The last 12 months have been the worst in the history of the NHS. Our health system is under pressure like never before. The moment of crisis many warned of has arrived, and it is not clear that the NHS can be retrieved from this state of affairs.
We used to say that flailing A&Es represented an early warning sign that the health service was under pressure. And so that has proven to be. England’s major A&Es are under record strain with black alerts being regularly sounded, and in some instances wards turning patients away. Last year the A&E crisis spread to other sectors.
Ambulance response times have reached critically low levels, with one third of ambulances failing to meet their targets for life threatening callouts. The acute care sector is bulging with unnecessary admissions particularly from over-75s who are presenting themselves at A&Es when they should be cared for by the social care sector that has suffered £5bn of cuts.
In the community, general practice is on life support; as more is demanded of it, the proportion of the NHS budget that goes to primary care has effectively shrunk. Primary care provides 90% of the consultations in the NHS yet only gets 8% of the budget. GPs are leaving, and new entrants are declining to enter general practice.
We once bickered with the Treasury for clawing back millions in Department of Health underspend under Labour. Under the Tories, that is a distant memory as NHS trusts recorded a deficit in excess of £2bn last year.
A government elected to fix near-bankrupted banks has replaced that by bankrupting our hospitals. Idiotic spending decisions in the NHS have been rife.
The most worrying aspect of the government delivering the lowest additional funding increase to the NHS in its history has been the knock-on effect on patients, in terms of treatment and facilities available. More than 13,000 beds have been closed, cutting the capacity of the NHS by 5 million a year.
So bad was 2016, that nine former health secretaries condemned the government for failing to live up to its promises on mental health.
Commissioners and providers alike have had to resort to rationing care to try to balance their books. Unfortunately, this is not always to the benefit of customers or patients.
As the health service’s budget faces greater pressure than before, it is difficult to ignore the toll the intrusion of the free market has taken. Last year, £13bn of healthcare was purchased from non NHS providers (pdf), a 76% increase since 2010. Given that the private sector has a stated goal to make 8%-14% profits from the NHS, can taxpayers really afford this choice?
While the NHS has increased the cash it takes from the private sector by 30% to £558m last year (pdf), waiting lists have soared to an eight-year high. Now, 4 million patients are on waiting lists. This in effect means NHS patients are being delayed in their treatment to make way for wealthy private patients who can afford to skip the queue.
The pressure on our staff has also reached unprecedented levels. Nurses have seen real-term pay cuts since 2010 of over £2,000. Moreover, aspiring nurses will also be denied a bursary to train and this at a time when unfilled nursing vacancies have climbed 600% since 2010. It will not surprise you to learn that applicants for trainee nursing courses have fallen 20% this year.
Likewise, the pressure on junior doctors remains intense. They too have seen real-term pay cuts, as well as an enforced contract.
It remains impossible to meet the demands of the ill-described seven-day NHS until serious funding issues have been resolved, otherwise we are asking our doctors to shoulder the blame for unsafe care.
The continuing media war Jeremy Hunt has waged against doctors has so depleted workforce morale that there are more doctors wanting to leave the NHS than are in training.
It will take a political will only witnessed twice in the last 70 years, 1948 and 1997, to alter the current trajectory on which the NHS is set. The £22bn of efficiencies (a euphemism for cuts), dressed up as sustainability and transformation plans smacks of what was tried with the Nicholson challenge. The National Audit Office has warned that these efficiencies are not possible without causing lasting damage to the NHS’s ability to provide safe care.
We are at a cliff edge. Do we carry on into the unknown with broken funding promises and more cuts or do we cry foul now, and demand a rethink before it is too late?
Let’s pledge in 2017 to fight for its survival. The NHS belongs to us, not the politicians and not the privateers. We cannot trust the government to be its safe custodian. It’s up to each and every one of us to fight for the NHS, otherwise it won’t be there to look after us, never mind the next generation.
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2016 was the worst year in NHS history – we must fight for its survival
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