Things got so tough in the NHS last winter we said “never again”. Preparations this time have been more thorough and extensive than ever before, but here we are again: resources overstretched, staff run ragged, and - too often, in too many places - standards of care compromised and patient safety put at risk. In the past, mild weather and low flu rates helped us scrape by. Maybe if we had been lucky again this year we could, just about, have coped once more.
But it’s not turned out that way. Flu is rising, there is more respiratory illness, and the cold weather is taking its toll. Trusts are doing all they can to provide good care for patients. And every day in the NHS there are countless acts of kindness and compassion by staff who rise above these challenges. But the simple truth is that, within the current funding and workforce constraints, the health service can only do so much.
The simple truth is that, within the current funding and workforce constraints, the health service can only do so much.
If we run the NHS at 100% capacity, day in day out, permanently in the red zone, it’s not surprising that the service can’t cope when we get a high, but entirely predictable, spike in demand.
A lack of capacity
The key problem is a lack of capacity: not enough beds and permanent staff. This is now a year-round problem affecting mental health, community and ambulance services as well as hospitals. But in winter we have more patients who are sicker, requiring more care. If bed occupancy rates are higher than 85 per cent it becomes harder to ensure safe care, and there is less resilience to cope with spikes in demand. Most of the NHS was operating well above that 85% capacity level before winter had even started.
If we run the NHS at 100% capacity, day in day out, permanently in the red zone, it’s not surprising that the service can’t cope when we get a high, but entirely predictable, spike in demand.
NHS Providers, as the body representing frontline trusts, has written today to Jeremy Hunt to call for a proper public review of how well the NHS handled this winter and what could have been done better. We must, in particular, now properly review whether we have sufficient capacity to deal with the demand the NHS knows it can expect. A simple comparison with the last time the NHS met the 95% four hour A&E standard suggests the NHS may be 10-15,000 beds short of capacity, against a current NHS total bed base of around 130,000, recognising that much NHS care is delivered outside inpatient wards.
We must, in particular, now properly review whether we have sufficient capacity to deal with the demand the NHS knows it can expect.
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But this, emphatically, is not just about winter. It’s about whether the NHS can provide the right quality of patient care, 24 hours a day 365 day a year.
A watershed moment
And, make no mistake, we have now reached a key watershed moment. Put simply, the NHS can no longer deliver the standards enshrined in its constitution. Standards that were drawn up to reflect safe, decent, levels of patient care.
Put simply, the NHS can no longer deliver the standards enshrined in its constitution. Standards that were drawn up to reflect safe, decent, levels of patient care.
Last year, for the first time, all the main targets for A & E, ambulances, planned operations and cancer treatment were missed. The Government committed last March to recovering the four-hour A & E target by the end of 2018. This will not now happen. Whilst we recognise the rationale for cancelling elective operations to prioritise emergency care, this will knock performance against this target further off course. Across the piece, we are losing all the hard won gains the NHS made in the 2000s.
We must therefore now urgently review the long term funding settlement for health and care so that we can either sustainably deliver the constitutional standards (which is what NHS trusts want to do), or change them. There has been a lot of speculation about how such a review might be carried out, including calls for a Royal Commission and some form of cross party review.
But we do not have the luxury of time. We need urgent decisions – and only our elected government can take them. Increasing funding for health and social care in our taxpayer funded system has a major impact on overall public expenditure, the tax system and other public services, which all go to the heart of the mission of any elected Government.
Building a consensus
We are all for building a consensus around what needs to be done. But the last time we saw a structural increase in health funding, under Tony Blair and Gordon Brown, that did not require a Royal Commission. It was a clear political decision, supported by a Government commissioned and overseen review, run from the Treasury.
There is plenty of high quality work for this Government to now draw on, notably from the Office for Budget Responsibility on future health and care spending, the Barker Commission on how to pool health and care funding, and several all party parliamentary committees which have looked at what is needed to create a sustainable NHS. This is not just about funding, but also ensuring we have the right workforce and deliver care in the best way to meet future needs.
This is not just about funding, but also ensuring we have the right workforce and deliver care in the best way to meet future needs.
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This work should underpin a clear government-led process so that the key decisions can be announced in this November’s Budget. Failure to act now will lead to the targets moving further beyond reach. This would harm the quality of care, causing delays and distress for patients and weakening staff morale. It could also undermine public faith in the NHS. There is so much at stake. We can fix this, but there must be no more delay. The ball is now firmly in the Government’s court.
This article was first published by the Guardian on 11 January 2017
Read our press release and the letter in full.