“There will be no NHS crisis this winter.”
The Business Secretary, Sajid Javid, made this bold claim recently on Question Time. It was met with unconvinced jeers from the audience, and how can you blame them? We are regularly told about deficits, cuts, increased waiting lists, targets not being met… the list is almost endless. We hardly ever hear anything good about the NHS. The idea that there won’t be an NHS crisis this winter doesn’t seem plausible.
Why does the NHS seem to be in a constant state of paralysis? The biggest reason is that it is underfunded. The government denies all charges; their critics protest otherwise. The government uses one set of statistics justifying their record; their critics use others condemning it. Consequently, we’re all left confused and unsure who to blame.
We can get a better idea, however, if we closely compare the government’s claims with the reality. Let’s take a few of their statements in turn.
“I can today confirm the NHS will receive – in addition to the £2bn we’ve already provided this year – a further £8bn. That’s £10bn more a year in real terms by 2020” (George Osborne, 08/07/2015)
This is correct. The Stevens’ Plan called for at least £8bn of real-terms spending into the NHS every year, and this is what the government are doing. They also just agreed to frontload £3.8bn of the money, which will help alleviate the pressure this winter. So does this mean problem solved? Not exactly. Despite increased spending, new figures reveal that the NHS’s overall deficit has increased to £1.6bn, and is predicted to rise to £2.2bn by the end of the financial year. Of the total 239 NHS England trusts, 156 of them are in the red. This is the biggest deficit in the NHS’s history. While the government are telling us they are increasing spending into the NHS, the reality is that the NHS deficit is getting bigger.
“Every penny we do not save on welfare means savings we have to find in the education budget, the policing or the health budget” (David Cameron, 28/10/2015)
This is also correct – but it’s sneaky. It is true that the government are not making any direct cuts into the NHS, but this statement gives off the impression that there will be no cuts in the NHS whatsoever during the course of this parliament. The reality couldn’t be further from the truth. The government are calling for the NHS to make £22bn of ‘efficiency savings’ by 2020 – just another way of saying “we’re not going to cut it, but we want you to”. A significant proportion of the NHS’s deficit is due to the cost of contracts with the private sector. Last year, for example, NHS trusts paid private agency firms £1.8bn because they didn’t have enough of their own staff – around double what they planned to pay. Considering they paid £900m more than they wanted to, and the deficit is £1.6bn, this is a significant factor. Deficits mean cuts, and cuts will hurt patients – even David Cameron is now complaining about the impact of cuts in his own constituency.
“We got rid of 20,000 bureaucrats in the NHS and put that money into 9,000 more doctors and 7,000 more nurses” (David Cameron, 02/04/2015)
We hear this line every week from David Cameron at PMQs. Yet NHS Workforce Statistics provide a slightly different picture: since 2010 there have only been 7,293 more doctors and 6,434 more nurses. Not exactly a rounding error. Also, proportionally, the number of doctors has increased by 16%, while the number of nurses has only increased by 2%. Is a 2% increase in nurses enough over 5 years? Since the NHS is increasingly relying on private agency firms for nurses, it doesn’t look like it. And since the employment of private agency staff seems to be having a negative effect on NHS finances, the lack of NHS nurses is an important part of the bigger problem. If the junior doctor debacle continues any longer, we might also have a lack of NHS doctors.
Of course, the problems facing the NHS are not all down to government policy. Britain has an ageing population: the number of over-65s is expected to increase by 12% by 2020. Increasing levels of child obesity and the rising consumption of alcohol and cigarettes are creating new problems. In addition, whereas in the past the NHS just had to cure ailments, it is now expected to provide additional services relating to mental health, social care, maternity, contraception, and much more. The crisis cuts far deeper than just government policy, and it would be naive to think otherwise.
But we should not ignore the role of government policy, because the rhetoric is not matching their actions. When the government tell us they’re increasing spending and increasing the number of doctors and nurses, they’re not really addressing the question. And when they tell us they’re protecting the NHS from cuts, they’re not really telling the truth. The “strong economy, strong NHS” sound-bite is meaningless. The NHS will not just be in a crisis this winter – it is in a crisis right now.
