The sound and fury of the squalid scramble to lead the nasty party ignores all the real crises. The burning planet is nowhere on the agenda, bar locking up climate protesters. As the pay crunch heads for almighty strikes due to the public sector falling even further behind private pay, their remedies are agency strike-breakers and tax cuts that reward better-off people most.
But oddest of all is that there is so little said about the NHS gasping on a life-support machine, even though it ranks high in voters’ concerns. A devastating report from the Commons health and social care select committee reveals “the greatest workforce crisis” in its history, with long waiting lists caused by a shortage of 105,000 doctors, nurses, midwives and others.
The current cabinet may dismiss this as a revenge grenade from the committee chair, Jeremy Hunt, after his rejection in the leadership contest. But the sheer scale of staff shortages exposed is so gigantic that there’s no denying what voters themselves can see. Ahead it gets worse fast: with a growing and ageing population, another 475,000 clinical staff and 490,000 more social care staff are needed in the next decade.
When the largest hospital trust in Tory Essex declares its cancer waiting list is “unmanageable” and ambulances stuck outside hospitals across the country fail to reach heart attack and stroke cases, this looks like a service sinking under a backlog of defeat. No wonder the number of patients scraping together funds to buy one-off private treatments has risen by 39% since before the pandemic. It doesn’t help that the government pretends Covid is over, when the British Medical Journal and Health Service Journal editors’ rare joint editorial raises the alarm that weekly hospital admissions of Covid-positive patients in England have averaged 9,000 so far this year – compared with an average of under 6,000 last year and under 7,000 in 2020 – and with over 28,000 deaths.
Politically, Covid has sunk into the Tory culture war: to say the NHS is not successfully “living with Covid” is akin to saying Brexit isn’t working. Yet having so many beds taken by Covid patients means the waiting list backlog targets are falling further behind, and there are an estimated 2 million people living with long Covid in the UK. But says Alastair McLellan, the editor of the HSJ, the government effectively “pretends Covid no longer exists”.
As for humbug, in Boris Johnson’s bizarre statement of his achievements to the Commons last week, he dared to include the NHS: “more doctors and around 30,000 more nurses” (though far too few) and “the start of Britain’s biggest hospital-building programme” (with nugatory cash for his mythical 40 new hospitals). This week’s Sunday Times editorial is an eye-popping example of Conservative NHS thinking. It admits the crisis, but claims the cause is that “Successive governments have ducked real NHS reform”. That ignores David Cameron’s disastrous and expensive fragmentation “reform”, labelled by the NHS head at the time as “big enough to see from space”. Are they oblivious to the Tories’ second almighty NHS re-reform legislation now in progress, reorganising everything into integrated care systems?
But “reform” is Torydom’s perennial coded NHS threat, never spelling out their meaning because voters wouldn’t like it. The salient point of this editorial is that money is not the answer, but this untruth needs skewering: “The New Labour era showed us tipping cash into the top of the NHS funnel does not work.” Yet starved of money since 2010, the NHS is failing as never before. In 2010 Labour bequeathed an NHS with its lowest ever waiting times, highest patient satisfaction, lowest use of private operations and, yes, it almost reached EU levels of spending, according to John Appleby, research director of the Nuffield Trust. Now France has 11% more doctors per capita and Germany 48% more, and virtually all EU countries have more beds.
Rishi Sunak and Liz Truss pretend the past is another country. But they can’t whitewash history: they voted through the austerity spending and training cuts that caused this crisis. Sunak says he will put the NHS on a “war footing”, with a “backlogs taskforce” to set even more challenging waiting time targets than those already being badly missed before the pandemic. He tells the Daily Express that patients will get the right to have a nominated family doctor if they want one rather than being simply attached to a surgery, a fantasy he can’t possibly believe, since Hunt has told him home truths about medical staffing, including 6,000 missing GPs and numbers still falling.
Hunt tells me that when Sunak was chancellor, he showed him how underfunding training is a false economy when £6bn is wasted a year on locums filling vacancies. But Sunak was adamant in refusing to allow an independent workforce plan for future NHS staffing, for the usual Treasury reasons: spelling out the numbers would force the Treasury to fund NHS needs. Hunt admits that as health secretary he failed on training. We now have a health secretary, in Stephen Barclay, who belongs to the “NHS is a bottomless pit” school of punishment.
A strong economic case for funding the NHS came from Financial Times data research last week. Why has Britain alone lost large numbers of people from our workforce, who are urgently needed to raise growth and productivity? The number matches the chronically ill people of working age who are waiting for operations – a number not found in other countries, says the FT. Long waiting times damage the economy.
So what would Labour do, when there is no instant remedy for the past 12 years of damage? Wes Streeting, the shadow health secretary, tells me he will immediately launch massive training programmes for future NHS staff: plenty of the qualified apply to train. But that takes years to yield results. One urgent need is to stop so many exhausted staff leaving; seeing help arriving over the horizon is one step. As a purely temporary measure until more consultants are trained, he would relax pension rules that cause many in their 50s to quit: that’s costly, until a new cadre of valuable doctors is trained.
But the fastest way to grow capacity is by releasing NHS beds blocked for lack of social care. Labour’s promised National Care Service would train care staff on the same career path and pay grades as the NHS, stemming the alarming flight of care workers – an extra 50,000 have left in the past year. That would treat valued carers as they deserve. I joined Citizens UK demonstrating last week outside the big care companies, all reaping fatter profits than pre-pandemic, yet paying staff below the real living wage. One by one, care workers told of their hardship on pitiful pay, even though “You clapped for us”. And yet the Conservative leadership frontrunner Liz Truss would give away £30bn in tax cuts to better-off people. That money would go a long way in NHS and social care pay.
Polly Toynbee is a Guardian columnist
