Next week sees the new government’s first major domestic policy announcement – on the NHS. What’s needed? There are a number of issues to address.
First, after nine years of scrimp and save, make do and mend, the NHS now has a £6bn maintenance backlog, £3bn of it safety critical. A trust I visited this year had to cancel vital cancer diagnostic appointments as one of its ageing scanners had broken down. Another was trying to treat seriously ill mental health patients on wards built in the 1840s. One had to crash close its intensive care unit as water poured down the walls due to a leaking roof.
After nine years of scrimp and save, make do and mend, the NHS now has a £6bn maintenance backlog, £3bn of it safety critical.
We need to rebuild the NHS. But health service leaders have been told to cut this year’s building and equipment spend by 20%. Next week’s announcement must reverse these cuts immediately, make an early down payment on the rebuilding process, and commit to the longer term funds needed to create a 21st century NHS infrastructure. We need a fair allocation between hospitals, mental health, ambulance and community services. The NHS is a key public service with facilities in every town and city in the land. So, with the right geographic spread, we can also support communities that would otherwise struggle to attract investment – a key benefit of more money for NHS infrastructure. But, unlike previous promises, any new money must be real.
Next week’s announcement must reverse these cuts immediately, make an early down payment on the rebuilding process, and commit to the longer term funds needed to create a 21st century NHS infrastructure.
Meanwhile, waiting lists grow and patient care suffers as current NHS pension rules mean that many key NHS staff actually lose money if they work extra hours. One NHS chief executive told me this week “this problem is escalating rapidly and the negative impact on patient care is real, direct and growing”. The prime minister committed, during his election campaign, to end this perverse absurdity. Next week’s announcement needs to show how the government will do this, with real speed, including recognising that this problem doesn’t just affect senior doctors.
NHS leaders are seriously worried about the risks of a 'no deal' Brexit and are concerned they will get unfairly blamed if anything goes wrong. The government needs to demonstrate that it’s fully, honestly, and realistically assessed those risks, and has deliverable plans to meet them. There’s particular concern about trying to manage the consequences of a 'no deal' Brexit over winter when the NHS is at its busiest.
NHS leaders are seriously worried about the risks of a 'no deal' Brexit and are concerned they will get unfairly blamed if anything goes wrong.
Frontline staff are working flat out to deal with extra demand for NHS services. But they’re struggling to keep up, given we have 300,000 more people a year – 6.5% more year on year – coming to hospital A&E departments, alongside 100,000 NHS staff vacancies. The NHS frontline will be looking for clear recognition of the scale of these challenges and more support to address them – for example, how the prime minister’s new approach to immigration can help address the current NHS workforce gap.
One key driver of extra NHS demand is the current crisis in social care. The prime minister’s commitment to address this is welcome. But he’s the fifth prime minister in a row to make that commitment and none of his predecessors delivered. We need a concrete plan and timetable that mean it really will be different this time.
One key driver of extra NHS demand is the current crisis in social care. The prime minister’s commitment to address this is welcome. But he’s the fifth prime minister in a row to make that commitment and none of his predecessors delivered.
The NHS simply can’t cope long term unless, as a nation, we dramatically improve how we prevent illness instead of just spending all of our money treating it. The prime minister is reported as being against a sugar tax as it smacks of a nanny state. What are the positive things he will do to make the required step change in improving our national health and wellbeing? And it’s worth remembering that the smoking ban has been one of the biggest drivers in improvement in the nation’s health over the last three decades.
The good news is that the new NHS long term plan created at the beginning of the year sets out a clear and ambitious blueprint of how to improve the NHS. Better mental health and cancer outcomes, harnessing digital technology, leading the world in cutting-edge genomics, and many other commitments, promise an exciting future for the health service. But the NHS has had to carefully control the speed at which we can deliver those new benefits for patients, to match the sequencing of extra NHS spending. On current plans we don’t actually reach the Vote Leave extra £350m a week for the NHS pledge until 2023.
So the NHS will be hoping that the prime minister, the individual politician most closely identified with that pledge, will explicitly back the NHS long term plan and bring forward the extra spending needed to deliver it.
This blog first appeared in the Sunday Times.