Like a grotesque mirror image of Advent, the NHS “winter crisis” has become an annual fixture — a painful reminder of the limitations of the health service, a litany of awful anecdotes and a ritual political controversy.
This year’s difficulties, however, are different. The overflowing morgues, the lengthening queues of ambulances, the A&E patient forced to wait 99 hours at Swindon’s Great Western Hospital, the Royal College of Emergency Medicine warning that between 300 and 500 people are dying every week because of delays in urgent and emergency care — this is a system not only creaking at the joints but close to implosion.
Specifically, we are witnessing the long tail of Covid converging with a fresh spike in cases of the illness itself. During the pandemic, many with emerging conditions, especially cardiac and ischemic problems, stayed away from hospital, and now require more intensive treatment. Meanwhile, in the week before December 19, 7,158 patients were admitted with coronavirus — an increase of 36 per cent in only seven days.
Covid and flu cases presently account for 13,000 of the NHS’s 95,000 hospital beds. And lurking in the background is a justified anxiety about fresh variants arriving on these shores. China’s abrupt lifting of its “zero-Covid” strategy, poorly-vaccinated population and consequently low levels of popular immunity mean that new strains of the virus are all but certain to emerge (and may already have done so). In the north-east of the US, a powerful new strain of omicron, XBB.1.5, is already taking hold.
Compounding these epidemiological pressures, of course, is the wave of industrial action that is set to continue this month. The Royal College of Nursing has announced further strikes on January 18 and 19, while ambulance workers at five NHS trusts in England will take action on the 11th and 23rd.
Confronted with this dismal vista, ministers point out that, thanks to Jeremy Hunt’s Autumn Statement, cash spending on NHS England will increase by £3.3 billion in the next two years. The extra money is welcome, but it is a sticking-plaster applied to a patient in need of long-term, transformative care.
As an ecosystem, the NHS is simply no longer functioning. Primary care is in meltdown as face-to-face appointments — the essence of the whole service — dwindle fast. Meanwhile, the inadequacy of social care provision means that far too many people stay in hospital longer than they need to — an estimated 12,000 medically-fit patients are stuck in hospital awaiting discharge.
What this amounts to is not only a political challenge — that will always be true of the NHS — but a national moral dilemma. What sort of health service do we really want? What are the limits of our collective sense of solidarity? Since its foundation in 1948, the demographic, scientific and social context in which the NHS nestles has changed beyond recognition. The question is: what are we prepared to do about it? Certainly, the over-centralised bureaucracy of the system can be radically reformed.
The use of information technology in the NHS remains something of a joke in Whitehall and beyond. There are always efficiencies to be squeezed out of a structure that employs 1.2 million full-time staff in England alone.
Inescapably, however, the overhaul that the system needs is going to require a huge and sustainable increase in funding. During the pandemic there was much talk of adding spare capacity — moving from “just in time” to “just in case”; a preventive health strategy worthy of the name; pay structures that retained staff and prevented the ludicrous expense of depending upon private agency staff; mental health services that were known for more than their waiting lists and social care that was not a national disgrace.
For the most part, this talk has subsided, principally because to continue such conversations would compel a general recognition that, if we want a health service of this sort, we are going to have to start paying wealth taxes.
It is as stark a choice as that. Until, as a society, we recognise that our fixed assets and capital gains are the only logical source of the scale of funding required, nothing much will change.
This is not a welcome choice, but it is the one that really counts. And it is a choice. We can recognise what needs to be done and get on with it. Or we can read the increasingly dire headlines every winter — and accept the consequences of our collective decision.