IAt a TV studio in Stoke-on-Trent last month, Liz Truss and Rishi Sunak traded jabs on everything from credit card economics to Channel migrants to the accessories chain Claire’s. The list of issues the pair clashed over was incredibly long.
There was, however, one glaring omission. During the hour-long debate, there was not a single mention of the NHS – despite being engulfed in its biggest crisis ever. The NHS now shares the same characteristics as many of those who rely on him to keep them alive and well: he is elderly, has multiple co-morbidities and is in dire need of emergency care. The summer left him on his knees. The worst is expected this winter.
“The new Prime Minister will inherit an NHS in its worst state in living memory,” said Matthew Taylor, chief executive of the NHS Confederation, which represents the healthcare system in England, Wales and Northern Ireland. North. “It is undeniable that the NHS is in a state of crisis.”
The facts, he says, speak for themselves. “There are 105,000 vacancies. A&E are overcrowded. About one in seven hospital beds are occupied by patients who cannot be discharged. Some patients had to wait over 40 hours for an ambulance. Care is endangered by neglected buildings due to underinvestment. And then there are the waiting lists, which stretch into the millions in elective care, mental health and community care.
Jeremy Hunt, the chairman of the health and social care committee, is also concerned. “The new Prime Minister will inherit an NHS facing the most serious crisis in its history,” he warns. “A&E, ambulance, general medicine and social services are in grave danger across the country.”
The overarching problem for the new Downing Street incumbent is that, while in previous years NHS problems focused on specific areas, today the whole house is on fire.
“The NHS has never been more challenged than it is today,” says Alastair McLellan, editor of the Health Service Journal. “There isn’t a single area of NHS provision that isn’t really struggling… There’s literally nowhere that isn’t bad, and in some cases really bad.”
In the short term, says Robert Ede, head of health and social care at the Policy Exchange think tank, the main task will be to set priorities. “Almost all the lights on the dashboard are flashing. The only priority for this winter should be ensuring that patients can access basic services.”
One light that flashed all summer was urgent and urgent care. A record 29,317 people had to wait more than 12 hours in England’s A&E departments in July after a decision to admit they were indeed admitted. That was up 33% from 22,034 the previous month and is the highest of any month in records dating back to August 2010.
“Patients are facing extremely long wait times,” says Dr Adrian Boyle, vice-president of the Royal College of Emergency Medicine, who says many are in serious condition or have serious injuries. “We know that long wait times for patients can cause harm or worsen conditions or injuries. The large number of patients waiting for care is alarming.
Ambulances in England took an average of 59 minutes and seven seconds last month to respond to emergency calls such as strokes, compared to 51 minutes and 38 seconds in June – well above the 18 minute target . “If you call an ambulance in the Southwest…there’s a reasonable chance you’ll die before it arrives,” McLellan said. “As bad as the NHS has been in the past, that has generally not been the case.”
Richard Murray, chief executive of think tank King’s Fund, agrees. “While the waiting list having crossed the 6.7 million mark may seem quite breathtaking, the depth of the challenge in urgent care – seen in ambulance and A&E wait times – is worse. NHS recovery plans have been hampered by repeated waves of the Omicron variant and, more fundamentally, by deep labor shortages that have long been brewing.
General practice has been particularly affected by the inability to recruit and retain enough staff. “Too many patients say it’s hard to get a GP appointment even though primary care colleagues are working hard,” NHS England chief executive Amanda Pritchard admitted in a statement. memo to staff this month.
In 2015, the government pledged to hire 5,000 more GPs within five years, but the number has fallen rather than increased. In 2019 the government promised 6,000 more GPs by 2024, but progress has been glaringly slow.
“The new Prime Minister must make general practice a top priority if he is serious about ensuring the NHS remains sustainable to deliver care to patients now and in the future,” says Professor Martin Marshall, Chairman of the Royal College of GPs. “We are doing more consultations each month than before the pandemic and the care we provide is becoming more complex, but the number of fully qualified, full-time GPs is declining.”
Christina Pagel, professor of operations research at University College London, says Covid-19 ‘greatly worsened’ the NHS crisis but did not cause it. “Essentially, we entered the pandemic with a health service already in shambles, with severe staff shortages, morale issues and underfunding.” Nigel Edwards, the chief executive of the Nuffield Trust think tank, agrees. “The pandemic has added fuel to the fire, but the root of these problems has taken decades to develop.”
Dr Subramanian Narayanan, chairman of HCSA, the hospital doctors’ union, said the NHS is in a worse position to deal with a pandemic now than it was in 2020. ‘Staff shortages are more serious than at the start of the pandemic and there is no evidence that the drivers of this are being addressed.
The labor crisis is the main problem. “The warnings about the lack of a health staffing plan have been there for years,” Pagel says. “Brexit has made the situation worse, especially in cities, as we have lost so many EU staff who have chosen to return home.”
Pat Cullen, general secretary of the Royal College of Nursing, which will vote with its members on industrial action next month, said the key to solving the NHS crisis is through “recruitment and retention – and that starts with paying off. staff fairly”.
With renewed focus on ambulance delays and the backlog of care, other areas of the NHS are slipping. Mental health is an alarming example. “Over the past few years, mental health has moved up the agenda,” says McLellan. “And the mental health investment standard, while not perfect, has actually seen more money spent on mental health. Mental health was getting there…my feeling is now [it’s] actually step back.
Saffron Cordery, chief executive of NHS providers, says mental health services have become overstretched. The Royal College of Psychiatrists warns that waiting lists are at record highs and care is at ‘crisis point’. The charity YoungMinds says thousands of young people attempt suicide due to long waits for treatment.
“The NHS has never faced such a deep crisis and there seems to be no political will to face the reality and tackle it,” says Boyle. “It is deeply concerning that neither the Prime Minister nor the leadership candidates have grasped the gravity of this crisis, the extent of the damage to patients and how much worse it could get in the winter.”
Since its absence from the Stoke-on-Trent debate, the NHS has barely featured in the leadership race. Only recently Truss said she would divert £13billion of NHS funds to social care.
In theory, it’s a good idea, McLellan says, but it should have happened years ago. The problem is now a “dangerous time to do so”. “Does social care need more money than the NHS? Yes. But we are now in a situation where they have let the NHS into crisis as well as social care. So both need money.
Tough decisions have to be made, Edwards says. “The new Prime Minister will have to quickly face up and make tough choices to tackle the interconnected challenges of health and care if he hopes to reverse declining performance, declining public satisfaction and growing inequities in access. “
That means urgent action, Murray points out. “What can be done? Winter is still by far the most difficult time for the NHS, and time is desperate to do anything, but anything that can be done should be done.
“This includes supporting Covid and flu vaccination campaigns; produce a quick fix to the pension problem that drives senior staff out of the service; and be ready for emergency social care support which can also help the NHS by getting patients out of hospital quickly when they are ready. Beyond that, a lasting recovery can only come from confronting the labor crisis.
Hunt says: ‘A horrific winter awaits us, and a serious, NHS-funded workforce plan is the only way to prevent the build-up of preventable deaths in the months to come.’ Ede argues that an urgent investment in NHS capital, such as new kit and facilities, “has the potential to deliver a much bigger return: solving problems like delayed diagnosis”.
Meanwhile, the NHS crisis and the choices facing the new Prime Minister come at the worst possible time, says Edwards. “These decisions will be made even more difficult against a backdrop of 90s austerity, a lack of vision reminiscent of the 80s and industrial relations and inflation of the 70s. There will be no easy path to cross.