A “decade of neglect” by successive Conservative administrations has weakened the NHS to the point that it will not be able to tackle the 7 million-strong backlog of care, a government-commissioned report has concluded.
The paper by the King’s Fund health thinktank says years of denying funding to the health service and failing to address its growing workforce crisis have left it with too few staff, too little equipment and too many outdated buildings to perform the amount of surgery needed.
The UK’s poor public finances, health service staff suffering from exhaustion, and a wave of NHS strikes this winter will also lead to ministers being unable to deliver key pledges on eradicating routinely long waits, the thinktank says.
The findings are especially embarrassing for the Conservatives because the report was ordered by the Department of Health and Social Care (DHSC) late last year. They are critical of the impact on the NHS of the austerity programme initiated by David Cameron in 2010 and continued by his successor, Theresa May.
The report draws an unfavourable contrast with the tactics used by Tony Blair and Gordon Brown’s Labour governments in the 2000s to address the horrendously long waits for care they inherited in 1997.
“Though Covid certainly exacerbated the crisis in the NHS and social care, we are ultimately paying the price for a decade of neglect,” said the King’s Fund chief executive, Richard Murray.
“The sporadic injections of cash during the austerity years after 2010 were at best meant to cover [the service’s] day-to-day running costs. This dearth of long-term investment has led to a health and care system hamstrung by a lack of staff and equipment and crumbling buildings. These critical challenges have been obvious for years.
“The NHS in 2022 faces many of the same challenges it faced in 2000: unacceptably long waiting times and a service hobbled by staff shortages. To that is now added a cost of living crisis, industrial action by staff and a backdrop of a weak economy and weak public finances.”
The report is based on the first in-depth academic research undertaken in the UK into what measures ministers and NHS bosses can deploy to tackle situations such as those prevailing today, where massive numbers of patients are again facing long delays to access planned hospital care.
Its findings are based on a review of evidence around waiting times and, in particular, interviews with 14 experts, including many of the key figures in Labour’s successful eradication of long waits.
One of the experts, none of whom are named, said: “We have essentially had 10 years of managed decline. This is not a Covid problem. This is an austerity problem.”
The report pinpoints Cameron’s decision to reduce the NHS’s annual budget increases from Labour’s 3.6% to an average of just 1.5% as the key reason for the service’s loss of capacity. The service’s performance against a number of waiting time targets that Labour introduced began spiralling downwards in 2015 and has worsened every year since.
The report comes days after the latest official figures showed that the waiting list in England for non-urgent care in hospital had reached a new record high of 7.2 million people. Of those, 410,983 had been waiting for more than a year for treatment – such as a hip or knee replacement, cataract removal or hernia repair – that should take a maximum of 18 weeks.
The leaders of Britain’s A&E doctors as well as NHS ambulance service bosses in England have voiced acute concern about the number of patients coming to harm, and even dying, as a direct result of waiting for an ambulance to arrive or to get into A&E or from there into a hospital bed.
The 81-page document is being published later this week. It says the NHS’s lack of resources, combined with the different political, financial and economic circumstances that apply today, mean that politically important promises made earlier this year in NHS England’s “elective recovery plan” are highly unlikely to be met.
They included pledges to end waits of two years, 18 months and one year by the summer, next spring and 2025 respectively.
The government has promised to put £8bn into tackling the backlog and NHS England has set up dozens of community diagnostic centres to help speed up patients’ tests and treatment.
In his response to the Guardian about the report, Blair criticised all six of the Tory administrations since Labour lost power in 2010, for deviating from the three strategies he used to eradicate delays: reform, investment and political focus. He said that change of approach damaged the NHS’s ability to deliver care within established waiting time targets.
“These key elements were, and I believe still are, essential in improving public services. Since Labour left office, each pillar of these principles has been weakened in regard to our health service,” Blair said. “As the report says, waiting lists are now at their highest level since the 18-week referral to treatment measure was introduced in 2004, as well as a collapse in urgent care.”
He also took aim at ministers’ repeated efforts to depict the massive waiting list for care – which already stood at 4.4 million when the pandemic hit in spring 2020 – as “the Covid backlog”. Blair said: “This isn’t a result of Covid, but chronic underinvestment and mismanagement exacerbated by Covid.”
He added: “The lessons of that [Labour government] period, which ended with satisfaction levels with the NHS at record highs, remain the same because they are lessons about governing: the government and prime minister make it a priority, devoting time and energy; a policy is put in place which is based on what works; and then there is a relentless effort across government to ensure delivery.”
Blair said the King’s Fund’s findings “must act as a political wake-up call to renew efforts to reform the NHS, give this reform the political focus and grip it needs and align this with the right strategic investment”.
In a statement the Department of Health and Social Care defended the government’s approach to the NHS.
“Tackling the Covid backlogs is our absolute priority, following the impact of the pandemic, and the NHS is making strong progress by reducing waits of 18 months by 60% in a year and virtually eliminating waits of more than two years.
“The core NHS budget in England is currently at £152.6bn and will increase to almost £166bn in 2024-25 as announced in the autumn statement – the highest spend on health and care in any government’s history. This will enable rapid action to improve emergency, elective and primary care performance towards pre-pandemic levels.
“We are also growing the NHS workforce, with over 34,500 more staff than a year ago, including over 9,300 more nurses and almost 4,000 more doctors”
