To start with, the good news: the British public does not want the NHS to be replaced with an insurance system. Of those questioned for the latest British Social Attitudes survey, 94% support the existence of a health service that is free at the point of delivery and 86% think it should be funded mainly through taxes. But beyond this striking support for the principles that are the service’s bedrock, there is little or no comfort to be found in these results. At 36%, overall satisfaction with the NHS is at its lowest level since 1997. A 17 percentage point fall between 2020 and 2021 in the number who are satisfied is the steepest ever.
Troubling though it is to be confronted with such numbers, and the painful reality to which they point – of people not getting the treatment that they need, including for cancer – the crisis now facing the country was not only predictable but predicted. With 7.4 million people on waiting lists for treatment in England, Scotland and Wales, a huge proportion of the population is now being directly affected by delays. Coupled with the publication of Donna Ockenden’s distressing report into failings in maternity care by the Shrewsbury and Telford hospital NHS trust, the research is rightly prompting widespread alarm.
The crisis engulfing the system due to long-term underinvestment must not, of course, be elided with the specific events in Shrewsbury. The Ockenden report uncovers appalling failures of management, culture and practice, and concludes that the lives of 201 babies and nine women were needlessly lost. That the investigation took place at all was only down to the courage of the families, in particular those of two babies who died soon after birth – Pippa Griffiths and Kate Stanton Davies. Their parents began the work of collecting other cases.
Poor care in Shropshire was compounded by a deadly unwillingness to admit to mistakes, while the hospital became gripped by an erroneous belief in its own success based on a low rate of caesarian deliveries. An adversarial culture, with midwives and doctors in opposing camps, contributed to multiple errors, including a lack of foetal heartbeat monitoring. But while it is essential to note what is distinctive about these findings, resemblances must also be heeded – for example, to failings in maternity care at Morecambe Bay and East Kent.
Poor training, staff shortages and weak management are all cited as contributory factors by the Ockenden report. There is no suggestion that all patients face the same risks as pregnant women in Shrewsbury did. But nor are these problems the unique features of a handful of maternity departments. While the current shortage of 2,000 midwives in England is particularly acute, there are rising numbers of vacancies across the NHS and in primary care as well as hospitals. Making it easier to get a GP appointment was the single most popular answer to the question of how the NHS could be improved, cited by 48% of respondents to the British Social Attitudes survey.
Boris Johnson fought the 2019 election with a raft of promises to improve the health service. While new investment is being made following years of cuts, specific pledges have not been met. Waiting-time targets that are supposed to be legally binding are broken as a matter of course.
Covid is of course a factor in all this, as the public understands. But it is not the only one. With a 184-bed private hospital due to open shortly in London, while the number of NHS vacancies skyrockets, ministers are – through their actions if not their words – showing a preference for the kind of tiered health system that the public rejected in the 1940s. Conservative MPs were whipped to vote against an amendment to recent health legislation that would have made workforce planning a legal requirement. With millions of people queueing for treatment, and suffering while they do it, ministers must support the NHS to meet the needs of the public – as the public demands.
