November 2019 saw the worst four-hour wait performance in A&E since figures were first collected, back in 2010. This has been matched by failures on key targets for cancer, GP appointments and hospital treatment waits. At the same time, rationing of medicines is on the increase – with failings being increasingly revealed in ambulance services, mental health support, and for people with learning disabilities.
Given all of this, it’s a huge tribute to NHS staff that so much care remains of a very high quality. But the calamitous drop in performance over the past decade is having an impact on patient safety as well as leading to longer waits.
Just before Christmas, the Norfolk and Norwich University Hospital advised staff to make the “least unsafe decision”, following a huge rise in admissions. It was not an isolated incident. Indeed, 2020 has already seen the Royal Cornwall Hospital NHS Trust tell its staff to help reduce severe overcrowding by discharging patients – despite the obvious risks involved.
While many factors and pressures are at play, the alignment of austerity with workforce shortages, inadequacies of adult social care and a complete failure to factor in a growing older population, means it’s little surprise the NHS is reeling.
The lowest five-year period of funding growth occurred over the 2010/11 to 2014/15 period and the past five years have seen little improvement. Is it any wonder that the NHS is cash-strapped, in deficit and finding it very hard to invest the resources necessary to prevent hospital admissions? Latest estimates by the Health Foundation show a shortage of more than 100,000 staff, including 40,000 nurses.
All of this is happening when social care is in meltdown. By 2018, the House of Lords Economic Committee had reported that 1.4 million older people in England had an unmet care need. The number of older people and working-age adults requiring such care is increasing rapidly, yet public funding declined in real terms by 13% between 2009/10 and 2015/16.
To date, the government’s response has been inadequate. A new five-year settlement of around 3.4% growth per annum is welcome. But that’s still less than the 4% most commentators think is required annually. And as NHS leaders have pointed out, it does not include areas of funding crucial to the well-trailed Conservative election promise that it would be provide more hospitals, nurses and GP appointments.
So, no additional money to cover investment in buildings and equipment – meaning little relief for crumbling infrastructure or the funding of new technology. No additional money to cover education and training budgets, to help tackle the NHS workforce crisis. And no additional money for public health and social care services, to help keep people healthy and independent. It’s tantamount to mis-selling.
On current financial and demographic projections, the gap between what is expected and what is delivered will widen. Only yesterday, a damning National Audit Report (NAO) concluded that while the NHS may be treating more patients, it has not yet achieved the fundamental transformation in services and finance regime to meet rising demand. In fact, short-term fixes have made some parts of our health service seriously unstable.
In a House of Lords debate today (Thursday), I will challenge Ministers to face up to the long-term funding challenge, to reform social care, improve recruitment, retention and training, and – most importantly – set the NHS on a secure path for the future.
Lord Philip Hunt of Kings Heath is a Labour Peer and former Health Minister.