0736 GMT November 18, 2019
Tens of thousands of patients have seen their surgery postponed. Targets for waiting lists and times have been dropped. Accident and emergency centers are close to breakdown, while patients are lined up on trolleys in the absence of hospital beds. Hunt’s apology is well merited. It is not enough, ft.com wrote.
The chaos — the worst since the 1990s — was predicted and predictable. The winter months have always put pressure on the state-funded health service. But the expected seasonal upswing in demand for treatment from an ageing population has now collided with a number of secular trends. Since 2010, the government has imposed on the NHS the fiercest financial squeeze since its inception. Simultaneously demography, the spread of chronic illnesses such as diabetes, rising expectations, and accelerating medical inflation have raised demand and costs.
To complete the grim picture, deep cuts in public funding for social care have shifted to the NHS much of the cost of looking after the elderly.
There will always be room for efficiency gains in so vast an institution. The least well-performing parts lag far behind the best. There are too many administrators and not enough front-line medical staff. There should be no let up in efforts to streamline decision-making and reduce bureaucracy. So far the government has not helped. Its supposedly flagship reforms during the last parliament spurred fragmentation and new layers of bureaucracy.
That said, independent analysis shows productivity in the NHS running ahead of the rest of the economy. It is treating more patients for less, a trend confirmed by the Institute for Fiscal Studies. The potential gains are not infinite. Simon Stevens, the head of NHS England, is right in arguing that improved efficiency cannot fully substitute for insufficient funding.
Stevens, a hard-headed professional, has been unsentimental about pushing through change. He has made significant progress in rebalancing NHS provision — above all in shifting the focus of treatment towards primary rather than hospital care. Change demands upfront investment. Hospitals cannot close facilities without parallel expansion of general practice and better public health promotion.
By Stevens’ calculations the NHS needs an immediate injection of funds of between £2 billion and £3 billion to avoid meltdown this year. In the medium term the figures are much larger. Comparable rich European nations such as France and Germany spend between £20 billion and £30 billion a year more.
Narrowing that gap requires a new political consensus — a cross party accord on both the level of new funding and how it should be financed. Such a deal must embrace a sustainable mechanism for the provision of social care for the elderly. It is the UK government’s responsibility to take the lead. The opposition Labour party has said that it would spend more. The government should look for agreement on how such money should be raised. Stale Treasury prejudices against innovative funding mechanisms and hypothecation must be put to one side.
The NHS performs well by international standards. The government’s consuming preoccupation with Brexit cannot be an excuse to allow it to fall into chaos.
The Brexiters’ much-touted claim that leaving the EU would free up an extra £350 million for health was palpably false. But if Britain wants an NHS it can be proud of, the need for extra funding is indisputable.