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| The Guardian view on the NHS crisis: it’s not just the flu | The Guardian view on the NHS crisis: it’s not just the flu |
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| There is no mistaking the depth of the crisis faced by the health service. But how much are we prepared to pay, who will pay it – and what exactly will it buy? | |
| Thu 11 Jan 2018 18.28 GMT | |
| Last modified on Thu 11 Jan 2018 22.01 GMT | |
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| It has been a terrible day for the NHS in England and Wales (and not a lot better in Scotland, where there are also complaints about long waits, or Northern Ireland). But it was even worse for the health service’s political masters. An unprecedented letter was sent to the prime minister by 68 of the most senior emergency medicine specialists from across England and Wales. It warned in the starkest terms of the extent of the crisis in A&E caused by “severe and chronic” underfunding: some care was not safe. Treatment was taking 10-12 hours from the decision to admit to finding a bed. For want of that bed, people were dying on trolleys. Patients were sleeping in clinics. Sometimes 50 patients at a time were waiting in emergency departments. They need more staff, more beds and more cash for social care. | It has been a terrible day for the NHS in England and Wales (and not a lot better in Scotland, where there are also complaints about long waits, or Northern Ireland). But it was even worse for the health service’s political masters. An unprecedented letter was sent to the prime minister by 68 of the most senior emergency medicine specialists from across England and Wales. It warned in the starkest terms of the extent of the crisis in A&E caused by “severe and chronic” underfunding: some care was not safe. Treatment was taking 10-12 hours from the decision to admit to finding a bed. For want of that bed, people were dying on trolleys. Patients were sleeping in clinics. Sometimes 50 patients at a time were waiting in emergency departments. They need more staff, more beds and more cash for social care. |
| Earlier, the body representing all NHS providers warned that the funding crisis had driven hospitals to a watershed where hard choices were becoming unavoidable. As they have for more than a year, most hospitals are breaching their constitutional obligations. The warning accompanied statistics showing that only 77.3% of A&E patients met the four hours target in December. Performance is already worse than in its worst month, January 2017. It the worst since records began, and it is very likely to get worse still. Theresa May suggested to reporters that it was because of the flu epidemic. This is not the flu: it is a system-wide crisis brought about by seven years of mounting austerity. Oh, and that is getting worse, too. The official defence is that this is not a crisis, because there is a plan. Certainly the consultants acknowledge in their letter to Downing Street that huge effort went into trying to avert a crisis. But planning can’t magic up highly trained doctors and nurses. Plans do not make hospital beds. And while vaccination helps, you can’t entirely plan your way out of the impact of flu. | Earlier, the body representing all NHS providers warned that the funding crisis had driven hospitals to a watershed where hard choices were becoming unavoidable. As they have for more than a year, most hospitals are breaching their constitutional obligations. The warning accompanied statistics showing that only 77.3% of A&E patients met the four hours target in December. Performance is already worse than in its worst month, January 2017. It the worst since records began, and it is very likely to get worse still. Theresa May suggested to reporters that it was because of the flu epidemic. This is not the flu: it is a system-wide crisis brought about by seven years of mounting austerity. Oh, and that is getting worse, too. The official defence is that this is not a crisis, because there is a plan. Certainly the consultants acknowledge in their letter to Downing Street that huge effort went into trying to avert a crisis. But planning can’t magic up highly trained doctors and nurses. Plans do not make hospital beds. And while vaccination helps, you can’t entirely plan your way out of the impact of flu. |
| Amid the mounting alarm, some influential voices are calling not just for an urgent dose of cash but for a different funding model altogether, one that would avoid the financial rollercoaster in which the NHS and the patients who rely on it are trapped. There are proposals – the latest came from the Conservative MP Nick Boles, who has cancer – for a hypothecated NHS tax. The Health Foundation thinktank has just launched a programme with the Institute for Fiscal Studies to try to reach an independent assessment of what a sustainable 15-year plan for the health service would look like. The Tory chair of the Commons health committee is among 90 MPs calling for a non-partisan conversation on the shape of a sustainable settlement. In a Commons debate on Wednesday, even the health secretary, Jeremy Hunt, accepted the need for more money and a 10-year settlement. | Amid the mounting alarm, some influential voices are calling not just for an urgent dose of cash but for a different funding model altogether, one that would avoid the financial rollercoaster in which the NHS and the patients who rely on it are trapped. There are proposals – the latest came from the Conservative MP Nick Boles, who has cancer – for a hypothecated NHS tax. The Health Foundation thinktank has just launched a programme with the Institute for Fiscal Studies to try to reach an independent assessment of what a sustainable 15-year plan for the health service would look like. The Tory chair of the Commons health committee is among 90 MPs calling for a non-partisan conversation on the shape of a sustainable settlement. In a Commons debate on Wednesday, even the health secretary, Jeremy Hunt, accepted the need for more money and a 10-year settlement. |
| The thought behind these increasingly urgent demands is that there is some way of reaching agreement on what the NHS needs. That is not as easy as it looks. The percentage of GDP spent on healthcare is a useful comparator with other similar countries but it doesn’t describe what an individual health service looks like. | The thought behind these increasingly urgent demands is that there is some way of reaching agreement on what the NHS needs. That is not as easy as it looks. The percentage of GDP spent on healthcare is a useful comparator with other similar countries but it doesn’t describe what an individual health service looks like. |
| The US spends most in the world, more than 17% of its national income, on health while denying access to it to 44m uninsured Americans. The Commonwealth Fund, where across the board the NHS repeatedly performs better than any of the other 11 richest countries, uses technical measures like access and efficiency. It may be more useful to ask – as the limited obligations set out in the NHS constitution try to do – what the NHS should provide. Knee replacements for 90-year-olds? IVF for 50-year-olds? Mixed-sex wards for our elderly mother? A local A&E or a more distant centre of excellence? On Wednesday, Chris Williamson, a junior Labour spokesman, “resigned” after suggesting doubling the top two bands of council tax, to meet the bill for social care. But he is right to highlight the political debate we need to have. How much will we pay and who will pay it? | The US spends most in the world, more than 17% of its national income, on health while denying access to it to 44m uninsured Americans. The Commonwealth Fund, where across the board the NHS repeatedly performs better than any of the other 11 richest countries, uses technical measures like access and efficiency. It may be more useful to ask – as the limited obligations set out in the NHS constitution try to do – what the NHS should provide. Knee replacements for 90-year-olds? IVF for 50-year-olds? Mixed-sex wards for our elderly mother? A local A&E or a more distant centre of excellence? On Wednesday, Chris Williamson, a junior Labour spokesman, “resigned” after suggesting doubling the top two bands of council tax, to meet the bill for social care. But he is right to highlight the political debate we need to have. How much will we pay and who will pay it? |
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