Jeremy Hunt will say the NHS is treating fewer patients with more money. Whose fault is that, chancellor? | Polly Toynbee
WInter are coming, as always, and the NHS is creaking and groaning. The chancellor will not hand over the £1 billion he needs to cover the costs of the strikes tomorrow, even as NHS debts mount while almost 7.8 million people in England are on waiting lists.
But Jeremy Hunt will have an easy answer: hot ammunition to hurl at the NHS as he rehearses for the upcoming election. A wave of alarming reports all say the same thing: NHS productivity has fallen since the pandemic, with more money and more staff treating fewer hospital patients. That’s what the authority says Institute for Fiscal Studies (IFS), parliament public accounts committee and the Library of the House of Commons. Here’s what the Chancellor can say: Over the past five years the NHS has had more money and around 20% more doctors and nurses, yet it is treating fewer hospital patients than before the Covid-19 epidemic. Forget asking for more.
But it’s not that simple. Everyone wants value for money, but measuring service productivity is notoriously difficult. What gets measured is what is easy, but often not what actually happens or what matters most. If you double the size of school classes, teachers are twice as ‘productive’. Halve the number of nurses in a department and they double their ‘productivity’. Important note: GPs’ measurable productivity is the exception in the NHS. There are less of them, where we see more patients than before, under great pressure. They offer these services together with other primary care services 90% of all NHS treatments. Patients in 10,000 new beds in “virtual departments”, who are treated intensively at home under hospital supervision, do not appear in these productivity figures.
These thoughtful reports suggest numerous reasons for declining hospital throughput. There are fewer beds than before. Covid-19 is not over yet more than 2,700 beds in England currently occupied by Covid patients. Since the pandemic, infection control has been much more rigorous and has taken more space, work and time.
The failure to deliver Boris Johnson’s promised ‘oven-ready’ social care plan has contributed to a situation where more than 13,000 hospital beds (out of a total of approximately 100,000 beds in England) are filled with people who are medically fit for discharge. The President of the Royal College of Emergency Medicine has called hospitals “lobster traps”: easy for the weak to get in, hard to get out.
Best to forget the Tories manifesto promise to make the NHS the “best place in the world to give birth”, given the terrible Care Quality Commission (CQC) reports on maternity wards.
More difficult to measure is the attrition and change in experience level of NHS staff. Many who gave it their all during Covid ran out and left, the most experienced being replaced by beginners. (A new surgeon has to undergo fewer operations.) Absenteeism due to illness is higher. Those who were once willing to work extra hours – paid or often unpaid – are reluctant: the government’s political attempt to weaponize wage demands caused damaging strikes that always leave the workforce discouraged.
Now add the shocking cuts to spending on buildings, diagnostic equipment and IT, with trusts being instructed to spend their capital budgets on daily care, committing the fiscal sin of mortgaging the future. Forget the forty new hospitals, most of which are unlikely to be built.
In terms of money, years of drought have left long-term scars, with NHS funding barely rising as the number of patients and population increased. The average budget increase of 2.9% per year for the five years to 2024-25 is well below the NHS target, according to the IFS. 3.6% lifetime average – let alone the 7% in the Labor years that left an NHS in the best condition ever.
And then there are the patients. They are older and sicker, and the longer they wait for treatment, the worse their condition. Long Covid has weakened many. All of these reports report greater disease severity, with patients requiring longer hospital stays. The increase in life expectancy is slowing, and for some the reverse is true. The gap in health outcomes between the north and south of England is widening, reflecting the wealth gap. In terms of quality, the CQC rates 68% of hospitals in London as inadequate or requiring improvement.
Expect the government to shift the blame onto the NHS and its staff, hoping everyone forgets the austerity years, and the catastrophic Andrew Lansley reforms of 2012 that blew the NHS into competing fragments, so chaotic that more reforms are still needed be implemented to restore them. Hunt might pause for a moment to remember who was in charge of NHS England during six of these drought years of declining performance.
This is Victoria Atkins’ harsh legacy as she takes over the health and social care department. She arrives full of brio, like a “optimist‘ who is ‘determined to sit down with the doctors’: let’s hope she had the wisdom to take the job only on the condition that she could reach an arrangement with them quickly, before the winter flu and illness take over that ambulance queues outside hospitals are getting longer.
All this will also be Labour’s legacy: with waiting lists still rising, you can hardly expect any improvement in a year’s time. Wes Straating promises that the £1.6 billion tax recovered from non-doms will buy thousands more mental health staff, district nurses, health visitors and others. By his speech At last week’s NHS providers conference, expect a repeat of Harold Wilson’s ‘white heat of technology’ in Labour’s health plans, with hopes from genomics and AI, alongside his emphasis on community and prevention. Drawing on the work of Michael Marmot, professor of epidemiology, on greater equality, he emphasized that health is determined more by social circumstances than by NHS treatment.
Like all shadow ministers faced with a pinching spending line, he is keen to find improvements and efficiencies that pay for themselves. He examined an anesthesiologist Dr.’s program Kariem El-Boghdadly at Guy’s and St Thomas’ NHS Foundation Trust, whose high-intensity theater lists on Saturday traversed four times as many operations just as safely, maximizing every minute: the fastest turnaround, he tells me, was just 30 seconds.
Then there’s the Leeds Teaching Hospitals Trust, where the chief executive, Prof Phil Wood, tells me that this year he has reduced the 350 beds blocked by patients waiting for social care to 200 by removing discharge bottlenecks to work and release people to cheaper, nurse-led recovery centers. . Working closely with Leeds City Council, he pays NHS money for social care: it’s a saving to increase the salaries of care staff, avoiding their flight to the better-paying Amazon warehouse nearby.
Why can’t everyone be as good as the best? Every new Minister of Health asks that, as if everyone could rise above the average. After the disastrously disruptive Tory ‘reform’, the very word is poisonous in the NHS. Streeting hopes that Labor, with at least a little more money, will arrive with more goodwill after the Tories’ poor treatment of staff, not by clapping but by attacking them. Increasing productivity, however it is measured, means rolling out efficiencies and innovative ways of working. They exist. It can be done. If not, the NHS will come under increasing attack from all its old enemies.