven to suggest – ever so politely – that the government has not been truthful about the money it is making available to the NHS.  The Nuffield Trust, Health Foundation and the Kings Fund have also all criticised the government’s claims to to be giving the NHS ‘more than it asked for’.  The truth is that the NHS faces a £30 billion funding gap by the end of the decade, two thirds of NHS trusts are in the red and there is no-one, including the Department of Health, who believes that the NHS can rescue the situation by making £22 billion ‘efficiency savings’. As Helen Stokes Lampard (the new chair of the RCGP) pointed out recently, the NHS lost the fat long ago and the knife wielded by the government is now cutting into bone.

What the government won’t admit and the media seem not to have noticed is that the NHS is chronically underfunded and understaffed. We have some of the lowest bed numbers per capita amongst comparable countries (Germany 8.3/1000 people, UK 2.8), lowest doctor numbers (Germany 4.1/1000 people, UK 2.8) and we spend the least per capita (Netherlands $5,131, UK $3,235). It is thus hardly surprising that ambulances queue outside A&E departments, patients languish (and die) on trolleys and highly skilled surgeons spend their days chasing beds for their sick patients instead of operating on them.  The president of the normally conservative RCS recently went public with concerns about cancer patients having their operations repeatedly cancelled, surely indefensible in any civilised country.

The government’s response to this is firstly to deny it and then, when it is impossible to ignore the evidence, to start the blame game. Too many patients are coming to A&E for frivolous reasons (and yes, that criticism came from Jeremy Hunt who took his own children to A&E so that he needn’t bother with a GP appointment). GPs are not pulling their weight and will be drafted in to help in A&E – that is when they are not being ordered by Mrs May to open their surgeries 7 days a week, despite the evidence that they are already stretched too thin and patients don’t want to be seen on Sundays anyway. As someone remarked on twitter – why not stick a broom in their hands and they can sweep up at the same time? It is grossly unfair to blame staff for the failings of government policy and May and Hunt appear deliberately antagonistic when they take on the very people upon whom the service and patients rely.

 What can be done? In the short term the service needs more real money now, both into the NHS and into social care whose failings are leading directly to overflowing hospitals. Where is the money to come from? Firstly abolish the costly and pointless NHS market in England. The government is understandably very coy about how much this costs but estimates range between $5 and 10 billion. Deal with the PFI contracts that are crippling our hospitals, delivering £11 billion worth of infrastructure at a cost to the tax payer of over £80 billion. Consider a hypothecated tax for the NHS, surveys show the public would support one as long as they are sure the money is indeed going to the NHS.  And in the longer term?  Fund the NHS to the level of other comparable countries, reverse Lansley’s ill judged legislation (thus putting a stop to the fragmentation and privatisation of the service), support the staff and allow the NHS a period of calm in which to recover and take its place as one of the most cost efficient, effective and equitable health services in the world.

Meanwhile, with the service underfunded, understaffed and overstretched, it is only NHS staff working flat out at the front line who are keeping the NHS from complete collapse. No-one could doubt their commitment and hard work, especially after watching BBC2’s excellent documentary Hospital. Staff are the ones who suffer from the government’s mismanagement of the NHS, and when they fail, as they inevitably must sometimes under impossible circumstances, it is patients who are paying the price. Something needs to happen and quickly, but firstly the government needs to admits that the situation is grave. By denying the NHS crisis May and Hunt not only appear arrogant and ignorant (a fatal combination) but they are putting patients in danger while making it impossible to tackle the problem.