Neil Kinnock understood that Labour was about to lose – and lose big. But two days before the 1983 general election, the then shadow education secretary (with sights on higher office) delivered, politics aside, one of the finest pieces of oratory by any British politician since the war. Speaking from Bridgend in Wales, Kinnock said:
“If Margaret Thatcher wins on Thursday, I warn you not to be ordinary, I warn you not to be young, I warn you not to fall ill, and I warn you not to grow old.”
39 years later, Conservative health minister Will Quince inadvertently invoked this line of argument, warning if people are “planning a risky activity, don’t do so“ tomorrow, as ambulance workers, paramedics, technicians, call handlers and other NHS staff walk out.
Separately Barts Health NHS Trust, London’s largest which includes The Royal London Hospital, issued a statement today urging expectant mothers to “make plans in advance for getting themselves to hospital”.
The reality is, even without tomorrow’s industrial action, ambulance waiting times have been soaring. All ambulance trusts should respond to Category 2 calls – which include heart attacks, strokes and sepsis – in 18 minutes on average and respond to 90% of calls in 40 minutes.
But from the introduction of the Category 2 targets in April 2018 to March 2020 (i.e. the start of the pandemic), both the average and 90th centile response time targets were never met. By March 2022, the average response time was 1 hour and 15 minutes and the 90th centile 2 hours and 17 minutes. Both have improved since then but remain far above target times.
This is despite the fact that the workforce has risen by 13 per cent since March 2018, according to The Health Foundation, a charity. But it notes that capacity has been reduced as ambulances are forced to wait longer with patients outside of hospitals. In July 2022, more than 1 in 10 ambulances waited over an hour – up from almost 1 in 50 in 2019.
A major cause of this is a lack of hospital bed capacity. The NHS in England needs more beds – estimates suggest an additional 23,000 to 39,000 would be needed in 2030/31 to deliver 2018/19 rates of care. But that alone isn’t enough.
Delayed discharges are the key problem – that is, the inability to discharge patients from hospital who are deemed medically safe to leave. This can be caused by waits for assessment, non-acute NHS care and, crucially, waits for social care.
Greater funding and recruitment in adult social care is needed in and of itself. But it is also vital to improve NHS health outcomes right across the board. The government knows this but action has been limited. There was the Health and Social care Levy – initially introduced via a 1.25 percentage point rise in National Insurance contributions. This was subsequently reversed.
In September, the government launched a £500m Adult Social Care Discharge Fund “to help people get out of hospitals and into social care support”. But this is to be funded from existing budgets, and has been roundly criticised by charities and social care providers as woefully insufficient. Indeed Mike Padgham, chairman of the Independent Care Group, called it “a sticking plaster put on a gaping wound by a doctor that doesn’t see how sick the patient is.”
In truth, we are nowhere close to fixing this problem. Little wonder that, as our Political Editor Nicholas Cecil reports, a new poll shows that more than half of adults in Britain doubt people will be able to get high quality health care in their area this winter.
In the comment pages, Matthew d’Ancona says that, though not all subscription-based services will survive, this Christmas is evidence that we are living in the golden age of streaming. While Martin Robinson is proud to admit it: he’s a Christmas dinner diva.
And finally, apropos of nothing, Reveller Editor David Ellis serves three cocktails to cure a hangover.
