Health

The Observer view on the existential NHS crisis that demands a PM with a plan | Observer editorial


When the NHS was founded in 1948 by Aneurin Bevan, it had three core principles at its heart: that it would meet the needs of everyone, that it would be free at the point of delivery, and that it would be based on clinical need, not ability to pay. Those concerned about existential threats to the NHS usually focus on the risk of the “free at the point of use” principle being dismantled. But by far the most significant political threat, as we are seeing at the moment, is the slow erosion of the guarantee that it will meet the needs of all, due to persistent underfunding and a failure to train the staff it needs.

A report from the health select committee last week has concluded that the NHS and the social care system are facing their greatest workforce crises in their history, with around 100,000 vacancies being advertised in each at the end of last year. It predicted that the NHS and social care service will require an extra 475,000 and 490,000 employees by the early 2030s, but highlighted that the government has no credible plan to meet that need. Hospitals are having to cope in a system where one in 10 clinical positions are vacant in areas from intensive care to emergency medicine, maternity care and GP services. This is leading to low morale, high stress, burnout and higher levels of absence due to sickness right across the health service and social care systems, posing a grave risk to patient safety.

Moreover, the NHS and social care systems have been chronically underfunded over the past decade: budgets have failed to keep pace with the demands placed on them by an ageing population and advances in medical technology. Long-term international data shows that the UK spends significantly less per person on healthcare than countries such as Germany, France and Sweden. We have far fewer hospital beds, nurses and doctors than our best-resourced competitors. This year alone, rising inflation means the NHS is facing a real-terms funding cut of up to £9.4bn.

Even before the pandemic hit, the NHS was under significant strain, with important operations cancelled during winter crises due to insufficient capacity, and waiting lists growing. Covid has made things worse, adding to the backlog and to staff absences. As highlighted by the health select committee, NHS waiting lists now number 6.5 million – the highest they have ever been. People cannot access the critical care they need, of the quality they should be able to expect, in a timely manner. They are consigned to worsening health problems, living in pain and unnecessary death simply because the government has chosen not to provide adequate funding for health services.

In social care, the situation is no better. Social care funding per person aged over 65 fell by an astonishing 31% between 2010 and 2018. This has meant growing numbers of older and disabled people not getting the help they need with basic tasks such as washing, dressing and eating, heaping extra pressure on the NHS when they suffer the terrible costs, such as dehydration and falls.

The NHS’s critics point to its worsening performance indicators to argue for abandoning its core principles altogether and moving to a system of social insurance. This ignores the fact that they are the direct product of sustained underfunding and a lack of workforce planning, both deliberate political choices taken by Conservative prime ministers, most recently by Boris Johnson. A huge issue of old and dated equipment has left the NHS operating below par. The UK certainly suffers poorer health outcomes than in some comparable countries, but this is in the context of spending less per person and in a society where there are greater social inequalities and higher levels of obesity, important determinants of health outcomes.

The NHS does not need a big-bang structural reform imposed top-down on it by politicians; its founding principles are as sound as they were in 1948. It needs sufficient funding to ensure it has the capacity to adapt to a rapidly ageing society, to develop more integrated provision with social care at the local level, and to shift its focus to public health and preventative care alongside acute care, for example, through reducing levels of obesity and improving early diagnosis of diseases such as cancer and heart conditions.

The remaining candidates to succeed Johnson as prime minister, Rishi Sunak and Liz Truss, have failed miserably to acknowledge the scale of the challenge facing the NHS and social care system. They have instead resorted to cliched soundbites about reducing the number of NHS managers – as if multimillion-pound hospital trusts do not need people to run them – and improving the use of technology, without acknowledging that insufficient capital spending is why many hospitals are reliant on barely functioning IT systems. The lesson of the 1980s and 90s is that the problems created by an underfunded health system cannot be reversed overnight by turning the taps back on: they will leave a legacy for many years to come, which the nation will pay for with its health.



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