The NHS is in reverse, the decision on waiting times masks a lack of investment and worsening service to patients, writes Daniel Sleat
In any ordinary political period the growing crisis in the national health service would be a topic of serious public concern and debate, yet it is lost in the Brexit fog alongside issues like rising violent crime and homelessness.
Official NHS stats show that current waits at accident and emergency departments are at their worst since records began. Only 84.4 per cent of patients are being seen within four hours of arrival, well below the target of 95 per cent. Rather than address the underlying causes of these deeply worrying trends the decision instead appears to be to remove the targets, knowing they cannot, and are not, being met.
The tragedy for patients, now waiting longer than ever for help at A&E, is that this is a crisis the government has created itself. It inherited an NHS that Labour had fixed and put on a strong footing, it is now slowly dismantling the building blocks of those reforms.
Labour made significant improvements to healthcare during its period in office: waiting lists were halved, life expectancy improved, infant mortality fell and overall satisfaction with the NHS rose from 36 per cent in 1997 to 71 per cent in 2010. It achieved this through a combination of increased resource and drive from central government to improve services.
Between 1997 and 2008 expenditure on health doubled, from £55.1bn to £125.4bn. Staffing levels were increased: 50,000 more doctors, 10,000 more GPs and almost 100,000 more nurses. In 2004 Labour introduced waiting time targets: 98 per cent of patients were expected to be seen in A&E in no longer than four hours, no patient to wait longer than 18 weeks for an operation after referral by a GP. This was a key element in adding further energy and focus to the efforts to improve the NHS.
In recent years each plank of what underpinned the transformation in the NHS has been eroded. Resources have diminished. Even taking into account the recent government pledge to increase funding by £20.5bn by 2023/4, funding commitments so far will not enable the NHS to meet its needs or improve its services.
The NHS faces its worst ever staffing crisis. The number of vacancies hit a record high last year, with 107,743 posts unfilled. So acute are the issues around staffing that Siva Anandaciva, chief analyst at the King’s Fund, said the situation risked becoming a ‘national emergency’.
Targets that helped set a minimum standard to drive improvement are being set aside. The first casualty appears to be the four-hour A&E target, with others under review. While a discussion on how best to set these type of standards is needed, today’s announcement provides little encouragement that a drive to raise standards is being put first.
Critically, the focus from the centre of government has also been lost, with its bandwidth now solely focussed on Brexit; a situation unlikely to change in the short to medium term.
Taken together the lessons of what works from the Labour period are being abandoned, leaving the NHS facing a growing crisis and patients health put at risk. The government is unwilling and unable to take the action needed to fix the situation now, let alone give any thought to the long-term future of the NHS.
It is time for radical but deliverable reform on healthcare. The first element must be putting the right funding in place. It isn’t acceptable to ask patients to accept reduced levels of service at the same time as billions of pounds are being wasted on Brexit. Coupled to the right funding package to secure the NHS in the medium-term, a long-term transformation plan is needed, which, critically, puts the coming technological revolution at its heart. With the right political leadership, the United Kingdom can and should be a world-leader in harnessing the potential new technology has to save lives, deliver better outcomes and save money.
On the eve of the 1997 general election, Tony Blair said that we had 24 hours to save the NHS. As things stand, we have a lot more time than that: lets make use of it to create a radical plan to transform and secure its future.
Daniel Sleat is special adviser to Rt Hon Tony Blair
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