The NHS, then and now
Health Secretary Jeremy Hunt was up to his usual cherry-picking tricks at the Tory conference, claiming that the brains behind the NHS was not Nye Bevan, but Conservative health minister Sir Henry Willink and his 1944 white paper. In fact, the idea for a state health service is usually credited to the social researcher and poverty campaigner Beatrice Webb in 1909. Lloyd George introduced state organised health insurance in 1911, but for workers only. Lord Dawson, President of the Royal College of Physicians, reported in 1920 that ‘the best means of maintaining health and curing disease should be made available to all citizens’ and it was William Beveridge who first proposed ‘cradle to grave care’ in his 1942 report. Willink’s contribution was important – garnering cross party support for a consensus that ‘everybody irrespective of means, age, sex or occupation shall have equal opportunity to benefit from the best and most up-to-date medical and Allied services available. The service should be comprehensive and free of charge and should promote good health rather than only the treatment of bad.’ But it was Bevan who fought the vested interests and made it happen in 1948. The Conservatives voted against the creation of the NHS 22 times, including in the third reading.
Bevan resigned from government in 1951, as a matter of principle over the introduction of prescription charges introduced to meet the demands both on the NHS and of the Korean war. Nothing, it seems, will tempt Jeremy Hunt to resign and five years in he is the NHS’s longest serving health secretary. His conference speech was full of praise for NHS staff and promised that they would get first refusal on any affordable housing built on NHS land that was sold off. Alas, the pressure on NHS finance directors to balance the books is so great it’s likely that any such ‘surplus’ land will be sold off in a hurry and on the cheap, rather than getting a proper market price for it. Hunt was ‘confident’ the 150,000 vital EU health and social care workers would be able to stay after Brexit but 18 months on could offer no guarantee. Many are now leaving, and many more are no longer coming.
Hunt said that the ‘most important thing I have learned as Health Secretary’ is that turning around poor performance in the NHS ‘wasn’t about the staff, it was all about the leadership.’ It’s true that the NHS has some decidedly mediocre leaders alongside the great ones, and with an average tenure of 18 months the job of an NHS chief executive is hardly attractive. But Hunt also knows the NHS and social care system is falling off a cliff edge due to a lack of adequate staff numbers, and to suggest you can ‘lead’ your way out of the danger zone without more staff is laughable. Hunt knows this, but his belated decision to train more doctors, nurses, physician associates and nurse associates is too late.
The current state of play in the NHS makes grim reading. The CQC’s annual report found that more than a quarter of mental health trusts and almost a fifth of acute trusts previously rated “good” have got worse on re-inspection. There are 1.2 million older people with unmet care needs, and 90,000 vacancies in adult social care staffing. 2.5 million patients breached the 4-hour waiting time target, acute bed occupancy rates averaged 91.4% (85% is considered safe), and nursing home closures cut beds by 4,000. Over 2 million days were spent in hospitals by patients who didn’t want or need to be there, but had no alternative. Ambulances were stuck in queues in emergency departments resulting in 680,000 lost hours. Ambulance responses to life-threatening calls have risen by 22.5% over the past three years, and ambulance waiting time targets have not been met since 2015. The waiting list for consultant-led treatment has risen to 3.85 million – 25% higher than it was three years ago. 25,000 operations were cancelled last year in the NHS in England because of a lack of beds. And austerity has made it much harder for people to adopt healthier lifestyles and take the strain off the NHS.
A report by the Children’s Commissioner details ‘shockingly’ poor support from the NHS for children with mental health problems. 50% of local areas failed to meet standards on crisis care. Only 25% of the 210,145 children aged 5-17 with mental health issues received help last year. Vacancy rates for mental health nurses are 25% in London. There were 42,692 reported attacks on NHS mental health staff in 2016-17 in trusts who responded to an FOI, up from 33,620 in 2012-13. There are 1,000 fewer nurses and health visitors than a year ago. The number of GPs have fallen by 3% since September 2015. One in five practices report 2 or more vacancies, and waiting times for a routine GP appointment are commonly 3-4 weeks. None of this appeared in Hunt’s speech, so may not be on the radar of Brexit preoccupied chancellor Philip Hammond. But if he doesn’t get his cheque-book out on November 22, the chances of the NHS being ‘lead’ out of the crisis by Hunt are slim indeed.