Crisis, what crisis? Because the NHS winter crisis was absolutely predictable that doesn’t stop it being a crisis. Some 55,000 people will have their operations cancelled – who knows for how long, with what knock-on effect on waiting times. But no, they say this is definitely not a crisis because it is “planned”.
Where is health secretary Jeremy Hunt? Like Chris Grayling on the day train fares increased, not out there on the Today programme to say this worsening winter “event” is not a crisis. Instead, he sent out a civil servant, Prof Keith Willett, director of acute care, because he couldn’t be asked the crucial political question. Is this the direct and predicted result of an NHS that was given less than half the £4bn it needed to stay afloat?
Why wasn’t Simon Stevens, head of NHS England, sent out there? Because he would probably have given the right answer: yes he warned £4bn was the minimum needed, but was snubbed by the chancellor.
Doctors and managers around the country are warning they have never seen it so bad, so many sick people in long trolley queues, ambulances stacked up outside, no beds free. And so far, though there are more flu cases, there is no flu epidemic. This is normal winter: what’s abnormal is the longest squeeze in funding the NHS has ever known. The lack of nurses and doctors was planned: cutting nurse training was one of the first acts of the Cameron government in 2010.
But, as Willett said, some of these doctors and managers may be too young to remember how most winters before 2000 used to be worse. He recalls worse in the 1990s. Yes indeed, I reported on hospitals regularly closing wards from January to the new financial year in April because they ran out of money: waiting lists grew, reaching to two years ahead. Rationing by waiting time was the natural fiscal control mechanism in the NHS since it was founded.
There is an iron law: when NHS funding falters, there will be winter crises
Now, for its 70th birthday, the NHS looks set to return to those bad old days. Seasoned observers doubted the feasibility of the Blair-Brown pledge to bring waiting times down to a maximum 18 weeks, cancer waits to two weeks, A&E to four hours. But by pledging to raise NHS funding to EU average levels, they did it. Waiting lists were all but abolished.
But that’s a distant golden age: since 2010 the NHS has gone into steady reverse, its funding falling further behind the 15 comparable EU countries. Now spending 5% less, despite accelerating numbers of the old, the NHS has considerably fewer beds, doctors and nurses per head than those countries.
Listen to the old Tory drum-beat: this shows the NHS is unaffordable, a bottomless pit, insatiable. Never mind that despite falling down the funding tables, the NHS remains top for most efficient bang-for-the-buck, according to the Commonwealth Fund. Never mind that no other funding system, private or co-paid or whatever, will be as effective, it’s an article of faith that charging will reduce demand. Maybe it would, if families on below-median earnings couldn’t afford to pay – but everyone would end up paying more. Every crisis in the NHS is ammunition to privatisers. Look, it’s not working! Try something new!
But the old remedies have proved the best – the post-1945 nationalisations of natural monopoly utilities were a rational model compared with the bogus competition and corrupt franchising in rail, energy and water. The 1945 nationalisation of health, with its simple district model of providing for a local population – which accountable care organisations are making a confused stab at returning to – was the rational system, without phoney competition and pretend choice.
Endless NHS restructuring matters less than the bottom line. Labour’s 2000-2010 funding uplift showed what the NHS can be. There is an iron law: when NHS funding falters, there will be winter crises with operations cancelled, A&E’s overflowing and black alerts. As trusts have been ordered to spend scarce capital on running costs, leaving no money to replace old equipment and decaying infrastructure, the future looks worse still. This is NHS Narnia, winter all year round.
• Polly Toynbee is a Guardian columnist