The NHS and social care systems need more money. If there is anything else that they need as much, it is honesty from the government. Post-Covid, the UK’s health systems are in a perilously fragile state. As analysis by the Guardian showed this week, logjams created by delayed discharges appear to be getting worse. An average of 13,600 hospital beds in England are occupied by patients with nowhere else to go. As well as making new admissions impossible, unnecessarily long stays can make it harder for people to regain their independence after leaving. So far, a £500m emergency fund promised by ministers to ease the pressure has failed to materialise.
It is a symptom of the social care crisis that hospitals find it so hard to discharge people who are well enough to leave. Last year, Jeremy Hunt, then chair of parliament’s health and care committee, said social care needed £7bn annually, not the £1.7bn over three years that ministers promised. Chronic workforce shortages in the sector, which are linked to funding shortfalls and inadequate pay, are one reason why social care capacity lags so far behind demand – leading to blockages throughout the health system. Currently there are an estimated 165,000 social care vacancies, after 50,000 staff quit last year.
In the NHS too, vacancies have rocketed, with almost one in 10 posts unfilled. At a time when demand has never been higher, this situation is untenable and creating new risks as patients struggle to access appointments and treatments while staff morale is undermined. The waiting list now stands at 7.1 million people in England, with almost 2 million more across Northern Ireland, Scotland and Wales. This is the longest ever, and 60% higher than before the pandemic. Delays have been linked to 30,000 excess deaths involving heart disease alone.
Mr Hunt was brought in as health secretary to clean up the mess left by his predecessor, Andrew Lansley – and went on to preside over decline of a different sort. Between 2010 and 2015, the NHS budget grew by 0.9% a year on average, an unprecedented squeeze when rises of around 4% were needed to keep pace with demographic changes as well as advances in treatment and technology.
Under Theresa May, funding increased. But the enormous burden placed on the NHS by the pandemic since 2020, combined with long-term failures in workforce planning, mean that the overall situation has dramatically worsened. Mr Hunt knows this better than most of his colleagues. As chancellor, he must speak plainly about the size of the challenge and how the government plans to meet it. This includes driving through proposals for a workforce strategy with the health secretary, Steve Barclay, as well as funding increases.
Mr Barclay and Rishi Sunak have both been challenged by members of the public over the state that health services are in. By accepting £400,000 to appear on ITV’s I’m a Celebrity … Get Me Out of Here! barely a month after the Covid-19 public inquiry opened, the former health secretary Matt Hancock has displayed exceptional crassness. However, the current problems were not caused by any one individual – but by 12 years of Conservative government. Health and care services have been set up to fail by being underequipped to meet rising demand. This crisis is not going to be fixed overnight, and could get worse before it gets better. But a dose of realism from the chancellor would be helpful.