Last week, a hospital trust in Bury offered its condolences to the family of an elderly patient who died in the back of an ambulance after waiting a reported three hours just to get into A&E.
Doctors came out to try to treat the patient in the vehicle, but unfortunately to no avail. It’s the sort of story that sounds as if it should be a shocking one-off, but may soon become more common. One anonymous paramedic spoke afterwards to the Manchester Evening News of patients waiting for up to eight hours in ambulances, being treated inside them, and then being driven home without ever actually managing to get through the doors of a hospital that was full to overflowing.
The last few days alone have seen reports in the Health Service Journal (HSJ) of a Liverpool hospital redesignating a corridor as a ward by closing the doors at both ends, and a heartrending letter to this newspaper from a reader describing the nine and a half hours her 91-year-old brother had spent lying on the floor with a broken shoulder waiting for an ambulance. The letter-writer understood there had been a lot of high drama at Westminster lately, but felt that what was happening to the NHS should be “foremost in everyone’s minds” now. Frankly, she had a point.
As it happens, I listened to Rishi Sunak’s first speech to the nation as prime minister on the way back from a routine hospital appointment. The staff were great, but the clinic was basically a prefab in an old car park: in high winds it’s noisy and in winter, the nurses said, it gets pretty cold. This clinic was in a specialism that must have expanded very fast lately, so some make-do-and-mend is understandable. Still, it wasn’t reassuring that when Sunak was asked in parliament this week whether the 40 “new hospitals” Boris Johnson rather misleadingly promised are still definitely happening, he didn’t quite answer. Next week, meanwhile, the Royal College of Nursing will reveal the results of a strike ballot over pay.
As the dust settles around this month’s prime minister, we can now see the shape of him more clearly. The country does feel on a more even keel, and the polls will probably narrow from sheer relief that he isn’t Liz Truss. But he remains living proof that you can be young and modern and genuinely affable but not necessarily a cuddly liberal Tory; that if anything, the idea he’s some kind of centrist wet is a reminder of how far right the Conservative party has moved lately.
Sunak clearly plans to reoccupy the electoral sweet spot – socially conservative but economically left of traditional Tory thinking – identified in 2019 by Boris Johnson, except without the associated toxic Johnson behaviour. That makes perfect electoral sense, given that a report this week for the centre-right thinktank Onward shows it’s the so called left-authoritarian voters – hardline on immigration but keen on help for low earners and more money for the NHS – who have deserted the Tories in large numbers for Labour. Sunak’s staggering decision to reappoint Suella Braverman, days after she resigned in disgrace from a job she shouldn’t have been doing in the first place, suggests he’s certainly going all out to tick the socially authoritarian box. The economically leftwing bit, however, looks a lot harder than it did in 2019 when Johnson was still sunnily promising an end to austerity. How Sunak responds to a potentially brutal winter ahead for the NHS, with seven million patients already backed up on waiting lists, is now a crucial test.
His chosen health secretary, Steve Barclay, has a formidably hawkish reputation earned in his days at the Treasury. (In an unusual twist, the reverse is arguably true for the new chancellor, former health secretary Jeremy Hunt.) The normally restrained HSJ greeted Barclay’s first brief stint in the job this summer under Johnson with an editorial headlined “Steve Barclay is the NHS leadership’s ‘worst nightmare’”, suggesting he saw the service as a “bottomless pit, resistant to change and unaccountable”. The HSJ’s editor, Alastair McLellan, calls him “the Millwall of health secretaries”, someone who wears NHS leaders’ dislike with pride.
Back in September, Barclay did identify ambulance handover times as his top priority in a speech to the Policy Exchange thinktank, which is a promising start. Mainly thanks to holes in social care, the NHS has 12,000 beds occupied by patients who are medically fit to discharge. This means those who actually make it into A&E can’t be moved on to wards, and those waiting in ambulances sometimes can’t make it through the door. Tackling one means tackling logjams throughout the system. But he also complained that there was “too much management” in the NHS, a favourite Tory rightwing theme that’s increasingly used to back up demands for yet more so-called efficiency savings, but which is often mysteriously short on detail.
Over-management is not what is making the NHS sick. The truth is that soaring inflation plus anticipated pay awards are already eating into budgets, while a recent analysis for the health thinktank the Nuffield Trust suggests that once rising demand for healthcare from a growing and rapidly ageing population is factored in, even the real-terms spending rises of recent years look more like a period of stagnation. That helps explain why things feel threadbare on the ground, even as billions pour into the NHS. During the leadership hustings, Sunak declared that putting more money into the NHS, was “not enough; we need to reform things so we can get more efficiency”. But what that meant was never quite explained; all we really gleaned from summer about Sunak’s thinking is that his dad was a GP and his mum a pharmacist, and now he wants to fine people for missing appointments.
NHS reform needn’t be just a weaselly euphemism for cuts and privatisation. There are perfectly benign and sensible ways of dealing with the fact that hospitals are full of people who shouldn’t really be there – above all by sorting out social care. There’s more we could do to prevent people getting sick in the first place, too, including using the newly revived levelling up agenda to help tackle health inequalities in poorer communities.
But there are ominous rumbles on the broader Tory right now about whether the NHS is sustainable at all in its current form, an argument that has lingered uneasily in the background for a while now without ever quite daring to show its face. Our correspondent was right: the political drama is compelling, but real life must now share the stage.
Gaby Hinsliff is a Guardian columnist
