This is a sick country, getting sicker. NHS waits will take years to clear, if at all. While people wait, they get sicker. When more and more people slip into absolute poverty – a fifth of people now – they get even sicker. More sicken as they age, and that peak has not yet been reached. Every part of the NHS feels at the sharp end, coping mostly because, amazingly, they just do, even with no end in sight to the stress.
NHS data released last week on people waiting more than 18 weeks with serious heart problems suggests some will probably die before they get treatment. When waiting patients have heart attacks and strokes they call an ambulance – so there’s been an astonishing 7% rise in those category 1 calls, says Saoirse Mallorie, senior analyst at the Kings Fund.
I listened in to calls like this at the South East Coast Ambulance Service dispatch centre in Gillingham, north Kent, covering Surrey, Sussex and Kent. I sat with D, a seasoned and sympathetic emergency medical adviser, call handler and life-and-death decider.
As it happens, the first call comes from one of those acute heart patients. Mr X, aged 65, suffering a heart attack, had his daughter with him on the line. Yes, he’s conscious, but his chest pain is severe. Does he have a GTN spray (for chest pain relief)? Put it under his tongue. Yes, he’s been through this before, a familiar very sharp pain. He’s on their system and he’s an emergency, again. He is told: “There’s a 22-minute wait in your area right now.” Ambulance times are improving, but still miss their targets.
Mrs Y, bedridden, aged 72, has a nurse who got to her side first, and is alarmed her blood gases have sunk dangerously low. She needs an ambulance and a stretcher, but no, she has no relative to accompany her. The nurse will wait for the ambulance, but any delay will delay her next patient too.
Then comes a call from J, who has called recently. She is attempting suicide, taken an overdose, a lot of pills, she says, voice low and croaky, asking where the ambulance is she called earlier. Notes show that they took her to hospital three days ago after another attempt. He took a note of what pills she had taken: they were anti-allergy, and for diabetes. “I’ve got bad chest pains now,” she says. Like a thunderclap, D asks? Yes, she says, and that instantly promotes her to category 2: urgent. The notes also show she calls often, lives alone, despairing, needing something that isn’t there. Only the NHS is there. An ambulance is on its way.
D says what J needs is a loneliness service, as he hears this need in his earpiece often: loneliness is a cause of sickness, and those with the least are loneliest. This is a fine new dispatch centre with an air of camaraderie, but 24% of the posts are vacant, as it’s hard to recruit for this invaluable but sometimes distressing job at £24,228 starting pay, especially in the expensive south of England. Verbal abuse of staff is common from desperate people waiting for ambulances to arrive. It was not quite a condition of my visit that I stress how much they need new recruits and how rewarding they find the job. Certainly D did value it, and callers getting him on the line would find him reassuring in a crisis.
No one in the health service doubts the country is sicker now. Ambulances and A&E are not getting more unwarranted calls. As the latest NHS figures were published, the national medical director, Sir Stephen Powis, talked of “enormous demand on services, with more people than ever before attending A&E in the last year, over a million more than before the pandemic”. But health secretary Victoria Atkins on X trumpeted: “This is the biggest 5-month fall in over 10 years outside the pandemic.” Only true-ish.
The gloss comes off when you realise that, as the Health Service Journal notes, the fall seems to be entirely accounted for by removing paediatric community waits to some less visible list elsewhere, and the Health Service Journal found that more than a thousand of these patients had waited more than 78 weeks. The Office for National Statistics also reports that the current figures may be missing an additional 2 million people.
The former health minister Lord Bethell said on Times Radio of Britons’ general health: “We’re the second-worst in the G7. We need to address the fundamental reasons why so many millions of people in Britain are carrying so much disease.” Yes, indeed. But Prime Minister Rishi Sunak, with a massive cull in disability benefits in his fantasy 2025 budget, said recently: “Do I think our country is three times sicker than it was a decade ago? The answer is no.” Ask any corner of the NHS, however, and the answer is yes. The DWP’s own projections expect disability and sickness claims to have risen by almost 2 million in five years’ time – and their work capability tests are ferocious. Today the Health Foundation issued an alarming report warning that 700,000 more working age people will be diagnosed with a serious illness by 2040, and 80% of them will be in deprived areas, “entrenching stark health inequalities”.
The diseases of despair, self-harm, suicide attempts and addiction join all the miseries of deprivation and hardship, where the poorest 20% suffer twice as much mental ill health, and mentally unwell people use emergency services four times more than those with physical disabilities, data analysts inside the NHS told me this week.
Time was – it seems aeons ago now – when Labour lagged a mile behind in the polls and any bad news for the government, economic or social, was a cause to celebrate (secretly) and hope for worse to come. No longer, as the mantle is about to be passed on to them and this scorched earth, this legacy of doom will be theirs. The social destruction of austerity has created a health deficit that may prove more onerous to shift than the national debt. Labour people admit it may take more than one term to restore the NHS to its peak state of 2010, when it recorded its shortest waiting times and highest satisfaction. How much will they spend? Wait and see is the only sensible answer.
Here’s a lesson the Tories need to learn from their failures: short-term cuts that increase hardship and poverty only put impossible pressure on the NHS, swelling waits for Tory voters too, and losing them elections.
Polly Toynbee is a Guardian columnist
