Comment by John Lister
In the days since the election it has become increasingly obvious that the situation facing the NHS is even worse than we knew, and in the aftermath of the limited promises made in the Queen’s Speech more warnings are now ringing out from doctors’ leaders and from NHS Providers.
While it will almost certainly take some of the voters who have returned Boris Johnson’s government for a 5-year time with an 80-seat majority a while to catch on, the promises Johnson made, which some clearly believed, are already being diluted and broken – or are being swiftly shown to have been simply inadequate in the first place.
The Queen’s Speech made a big gesture of enshrining the promised extra money for the NHS in law: but this also means that there is no immediate prospect of increasing the funding above the level set out in the manifesto – despite all of the evidence that the NHS is now drastically under-funded and failing to deliver performance targets after almost a decade of austerity-driven real-terms cuts.
NHS Providers Chief Executive Chris Hopson, while grateful for any relaxation in the virtual freeze on funding, has pointed out that if NHS spending had increased in line with the previous average prior to 2010, the Department of Health and Social Care budget would by now be £35 billion higher than it is.
The Johnson government has now promised to increase spending by “£34 billion in cash terms” over five years – but as campaigners warned the government’s own figures show than taking inflation and cost pressures into account that will only be worth £20.5 billion in real terms.
In other words real NHS budgets in 2024 will still be miles short of the level needed to deal with today’s increased population, the substantially increased older population, and nine years of decline that have left trusts in debt to the tune of £14 billion. The BMA has conservatively estimated the shortfall as a £6.2 billion annual “black hole”, in addition to existing deficits.
That’s why hospitals are struggling to deliver A&E performance targets, waiting list targets, cancer treatment targets, and why tens of thousands face trolley waits and delays in ambulance transfers every month this winter – and for the foreseeable future. NHS figures withheld on election day, and published on December 13, showed a further rise on demand for emergency care coupled with a fall in performance.
They showed there were 2.1 million attendances at A&E departments in November – a 5.2% rise from the same point last year, while 94.9% of front-line general and acute beds were occupied – meaning they were already as full as they were for nearly every week of last winter. This means hospitals are once again recording the worst performance against the four hour standard on record and the number of people waiting for routine surgery and treatment growing to 4.4 million.
Similar delays and shortages will continue to impact on mental health services, GP services and community services. Since the election and after the Queen’s Speech a letter to Boris Johnson from the Doctors’ Association UK (DAUK), signed by over 2,000 doctors – including 654 GPs and 312 GP trainees – has highlighted the devastating, but utterly predictable impact that years of underfunding have had on the NHS, and warned that the NHS is “on its knees”.
Doctors’ organisations and NHS Providers have tried in vain to push the Johnson government into taking its own promises to improve the NHS more seriously. Instead the double talk and deception of the Conservative Manifesto have been repeated in the Queen’s Speech.
Social care has again been kicked into the long grass, with vague proposals to seek a “cross party” consensus having failed to make any headway in the past 9 years, while the yawning gaps in services leave over a million vulnerable people without any care at all.
The promise of 6,000 extra “doctors in general practice” is not included in the legally binding proposals – for good reason. Since the initial promise of 5,000 extra GPs was made by Jeremy Hunt back in 2015, (and reiterated no fewer than FIVE times since by Hunt and now Matt Hancock, the numbers have actually gone down by over 1,000: and during last year alone the numbers fell by another 340.
Staff shortages of course are another major factor, and ministers repeatedly tied themselves in knots trying to explain the promise of an “extra” 50,000 nurses. In fact it’s clear that the plan is for an increase over TEN years, not five. And it hinges on trying to retain over 18,000 nurses who are already working for the NHS: in other words only 32,000 “extra” nurses would be added. To make matters worse, while talking about extra “nurses”, it also relies on using thousands of less qualified nursing assistants to cover for qualified staff.
The promised restoration of the bursary turns out to be nothing of the sort: those applying for nursing course would get a £5,000 annual maintenance grant, but still have to pay the £9,000 per year tuition fees, which David Cameron’s government introduced.
The plan for extra nurses also relies heavily on further recruitment from overseas. It’s not clear if many of those who supported Brexit as a way to reduce immigration were aware of the extent to which the entire NHS depends on migrant workers.
The Queen’s Speech states that “a new visa will ensure qualified doctors, nurses and health professionals have fast-track entry to the United Kingdom.” But recruitment from the EU has fallen massively since the Brexit vote, and the new £400 visa plus the immigration health surcharge, which ministers have recently pledged to increase to £625 per person, mean that after Brexit EU nationals will face a new £1000-plus up-front cost in coming here – in addition to paying the same taxes that we do: how this is supposed to attract extra recruits is a mystery, especially given the increased incidence of racism towards overseas and BME staff.
The Conservative manifesto pledge to scrap some hospital car parking charges, also turns out to be deceptively phrased in the Queen’s Speech as scrapping charges “for those in greatest need,” even though devolved governments in Wales and Scotland have abolished these charges years ago.
After Johnson’s minimal changes a large majority of people using hospital car parks – outpatients, visitors and day-shift staff – will still have to fork out hefty sums to park, while the continued centralisation of services and loss of local access in many areas, combined with poor or non-existent public transport, ensure that many have no choice but to travel by car.
Reduced to a mere heading in the Queen’s Speech, with no further explanation is the proposal for an “NHS Long Term Plan Bill” – to implement a 10-year plan that lacks adequate revenue or capital funding, a coherent workforce plan, or any details on how some of its ideas are to be translated into reality. The Plan also embodies deeply worrying plans to strip away the last vestiges of local accountability and implement so-called “integrated care provider” contracts that carve the NHS up into 44 separate health services, with fears that this could open the way to larger-scale private sector involvement.
However it’s unclear how many of NHS England’s proposals the new government will want to progress with new legislation to dismantle some of the widely-despised 2012 Health and Social Care Act that was forced through by David Cameron’s government with active LibDem support. The Briefing Notes with the Queen’s Speech are evasive:
“The Government is considering the NHS’s recommendations thoroughly and will bring forward detailed proposals shortly. This will include measures to tackle barriers the NHS has told Government it faces.
“This will lead to draft legislation that will accelerate the Long Term Plan for the NHS, transforming patient care and future-proofing our NHS.”
On capital investment, it’s now quite clear that only six of the promised “40 new hospitals” will even get beyond the drawing board before 2024, while 21 other trusts have been fobbed off with a share of £100m “seed funding” to draw up plans which the next government will have to finance. And while 20 more trusts will get a capital sum for long-awaited upgrades and maintenance, and others will get a hand-out to help buy new scanners, over 100 trusts with hefty and rising backlog maintenance bills know they will get no help to repair and upgrade crumbling buildings or equipment unless the new government does an abrupt u-turn in the budget.
To sum up, if anyone really believed that Johnson’s “new” Conservative government, following nine years of Conservative governments, was going to pump big money into the NHS and tackle the problems that are increasingly in the headlines, they will have five miserable years to reflect on how wrong they were.
Our team at the Lowdown will continue to monitor the policies and their impact as they roll out, paying special attention to the plight of health services in the northern and midland constituencies that broke with tradition to vote for Tory candidates, perhaps in the belief that the government might change course.
While the NHS itself is now bracing for a bleak midwinter and a grim year to come, we wish all our readers, especially those who have donated to support us, all health workers, campaigners and activists committed to defence of our NHS a happy Christmas and New Year. We are with you all the way, aiming to ensure you have the best and most solid information and analysis.
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