Has politics failed the NHS?

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Every autumn, with gloomy predictability, health bosses warn that a winter crisis is about to afflict the NHS. Alerting that our health service could be ‘overwhelmed’ throughout the coldest months, they sound a message so familiar that it has arguably started to lose its impact.

Yet those omens feel very different this year as an alarming picture is already emerging of hospitals inundated and overstretched. The recent sight of ambulances queuing for hours to hand over patients has revealed a health service struggling even before predicted leaps in Covid-19 and flu-related admissions. 104,875 people waited outside A&E for at least four hours in September – 4% more than the worst January on record – while 5,025 patients waited for twelve hours or more. The sad result has been that people have died due to delays.

Since its creation in 1948, the NHS has occupied a unique place in British hearts. Surveys consistently place it as the most popular institution in the country, with overwhelming support for its founding principles that health care should be free at the point of delivery and funded by taxation. For many, the NHS also transcends the mantel of public service, representing the country itself, embodying values of compassion and decency, and maintaining egalitarianism in an increasingly individualistic age.

Lives surely depend on confronting its shortcomings

But for all our pride in the NHS as a linchpin of national unity, lives surely depend on confronting its shortcomings too. Indeed, while undoubtedly revealing the extraordinary resilience of the health service and its heroic front-line staff, Covid-19 also seems to have exposed and exacerbated many of the problems which nearly pushed the NHS to breaking point even before the pandemic struck, when the waiting list for treatment already stood at a record high.

Whenever trying to make sense of the present, the question is always how far to reach back. Of course, health needs, treatment options and technology have transformed over time, requiring the NHS to regularly adapt to the demands of the day. Yet, looking back through past decades, a pattern seems to emerge of a political culture that has prioritised efficiency at the expense of quality, and has been unwilling to confront and truly address the fundamental long-term problem facing the NHS: the predicament of an ageing population.

Margaret Thatcher and John Major largely limited NHS resources, prioritising value for money. Then Tony Blair’s New Labour, despite overseeing huge growth in funding from 4.6% of GDP in 1997 to 7.6% in 2010, also supervised years of repeated restructuring and micromanagement, tinkering with the health service but never tackling the long-term challenges it continued to face. With the fiscal restraint under David Cameron after that, NHS performance diminished and much-needed resources were squeezed once again.

More money is certainly required

Today, beneath the apparent simplicity of the NHS’s single national model, there therefore lies a byzantine system of responsibility, control and accountability lines resulting from decades of dabbling reform which baffles voters and many politicians alike. Having endured austerity and facing increasing demands for years, meanwhile, the number of people waiting for NHS treatment in February 2020 stood at a record 4.4 million. Now at over 5 million following the pandemic, and possibly set to rise as high as 13 million according to the Health Secretary Sajid Javid, the unprecedented backlog remains an indisputable sign of a health service under perpetual pressure. 

The NHS may have been at the centre of every general election for decades, but in this context, it seems to have assumed an even greater salience.

More money is certainly required, a solution recognised by Boris Johnson’s big-spending Conservative government, which has promised £5.9 billion specifically to tackle waiting lists, and an extra £12 billion a year for health and social care for the next three years, funded through higher National Insurance Contributions. However, commendable as it is that social care finally has a possible long-term funding model after decades of delay, there remain several concerns for the future.

Despite touting the new £12 billion a year levy as ring-fenced, so it can only go to health and social care services, what the government has failed to do is place a clear barrier between the two. We are told that most of the extra money will initially go to the health service to clear the backlog before subsequently transferring to social care. But the first obvious problem is that the NHS may endlessly guzzle the new cash. Currently, ageing patients with conditions such as dementia, diabetes, hypertension and arthritis account for 60 percent of all appointments. The need to invest more in social care to relieve this pressure on the NHS is clear, but few see the health service ever offering to hand money over.

The nation will continue to adore the NHS

Secondly, the government’s new funding lacks an accompanying plan to drastically cut the waiting list. A significant unsolved problem remains in staff shortages across health and social care, which run into hundreds of thousands. There are over 1,800 fewer fully qualified full-time GPs than in 2015, and since the start of the pandemic, many staff have left due to stress, depression, or burnout.

Proposed reforming legislation, meanwhile, while seeking to expand successful integrated care among GPs and hospitals which has been rolled out across the NHS in recent years, would also give ministers more direct control over the health service. Increased accountability for a sector that will soon receive 40 percent of all government spending may seem justified. But the result will likely be many politically pleasing decisions, such as continuing to favour increased NHS funding over social care or pledging to build arguably needless new hospitals.

Like decades gone by, it therefore seems probable that fundamental and enduring improvements to health and social care services will remain evasive – a worrying prognosis as the NHS continues to face the greatest demands of its existence. Last year, the prime minister praised the health service as “the beating heart of this country. It is the best of this country. It is unconquerable. It is powered by love.” The nation will continue to adore the NHS, but we must hope that Boris Johnson has the courage to translate such sentiments into meaningful and lasting help for the system which cares for us all.

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