Last week, a hospital trust in Bury offered condolences to the family of an elderly patient who died in the back of an ambulance after waiting three hours just to get into A&E.
The doctors went out to try to treat the patient in the vehicle, but unfortunately to no avail. It’s the kind of story that sounds like it’s something unique and shocking, but could soon become more mainstream. An anonymous paramedic later spoke to the Manchester Evening News about the patients waiting up to eight hours in ambulances, being treated inside them, and then being driven home without even making it through the gates of a hospital that was packed to overflowing.
Only in recent days have reports been seen in the Health Service Journal (HSJ) from a Liverpool hospital. redesignation of a corridor as a room locking doors at both ends, and a heartbreaking letter to this newspaper from a reader describing the nine and a half hours her 91-year-old brother spent lying on the ground with a broken shoulder waiting for an ambulance. The letter writer understood that there had been a lot of drama in Westminster lately, but felt that what was happening to the NHS should be “top of everyone’s mind” now. Frankly, she had a point.
As it happens, I heard Rishi Sunak’s first address to the nation as Prime Minister on his way back from a routine hospital appointment. The staff was great, but the clinic was basically a prefab in an old parking lot: in high winds it’s noisy and in winter, the nurses said, it’s pretty cold. This clinic was in a specialty that must have been expanding very quickly lately, so understandably there are some tweaks and fixes. Still, it was not reassuring that when Sunak was asked in parliament this week whether the 40 “new hospitals” that Boris Johnson falsely promised are definitely still up and running, he did not answer at all. Meanwhile, next week, the Royal College of Nursing will reveal the results of a strike vote on pay.
As the dust settles around this month’s prime minister, we can now see its shape more clearly. The country feels more balanced, and the polls will likely drop out of sheer relief that he’s not Liz Truss. But he remains living proof that he can be young, hip and genuinely affable, but not necessarily a cuddly Tory liberal; that, if anything, the idea that he is some sort of wet centrist is a reminder of how far to the right the Conservative Party has moved of late.
Sunak clearly plans to reoccupy the electoral sweet spot, socially conservative but economically to the left of traditional conservative thinking, identified in 2019 by Boris Johnson, except without the associated toxic behavior by Johnson. That makes perfect electoral sense, given that a report this week for the center-right think tank Go ahead show it’s the call leftist authoritarian voters – hardline on immigration but keen to help people with low incomes and more money for the NHS – who have defected from the Conservatives in large numbers for Labor. Sunak’s amazing decision to reelect Suella Braverman, days after she resigned in disgrace from a job she shouldn’t have been doing in the first place, suggests she’s certainly doing her best to tick the socially authoritarian box. Yet the economically left-leaning side looks much tougher than it did in 2019, when Johnson was still gleefully promising an end to austerity. How Sunak responds to a potentially brutal winter ahead for the NHS, with seven million patients already on waiting lists, is now a crucial test.
The health secretary he chose, Steve Barclay, has a formidably aggressive reputation earned in his Treasury days. (In an unusual twist, the opposite is arguably true for the new chancellor, former health secretary Jeremy Hunt.) HSJ, normally moderate, greeted Barclay’s first brief stint on the job this summer under Johnson with an editorial titled “Steve Barclay is NHS leadership’s ‘worst nightmare’”, suggesting that he saw the service as a “bottomless pit, resistant to change and irresponsible”. HSJ editor Alastair McLellan calls it “the millwall of health secretaries”, someone who proudly bears the dislike of NHS leaders.
In September, Barclay identified ambulance delivery times as its top priority in a speech to the Policy Exchange think tank, 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 for discharge. This means that those who actually enter A&E cannot be moved to the wards, and those waiting in ambulances are sometimes unable to get through the door. Addressing one means addressing bottlenecks throughout the system. But he also complained that there was “too much management” in the NHS, a darling of the Conservative right that is increasingly used to back demands for yet more so-called efficiency savings, but is often eerily short on details.
Overmanagement is not what makes the NHS sick. The truth is skyrocketing inflation plus anticipated wage awards are already straining budgets, while recent analysis by the health think tank Nuffield Trust suggests that once you factor in the growing demand for health care from a population in growth and aging rapidly, even in real terms the spending increases 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 leadership campaigns, Sunak declared that putting more money into the NHS was “not enough; we need to reform things so that we can be more efficient.” But what that meant was never fully explained; all we really got from the summer about sunak thinking is that his father was a GP and his mother a pharmacist, and now he wants to fine people for missing appointments.
NHS reform need not be just a weasel euphemism for cuts and privatisation. There are perfectly benign and sensible ways to deal with the fact that hospitals are full of people who really shouldn’t be there, most notably through social care. We can also do more to prevent people from getting sick, including using the recently revived leveling agenda to help address health disparities in the poorest communities.
But there are ominous rumblings in the broader Conservative at the moment about whether the NHS is sustainable at all in its current form, an argument that has lain eerily in the background for a while without daring to show its face. Our correspondent was right: political drama is compelling, but now real life must share the stage.
