After fourteen years of Conservative rule, the NHS is in serious trouble. Waiting lists are at an all-time high, public satisfaction at an all-time low and life expectancy is falling. But Labour’s two flagship policies for restoring the NHS – increasing the number of medical appointments and doubling the amount of CT and MRI scanners – aren’t enough to bring it back to health, argues Andrew Street.
The NHS turned 74 on July 5, the day that Labour was returned to government. At the end of Labour’s last time in power, in 2010, the NHS was 60 years old and in good health. Public satisfaction was at an historic high, waiting lists and waiting times were as low as they had even been, life expectancy was improving, and the UK’s health system was ranked among the best in the world. Fourteen years later, all of this has been reversed: public satisfaction is at an all-time low, more people are waiting for treatment than ever before, life expectancy is falling for the first time ever during peacetime.
From being in top form when 60 years of age, at 74 the NHS has collapsed and is now more like a patient in intensive care. The condition of the NHS in England is particularly bad, almost entirely a consequence of Westminster’s Conservative government policies. The Scottish, Welsh and occasional Northern Ireland governments have looked after the NHS in their countries better, but it’s not in great shape anywhere in the UK. As the dominant political force, it will largely fall to Labour to set things right. Their two flagship policies are not enough.
It’s going to be challenging enough to get striking doctors back to work in the first place, let alone take on anything extra.
Extra appointments
The first is to tackle waiting times by creating an extra two million operations, scans and appointments a year. Two million sounds a lot, but represents just 2 per cent of annual activity, probably not enough to eliminate long waiting times. The plan is that existing staff will deliver these extra appointments by working overtime. This doesn’t seem very realistic: it’s going to be challenging enough to get striking doctors back to work in the first place, let alone take on anything extra. Staff are still burnt out after the pandemic, so much so that many have decided to give up on working for the NHS: there are now 125,000 staff vacancies. This means that remaining staff are already having to work longer to cover for these missing colleagues; there is little, if any, capacity for these staff to take on even more work.
This workforce crisis has been long in the making. From 2010 until 2023, first the coalition and then subsequent conservative governments dispensed with workforce planning. This is extraordinary given that the NHS is one of the world’s largest employers. We haven’t been training enough doctors and nurses; Brexit and increasingly stringent visa rules have made it ever more difficult to recruit from overseas; and pay erosion is encouraging existing staff to look for work elsewhere.
It’s not just scanners that we are lacking. There aren’t enough hospital beds, again fewer per capita than in most other European countries.
More scanners
Labour’s second flagship policy is to double the number CT and MRI scanners, to speed up diagnoses particularly for patients with cancer. The UK is close to the bottom of the European league when it comes to scanners per head of the population, and this is one of the reasons that our cancer survival rates are worse than in comparable countries.
But it’s not just scanners that we are lacking. There aren’t enough hospital beds, again fewer per capita than in most other European countries. So if you are unfortunate enough to have to be admitted to hospital, you might end up sleeping on a trolley in the corridor rather than in a bed on a hospital ward. There is a record backlog of repairs that need to be carried out on NHS buildings. Computer systems are outdated and an easy target for cyber attacks. A ransomware attack on June 3 has meant staff across south London still can’t access diagnostic tests electronically so are having to share test results with each other by using pen and paper. We’re a long way from the promised digital transformation to better harness healthcare technology.
Again this situation reflects badly on previous conservative governments which have overseen under-investment in NHS buildings and equipment. This has come about because money earmarked for capital spending has been regularly re-directed to pay for day-to-day activities instead. Cuts to capital spending might not be immediately apparent but become highly visible after fourteen years. We now simply do not have a physical or technological infrastructure that is fit for purpose in the 21st century.
Care plans are needed to support recovery
Given how long it takes to train doctors and nurses, it will be many years before we eventually have the right number and mix of NHS staff that we need across the UK. A priority for Labour will be to start putting the 2023 workforce plan into action. At least the promise to train 8,500 more mental health staff is a start.
It’s going to take a lot more than Labour’s manifesto promises to get the NHS out of intensive care and into rehabilitation, let alone up and running once again
As well as sorting out the workforce crisis, the new governments in Belfast, Cardiff, Edinburgh and Westminster will also need to develop the NHS estate and infrastructure. Guidance on capital spending typically has focussed more on how much money is (or isn’t) available, rather than how the money should best be spent. It is imperative that the incoming governments develop coherent investment plans for the NHS physical estate and infrastructure, including equipment and technology so that we have the right buildings in the right places, equipped with modern resources, to serve the needs of each country’s aging populations.
As the NHS enters its 75th year, it desperately needs to be nursed back to health. But it’s going to take a lot more than Labour’s manifesto promises to get the NHS out of intensive care and into rehabilitation, let alone up and running once again.
All articles posted on this blog give the views of the author(s), and not the position of LSE British Politics and Policy, nor of the London School of Economics and Political Science.
Image credit: Andrius Kazilunas on Shutterstock
