Have you noticed that this is the government’s “health week”? Sajid Javid, the health secretary, has appeared twice on Radio 4’s Today programme to try to make it fly, yet somehow it has failed to distract from other Westminster dramas.
Hoping health might act as a useful shield was an odd manoeuvre, as the NHS is the bad news story that will dog the Tories through the next election. But where else can No 10 turn, to which crippled department, for an iota of good news to distract from all the other bad news? Blank denial, upending the truth, is the Boris Johnson way: at prime minister’s questions on Wednesday, he boasted of his government’s “fiscal firepower”, just as the OECD told the world that the UK is heading for zero growth, bottom of the league (bar Russia).
When the NHS came up, he used a breathtaking blizzard of numbers, plainly not expecting to be believed. Inspect his numerology on staff recruitment and it reveals failure after failure. By July, no one will wait two years for an operation! But is that success? Labour left office with 18 weeks the maximum wait. No, Covid is only one of the reasons: 4.43 million people in England were on waiting lists just before the pandemic struck.
Johnson’s bluffing infects his cabinet. Javid on Today neither flinched nor blenched in claiming his 48 “new” hospitals by 2030 are on target. Listen carefully and they have become “hospital projects”, mostly wings and units, as only £3.7bn has been punted up when a new mid-sized hospital costs £500m. How are they progressing? The government watchdog, the Infrastructure and Projects Authority, downgraded the programme to “amber/red”, which means delivery “is in doubt with major risks or issues apparent in a number of key areas”, branding it seemingly “unachievable”. Meanwhile, crumbling hospitals hear no news on their rebuild. The collapsing roof of the intensive care baby unit at Queen Elizabeth hospital in King’s Lynn, Norfolk, is held up by 1,500 props. This one hospital needs £862m, but delay costs more as construction prices rise by 24%.
Anita Charlesworth, health economist and research director at the Health Foundation, spells out the size of the NHS shortfall. “Running to not stand still”, keeping the same inadequate activity level as the past decade, “would cost an extra £2bn a year”, and that’s before pay rises. For pay to keep up with inflation would cost £7bn, taken from the existing NHS budget: there’s no chance of that. After the deepest funding squeeze in its history, with 110,000 vacancies in England, she says: “We spend less on the NHS than equivalent countries, and by the end of the decade we’ll be short of a quarter of the staff, with the number of over-85s rising by a third.”
The danger now, she says, is the haemorrhaging of highly skilled and overstressed staff at the top of their pay grades, wooed into easier occupations. The government voted down having any workforce strategy, one senior Tory tells me, because the Treasury couldn’t let the world see the true state of future spending needs.
The Royal College of Emergency Medicine’s recent report on beds in the NHS is another grenade dropped into health week, showing 25,000 beds lost across the UK in the past decade, causing “unsafe” bed occupancy levels, with the fewest beds per head in Europe. NHS beds are blocked for lack of social care, causing cancelled operations and ambulances stuck outside overflowing A&Es. During prime minister’s questions, Keir Starmer hammered away at the 135,000 patients left waiting for delayed cancer scans, the lack of GPs and those 48 Potemkin hospitals. The commentariat wanted him to rub salt in Johnson’s leadership wounds, but it’s NHS delays that cause real alarm within most households.
Here’s the risk if Labour doesn’t win the next election: years of acute underfunding in the 1990s led to fevered debate that the 1948 system was broken, with a crescendo of calls for insurance and top-ups. In power, Labour could prove how robust funding restores the NHS to health.
As the prospect of power draws closer, the scale of the NHS collapse may make a good campaigning issue for Wes Streeting, Labour’s shadow health secretary, but what a nightmare to inherit. “It’s a two-term project,” he warns me. “We have to start with the most urgent priorities.” And that’s workforce, with a massive training programme to promise enough future staff.
“And pay must rise. In a Colchester food bank they’re giving food parcels to nurses.” On GP services, he says, “The NHS’s front door is broken. Young doctors don’t want to work as sole traders in an end-of-terrace house.” So, building on GP networks, he is reviving Labour’s plan for local polyclinics with multiple services including diagnostics – abandoned by the Tories. “Our National Care Service is the only way to unblock NHS beds, and with good pay, training and career progression we can attract people into care.” But it took Labour many years last time to repair the damage.
As health week has flopped, Johnson has turned to housing instead. But that only highlights a story almost as bad, with promises equally empty. The Downing Street grid will keep thrashing around from one issue to another. Crime, with the courts now booking criminal cases three years ahead? Climate, with Tory MPs tearing up net zero policy? Johnson will be driven back to Tory front-page pleasers, so expect loud and phoney culture wars to try to fill the great void.
Polly Toynbee is a Guardian columnist
