Philip Collins
(Picture: Daniel Hambury)Tony Blair once told me that he could announce the invasion of France any time he liked, just so long as he revealed the intention in a speech entitled The Skills Challenge. Serious government policy has become a bit like that these days. In the maelstrom of who attended which party, the expectation that photographs will circulate soon and the speculation about who will receive an email from the Metropolitan Police, there is a lot of bad news being buried.
Yesterday, there was some very bad news, which will haunt the Government, on the health service. Hardly anyone noticed but it was probably the most potent political event of the day.
The statement given by Sajid Javid, the Health Secretary, made for depressing listening for the public and was worrying for the Government. By the time the current backlog of patients waiting for treatment is cleared, in March 2024, there could be as many as 10 million on the list.
The NHS constitution declares that patients needing elective care in hospital ought to be treated within 18 weeks. In fact, that target is an insulting irrelevance to what is actually happening in English hospitals. There are currently 18,600 people waiting more than two years after diagnosis for the treatment they have been promised. Mr Javid has set a target that this backlog must be eradicated by July this year.
However, he had to concede that the numbers waiting for more than a year will not disappear before May 2024, which is the last date on which the next general election must be held.
More than 13,000 people had to wait more than 12 hours in the A&E department of a hospital last December. This is the highest for any calendar month since records began in August 2010. The number of people waiting for four hours or more was only slightly below the worst on record.
Labour’s impressive shadow health secretary Wes Streeting made a persuasive case that these problems in the NHS were by no means all caused by Covid. When the Conservatives came to power in May 2010, he pointed out, there were 2.6 million people waiting for treatment. There are now six million but even before the pandemic there were 4.4 million. This is a failure that has been a long time in the making. It is also the consequence of a long-term shift in illness, to which the NHS has not been able entirely to respond. More than 70 per cent of the resources of the NHS these days, before Covid, are taken up by people with long-term conditions.
Rather than needing episodic hospital treatment, which either cures them or doesn’t, these patients need regular care, often self-administered in a range of different institutions of the NHS. It is a very different model of care from the system that has grown up since the formation of the NHS in 1948.
This change, coupled with the great achievement of an ageing society is placing the greatest ever burden on health services. There were more calls to ambulances last year than any year on record.
The standard response within the NHS professions to these major challenges is that the system needs to be integrated. Too often patients are driven around the system, from place to place, repeating their symptoms over and over again. Yesterday, amid the political carnage to do with parties, the health minister Edward Agar introduced a White Paper on Integration.
The plans contained some worthy announcements, most of which had been heard before. There will be more community diagnostic hubs and more surgical hubs, which can undertake large numbers of operations more quickly. Patients who have been waiting the longest will be offered the chance to be treated either outside their home area or in a local private hospital.
Yet the declared objective of the White Paper — to bring the separate health and social care systems closer together — made you wonder which party had been in government for the past decade. As Matthew Taylor, chief executive of the NHS Confederation, pointed out, there is little hope the Government’s targets can be met until the necessary mix of staff is in situ.
It is not clear that the Chancellor is ready to release the funds and a Prime Minister with an uncertain future is not well placed to intervene. Tory strategists know that the NHS is an issue on which they are extremely vulnerable. Whoever leads them into the election, they will not win if they test the patience of the vulnerable.
What do you think of the Government’s handling of the NHS backlog? Let us know in the comments below.
