Back to reality for the NHS

Election is a time of politics. We’ve had a stark reminder over six weeks that in many ways it’s a time of fantasy politics, with policies and promises designed to cut through to voters rather than necessarily address reality.

The election is now over and we have a new Conservative administration with a substantial majority. One of its first tasks has been to draft today’s Queen’s Speech, and reality must be starting to kick in. What has been striking, and welcome, has been the emphasis the prime minister continues to place on the NHS. Speaking the day after his victory Boris Johnson said "I have heard it loud and clear from every corner of the country – that the overwhelming priority of the British people now is that we should focus above all on the NHS". So what is that reality?

For the NHS it is the scale of the task that lays ahead. The best illustration of this is the current performance figures. The restrictions of the pre-election period have meant these have not been published for a while. Their publication last Friday showed that performance in the hospital sector and across the urgent and emergency care pathway reached the lowest point in the 10 years since we have been monitoring the constitutional standards. And we know the pressures are just as great in community and mental health services, although not yet measured in the same way.

Election is a time of politics. We’ve had a stark reminder over six weeks that in many ways it’s a time of fantasy politics,

Saffron Cordery    Interim Chief Executive

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Here’s what some of the data said. In November, only 71.3 % of patients at major A&E departments were seen within four-hour waiting time target – the lowest on record. Bed occupancy, at 94.9%, was much higher than recommended levels. The number of ambulance arrivals over the week breached 100,00 for only the second time ever. You get the picture.

Although quality of care once you’re in the system has held up remarkably well, timely access to treatment in the NHS has been slipping for years, despite NHS frontline staff working harder than ever – so hard they’re in danger of burning out. Demand has been steadily outstripping supply, the gaps in the workforce have widened substantially, capital assets have deteriorated and financial investment has been lower in the past decade than at any point in the NHS’s 70 year history.

With a big majority, the prime minister has the opportunity to be bold. We need that. The legislation on the NHS expected in today’s Queen’s Speech will help. But, in reality, the boldest move by the prime minister would be to right some wrongs and tackle those issues that stand in the way of transforming our health and care system. These are:

• a sustainable solution to the current social care crisis, with an adequately funded adult social care system that meets the needs of older and vulnerable people
• a reversal of the cuts to public health spending and substantial investment across all local council prevention services
• a move away from the hospital-centric focus to invest in and sustain mental health services, boost primary care and enable community services to make inroads into cutting current and future demand.

In reality, the boldest move by the prime minister would be to right some wrongs and tackle those issues that stand in the way of transforming our health and care system.

   

The next bold move would be open public recognition of the scale of the task facing the NHS. We’re setting up hard working health service staff to fail if we pretend that taking NHS funding back to below its historic long-term average is going to enable us the service to keep up with rising demand, close the gap that’s opened up over the last decade and invest in the transformation it desperately needs. We need the government to be honest about what the extra funding, welcome as it is, can realistically buy. We need realism on how long it will take to get NHS performance back to where it ought to be and how long it will take to transform the way care is delivered to meet future needs.

So, alongside the pomp and ceremony, today’s Queen’s Speech is all about politics. Of course it’s the politics of a programme for government from a new administration. But, critically for the NHS, it should be the politics of reality and the politics of delivery.

This was also published in the Independent.