2019 has been a rollercoaster of a year in UK politics. There have been several themes throughout the year, including Brexit, the environment, the NHS, the General Election and the nature of the political debate. In the third of this series, the focus is on the NHS.
For a few years now, there have been countless discussions about NHS funding gaps and any investment being made in the health service only enough to stem decline rather than to further improve it.
Some of the stats make for uncomfortable reading. According to the Health Foundation:
Essential parts of the NHS in England are experiencing the worst performance against waiting times targets since the targets were set.The Health Foundation (https://www.health.org.uk/news-and-comment/blogs/nhs-performance-and-waiting-times#lf-section-49181-anchor)
This covers waiting times in A&E departments and for routine treatments in England. However, there are also problems in Wales and Scotland, even when there are different parties with responsibility for the NHS (due to devolution). Speaking in a more general sense, the Health Foundation adds:
If the NHS is to achieve its long-term vision of a service that can prevent ill-health, better manage long-term conditions, and treat people earlier, NHS staff will need time, space and skills to make change at all levels of the health and care system.The Health Foundation (https://www.health.org.uk/news-and-comment/blogs/nhs-performance-and-waiting-times#lf-section-49181-anchor)
This just highlights the challenges faced by the NHS, and that the problems faced by it have no simple solutions.
Alongside this, little has been done to address the social care crisis, where this is a still substantial deficit and a perceived lack of leadership on something which is only going to become more complex as the population continues to age. There is also a blame game, where nobody is apparently taking ownership.
There have also been high expectations of the Health Service to better address mental health treatment and to invest in new treatments – yet, the budget for the NHS is struggling to catch up and does not have the option to be proactive. The Conservatives committed to the “biggest” spending increase on health for a “generation” in their manifesto, amounting to £34bn (excluding inflation). That figure initially sounds impressive, but according to Full Fact:
Whether or not you count inflation, the funding that’s been announced for the NHS won’t be enough to address future issues the service will face, according to expert think tanks.Full Fact (https://fullfact.org/election-2019/nhs-spending-biggest-boost/)
The Conservatives were widely criticised for some of the other commitments made regarding the NHS, such as building new hospitals. Again, let’s hear what Full Fact said about this commitment in their manifesto:
One of the key pledges that appears in the manifesto, to build “40 new hospitals”, does not appear to be costed in this manifesto, as most of them are not intended to be built during the next parliament. £2.7 billion was committed in September this year to upgrade six existing hospitals, while the remaining hospitals were allocated £100 million to develop plans for upgrades. But there is no money yet for any actual building work on these, and the scheme has “the aim of delivering between 2025 and 2030”.Full Fact (https://fullfact.org/election-2019/conservative-manifesto-2019/)
There is also an issue of recruitment, where the Government made a vague commitment to 50,000 new nurses. Even this figure is misleading as it includes 18,500 existing nurses who will be encouraged to stay. It seems with the promises are soundbites rather than anything with more substantial planning behind it. This is concerning, particularly as the Conservatives have been in charge since 2010.
Linked to this, there has been more talk about the era of austerity being over, with increases in investment pledged for the Police. Sticking with this example, when the stats are interrogated further, the increase in Police numbers would still not fully account for the total roles cut since the Conservatives came to power.
A broader point arising from this is that there are a growing number of issues with public services, which are becoming difficult to manage, and require a longer-term view rather than short-term initiatives to plug a gap. They also require investment, and with this honesty with voters that for high-quality public services there is going to be a premium to pay. Decisions also need to be made about what the priorities really are. The woes faced by the NHS are merely a symptom of this failure to act in a meaningful way.
Those with responsibility for health and social care provision have a real opportunity as we enter a new decade to think carefully about both short and long-term priorities and how to address them in a way that is realistic about the costs. This needs to cross party lines, with balanced input from experts.