Hospitals are crammed full of patients, the staffing crisis in adult social care continues to escalate, and alarming numbers of junior doctors report that they are planning to quit their NHS posts to work abroad. The multiple problems confronting the UK’s health and care system are interconnected and have been years in the making. While the pandemic exacerbated many of them, hugely increasing pressures on staff, political failures and, above all, a lack of investment are making it impossible for the service to stand still this winter – let alone recover.
The alarming but very real prospect is that things could get worse. In a Christmas message to staff, the chief executive of NHS England, Amanda Pritchard, said she always worried that “ongoing pressures … could be even tougher” to cope with than Covid. Such fears appear prescient. With figures showing 13,697 inpatients ready to be discharged but with nowhere to go in November, and more strikes expected, Rishi Sunak’s government appears committed to a course of action designed to maximise conflict and disruption.
As chair of parliament’s health and care committee, Jeremy Hunt called for £7bn in additional funding for the social care sector, to prevent it from acting as both a block and a drain on the health service. Appointed chancellor just weeks later, he has not followed through on this conviction. The £500m winter fund created to facilitate discharges has not been increased. With cases of flu now rising sharply, and more people in some parts of England expected to be in acute hospital settings in the new year than for the past seven years, the inadequacy of such measures is painfully obvious.
It is highly doubtful whether Mr Sunak and his colleagues have the will or the courage required to do what is needed. No 10 is reported to have overruled a suggestion from the health secretary, Steve Barclay, that a one-off payment to nurses could ease the deadlock. But the truth is that years of underfunding, particularly in the period 2010-15, when annual health spending increases were held down to an average of less than 1%, badly damaged the service. The lack of a social care strategy, or a public health one aimed at limiting the harm caused by obesity in particular, have made matters much worse.
Ministers want neither to admit these past mistakes nor to explain to the public that if we wish to keep on living longer, fuller lives, with access to the latest drugs, and to be cared for if we develop dementia, then our health and care services need more money. The hourly rate of £4 paid by councils to care homes, for those who need 24-hour care, is derisory. Given that the number of people living with dementia across the UK is expected to rise to more than 1.6 million by 2050, from an estimated 944,000 today, problems including distressing instances of neglect and abuse should be expected to worsen in the absence of dramatically altered public policy.
Whether four in 10 junior doctors will really quit remains to be seen. A pay increase was agreed, but has been overtaken by inflation. The danger is that as conditions worsen, so does morale. Already, frontline workers are at increased risk of being physically attacked. The latest figures from Scotland show that there were almost 20,000 assaults on NHS staff there in the year to March 2022 – a rise of about 34% since before the pandemic.
This is an appalling statistic to set alongside the alarmingly high number of job vacancies, and a waiting list of more than 7 million people in England. Our health and care services are under serious threat. The government’s obduracy in the face of reasonable pay demands could not be further from a solution.