Demand for care in the NHS continues to outstrip capacity, worsened by the Covid-19 pandemic. There are record number of people waiting for treatment: in July the figure was 6.84 million, with 2.67 million people waiting over 18 weeks and 377,689 waiting over a year. This is 365 times the pre-pandemic figure. The median waiting time for treatment is now 13 weeks. While the waiting list is a visible backlog, there is also a rising hidden backlog of those cancelled, deferred or not yet come forward. The 93% target for people to be seen by a specialist consultant within two weeks of an urgent GP referral for suspected cancer has not been met since May 2020, and the number receiving treatment within two months of screening is still well below standard. The number of people waiting over 12 hours to be admitted onto a ward from A&E is 77 times the pre-pandemic level. From February 2020 to November 2021 there was an 87% increase in the number of people unable to get a hospital appointment after referral from their GP. A survey commissioned by the charity Engage Britain showed that one in ten adults in Britain have turned to private sector health care in the last year, the vast majority because they faced long delays or could simply not access treatment on the NHS.
In December 2019, then Tory Prime Minister Boris Johnson said he ‘heard it loud and clear from every corner of the country that the overwhelming priority of the British people now is that we should focus above all on the NHS’. He promised the biggest ever cash injection, 50,000 more nurses and 40 new hospitals. Then came the pandemic, Johnson ignored scientific advice, was proud of shaking hands with everyone on hospital visits, allowed the transfer of contagious patients from hospital back to care homes, oversaw the lack of testing facilities, lack of Personal Protective Equipment (PPE), the mess of NHS test and trace and the nepotism of who got the lucrative PPE contracts.
Empty promises
In October 2020, Boris Johnson declared ‘from Morpeth to Milton Keynes, we are building 40 new hospitals across England to level up our NHS’, with £3.7m promised by 2030. The Department of Health and Social Care sent out a ‘communications playbook’ to NHS trusts clarifying that an additional building on an existing site, a new wing or major refurbishment would count as ‘new hospital’. Of the 40 hospitals listed by Johnson’s government as new, three were rebuilds of non-urgent care hospitals, 12 were new wings and 22 rebuilding projects. The number of new hospitals was actually just three.
The government also promised to recruit 6,000 more GPs. In reality, the number of full-time equivalent GPs fell by over 700 between March 2019 and March 2022. The former health secretary Sajid Javid admitted in June that achieving the target even by 2024 was near impossible. There was then the promise of 50,000 nurses: NHS England data from June 2022 shows 46,828 nursing vacancies, a vacancy rate of 11.8%, up by 1.5% from 2021. In June 2022, the vacancy rate in England in the NHS stood at 9.7%, the greatest workforce crisis in history.
A recent survey of GPs showed that 68% felt it increasingly difficult to provide safe care and two thirds of GPs in training plan to work part time. The number of GPs per person in England dropped by 2.2% in the year to July 2022. There are 1,806 fewer fully qualified full time GPs as of June 2022 compared to September 2015. The majority of GP practices that have closed are in postcodes in more deprived areas. 1.7 million people had to find a new GP following mergers or closures between 2013 and 2017. Meanwhile online digital private healthcare provider Livi is offering GPs over £90,000 to work hours they want, online, from home, all training free. The number of people wanting to study medicine is up 10,000 on five years ago, but the government has capped medical school places. Prime Minister Liz Truss has said little about the NHS apart from retargeting £13bn to social care. This will solve nothing.
A new World Health Organisation (WHO) report on health services staffing in Europe shows that Britain is low in all tables, below average in the number of doctors per head of population (similar to Ukraine and Moldova), number of nurses (like Malta and Czech Republic), number of midwives (like Belarus), number of dentists (alongside Slovakia), and fewer physiotherapists than Albania. Nearly 25% of nurses in Britain are over 55 years old. Britain (population 67 million) is training the same number of nurses as Iceland (population 366,000).
In 13 European countries, including Britain, at least 40% of the doctors are over 55. The shortage all over Europe leads to doctors and nurses from poorer countries moving to higher-income ones, further damaging the health services they left behind. Nepal has a ratio of less than one doctor or nurse per 1,000 people. The WHO recommends 2.3 per 1,000. Hampshire Foundation Trust is recruiting 100 experienced Nepalese nurses and bringing them to Britain.
Cost of living
Up to 15 million people are expected to experience fuel poverty by January 2023, leading to significant health problems for adults and children. Cold homes are linked to increased risk of respiratory and heart disease, poor mental health and injuries. Cold, overcrowded, damp housing has consequences for children’s health now and throughout their lives. Health care settings will face huge energy bill increases, with some NHS hospitals in England expecting to limit services this winter because of the expenditure. Nottingham University Hospitals NHS Trust predicts a 214% increase in electricity and gas costs for the financial year 2022/23 compared to the previous year. This will represent an increase of £27m. Others expect monthly increases of £2m. NHS England has given £1.5bn to local NHS organisations to cope with cost pressures.
In October, the Royal College of Nursing is balloting for strike action for better pay. It is crucial the fight by health workers across the board takes on the wider issue of understaffing and outsourcing of workers and services as well as demanding an end to poverty pay in the NHS.
