Five weeks ago, as the election kicked off, we urged politicians to be straight with voters about what will be needed to sustain our taxpayer funded, free to use, NHS. We warned against letting the public down – yet again – with a superficial political debate on health and care.
Now, as full time nears, how has it gone?
We’ve had lots of impressive sounding commitments, certainly, but in reality the manifestos haven’t offered credible answers to most of the NHS’s biggest challenges. It’s been like touch rugby – watching the parties reach for the key issues without anyone really being prepared to go in for the tackle.
The fundamental challenge for the NHS during the last ten years been rapidly rising demand for care while the capacity to cope – be it workforce, funding, buildings or equipment – hasn’t kept pace, resulting in a widening gap between what’s needed and what can be delivered for patients.
The fundamental challenge for the NHS during the last ten years been rapidly rising demand for care while the capacity to cope – be it workforce, funding, buildings or equipment – hasn’t kept pace, resulting in a widening gap between what’s needed and what can be delivered for patients.
In the face of these pressures it is a huge credit to NHS staff that the health service is treating more people than ever. There have been failings, of course, and we must learn from them. But, it is remarkable how in recent years trusts, as a whole, have not just maintained the quality of care, but actually improved it, according to the independent regulator the Care Quality Commission.
However, we are now seeing the impact of that growing demand / capacity gap in the delays people face in accessing the treatment they need in A and E, for routine operations, for diagnostic tests and cancer treatment. We see it in the growing numbers of people who are seriously mentally unwell and have to travel, sometimes hundreds of miles, for care. And that gap is registering in terms of public satisfaction with the NHS, now at its lowest level in a decade.
The challenge for the health service, and for politicians, is to close that gap and focus on improving services. We need to make up for that lost decade of capacity growth and then modernise the way care is provided to ensure it is delivered quickly, seamlessly and closer to home. We must harness the opportunities presented by new technologies and treatments to meet the growing and increasingly complex needs of an ageing population.
The NHS has a long term plan to do this, but we need our politicians to articulate clearly and honestly what it will take to deliver the full vision, recognising the need as well to strengthen social care and public health. That’s where this election debate has, once again, fallen short.
While, of course, the extra funding commitments we see in the manifestos are helpful, in reality they go no further than restoring NHS funding growth to what they’ve been in past. As a comparison, the last time the health service was in a fix like this, nearly two decades ago, we had eight years of 6% real terms growth. The current increases on offer range between 3.3% and 4.5%. We needed our politicians to be realistic about the scale of the challenge, and either fund it accordingly or be honest about how far the extra funding would go. That’s not happened.
But it’s not just about money. The biggest current problem is securing the workforce the NHS needs. For year after year we have tried to meet rising demand for care by asking staff to work harder. That’s coincided with growing vacancies – now more than 100,000 - adding to pressure on overstretched staff. The result: tiredness, frustration and burnout. This is not what our dedicated staff signed up for when they joined the NHS.
While, of course, the extra funding commitments we see in the manifestos are helpful, in reality they go no further than restoring NHS funding growth to what they’ve been in past.
So whilst we are pleased that parties are committing to increase staff numbers, it’s still not clear how that will actually happen. We lack detail on how the immigration system will help secure our future health and care workforce while we work to improve retention and increase the home grown supply. Similarly, with the NHS pensions crisis that means many senior doctors lose money when they work extra shifts, no party has delivered a credible long term solution that meets the needs of all NHS staff. Both these problems are long standing so it doesn’t seem unreasonable to have expected proper detailed answers.
This election also presented a genuine opportunity for parties to tackle the scandal of our overstretched, underfunded social care services which have a profound impact on the quality of the lives of millions of people and the future sustainability of the NHS. The offers from the main parties have varied in scope and ambition, but none has developed a compelling worked-through and credibly funded long term solution.
So once again we see politicians responding to popular support for the NHS, presenting themselves as its advocates and champions but not really addressing what’s needed to sustain the NHS long term. Health service staff and leaders will continue to do all they can to provide outstanding care but they need more support, more realism and more forward thinking from a political class which has once again talked a good game, but ducked too many of the big tackles.
This was also published in the Times.