Stop focusing on hospitals and we may yet save the NHS

IF you get sick this Christmas, are you confident you’ll get the treatment you need? Or fearful that you won’t?

Even before ambulance workers and nurses go on strike later this month, we are increasingly worried about what happens if we call for help.

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We know we might be left waiting for hours, whether on our floor at home, in the back of an ambulance queuing outside an overwhelmed hospital or in that hospital as staff run around trying to get through huge lists of sick patients.

The NHS was set up so that patients needn’t fear getting ill, but today that looks more like an ambition than the norm.

Something is clearly wrong that goes beyond industrial action or even the crises that seem to come every winter.

There are lots of easy answers to the chaos in the health service.

They include “militant” trade unions representing staff, or that there aren’t enough staff, they’re not being paid enough, there are too many fat-cat middle managers, GPs are still hiding behind computer screens, the NHS needs more money — or some think the NHS actually has too much money and isn’t efficient enough with it.

Most of these are half-truths.

The Royal College of Nursing hasn’t historically been at all militant, certainly not in comparison to the British Medical Association, which is a well-dressed band of stethoscope-wearing street-fighters.

The RCN’s current pay demand of 17.6 per cent is clearly unaffordable in the current circumstances, but it is not unreasonable for nurses, who do a job most of us could not manage physically or emotionally, to expect to have their basic needs of covering their food and heating met by their salary.

What is unreasonable is that the system cannot stretch to paying healthcare staff decently.

The NHS is, compared to many other developed countries’ health systems, quite efficient and has had to become more so over the past decade or so of squeezed funding.

But it still has maddening flaws.

Chronic under-investment in IT, for instance, means even within individual hospitals there are computer systems that can’t talk to one another, meaning staff have to manually transcribe a patient’s details from one screen to another whenever they move to a different part of the same emergency department.

It’s worse in other departments, where waiting lists are written on Post-it notes stuck to the wall.

The system clearly isn’t working.

It has inefficiencies built into it which have little to do with managers clutching clipboards and a lot to do with where the money and attention from politicians goes.

These are the hard answers to the NHS’s failings. But it is here where the Government must focus.

We cannot keep throwing money at the NHS without asking why the problems never seem to go away.

The health service in England received £172billion in 2021/22, but the increases in funding have been tight for more than a decade now and demand has been rising too.

Squeezed funding

And money for maintaining hospitals and buying equipment is astonishingly low at just £10billion, even though many buildings are crumbling.

A record seven million people were waiting for treatment as of September this year — and those lists had been rising before Covid.

We need a new mindset when it comes to healthcare.

We are completely obsessed with acute care, to the extent that we pay little attention to the reasons people end up there.

Generally when we talk about the NHS, we think of hospitals, rather than the community services or primary care that should by and large keep us out of acute care.

While I’ve been working on my book on the history of the health service, I have found countless examples of MPs opposing the closures of hospitals that they had been repeatedly warned by experts — including the doctors working in them — were so bad people were dying needlessly in them.

No MP would dare swim against this, they’ve seen former colleagues lose their seats for being honest about local hospitals.

Even when local hospitals are good quality, they often contain people who simply should not be there.

Calms our fears

This might be because of a failure earlier in the system which means a diagnosis hasn’t happened, or someone’s condition has deteriorated when it could have been managed very easily at home.

Or it might be that the problem which resulted in them being admitted to hospital has now been treated, but there is no social care package that means they can safely be discharged.

It costs hundreds of pounds per night to keep a medically fit person in hospital but politicians never get round to reforming social care.

How can a system ever work when it is being let down this badly?

There will always be staff shortages and overworked, underpaid doctors and nurses if we keep seeing the NHS as being just about hospitals and not about keeping people out of them.

Serious politicians know this.

The Health Secretary, Steve Barclay, is very aware of it, as is his ambitious shadow Wes Streeting.

The problem they both have is convincing their political colleagues, or indeed the public, that the NHS doesn’t need more fiddling or a bonfire of bureaucrats, but an end to the obsession with hospitals.

Whichever brave politician manages that will be the one who calms our fears about our health service.

• Isabel Hardman is a political journalist and the assistant editor of The Spectator.

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