Yes, the NHS is creaking but Labour’s cynical hypocrisy is sickening
Published by The Daily Mail (7th January, 2015)
With headlines screaming that the NHS is in meltdown, a plethora of English hospitals have suddenly declared ‘major incidents’, unable to cope with the influx of patients swamping accident and emergency wards.
There are reports of hospitals shutting doors to paramedics, and desperate patients waiting more than 11 hours to see a doctor, while new figures reveal that emergency waiting times are at the worst levels for a decade.
Medical unions have issued doomsday warnings of an under-resourced service unable to cope with demand from 20,000 extra patients a week, while Labour politicians allege a heartless Tory-led government is hellbent on destroying the health service.
There is no doubt the heroically dedicated and highly skilled A&E staff are under the cosh — there are too few of them, and they are confronted with too many patients. But the causes are complex, the solutions costly and few things in this debate are as they seem on the surface.
Above all, Labour is behaving with gut-churning hypocrisy as it seeks to focus voters’ attention on the NHS — traditionally its strongest card — to avoid discussion of the economy and the deficit, a subject Ed Miliband famously failed to mention in his last party conference speech.
Let us consider the facts. Certainly, the number of patients demanding treatment at emergency departments has been rising; 403,305 people over the Christmas week compared with 361,870 four years ago.
The preceding weeks were even busier, as drunken festive revellers and families with winter bugs desperate to see a doctor ended up going to hospitals.
This crush sparked those formal declarations of major incidents, usually reserved for terrorist attacks or transport disasters. They allow hospitals to take special action to cope, such as calling in doctors on days off, diverting ambulances and postponing routine operations.
Partly, this is the result of a rising population and poor planning by politicians. But the root causes go back to Labour’s cack-handed contract deal with general practitioners in 2004, which — incredibly — gave them a huge pay rise despite requiring them to work far fewer hours.
Nine out of ten family doctors stopped providing emergency cover, offsetting a small pay cut for not treating patients out of hours with big bonuses for meeting various simple targets. Six-figure average salaries duly transformed them into the world’s best-paid GPs.
But when they shut surgery doors, or started relying on locums during anti-social hours, patients went instead to emergency wards — even for comparatively minor complaints such as aches and sniffles.
One recent study found nearly six million A&E visits a year are from people unable to see GPs, accounting for almost one-quarter of unplanned hospital attendances.
Parents, naturally nervous about sick children, ensured emergency admissions of under-fives alone jumped more than 50 per cent in a decade.
Patients know they get quicker treatment in hospitals. While GPs face no compulsion to treat them within a fixed time period, hospitals must see 95 per cent within four hours in order to hit critical targets.
Many other factors lie behind this latest health scare. GPs now control NHS budgets, yet are incentivised to shift bigger numbers of patients to hospitals, where managers admit people unnecessarily rather than breach waiting-time targets.
On the wards, beds are blocked by older people who cannot be moved out to nursing homes due to dreadful and worsening deficiencies in social care, which means vital operations in hospitals are cancelled as the system calcifies.
One legacy of this chaos is that idealistic young doctors, lured by the excitement of working in casualty, are driven out by the nightmarish realities even as hospital trusts import foreign medics to keep services from collapsing.
Dr Clifford Mann, president of the College of Emergency Medicine, told yesterday’s Radio 4 Today programme that half the places for the final three years of training are vacant as students switch to different specialities — or emigrate. ‘There are now 500 UK-trained emergency doctors working in Australia, who cost the British taxpayer a quarter of a billion pounds to train,’ he said. How depressing.
If anything, the A&E patient surge shows the scale and complexity of problems facing the NHS as society ages and healthcare costs soar — with warnings of a £30 billion shortfall by 2021. Yet Labour’s response to this is risible — especially given its role in provoking the crisis.
Certainly, the Coalition deserves blame for bungled health reforms that made bureaucracy worse, and for its timid reluctance to challenge vested interests such as the medical unions.
But Labour is desperate to exploit voters’ fears on health in order to deflect attention from its inadequacy on economic matters and its unloved leader. Hence, it even implied with its cynically dishonest first election poster that the Tories are seeking to abolish the NHS.
In fact — even as Labour complains about cuts — ring-fenced health spending has risen 3.6 per cent in real terms since 2010 according to the King’s Fund think tank, despite austerity elsewhere.
Labour’s stance as self-appointed saviour of the NHS is contemptible — and sadly Andy Burnham, a politician who once showed promise and now serves as the party’s health spokesman, is perhaps the biggest hypocrite in this demeaning debate. He is, lest we forget, the man who as Health Secretary ruled out a full public inquiry into horrific failures and patient abuse at two Mid-Staffordshire hospitals on the grounds that it might be ‘distracting to managers’.
Now, he rants about the evils of privatisation — even though Labour extended the use of private providers while they were in office, and he himself promoted the ‘powerful value-for-money argument’ behind such policies, which he said ‘most people in the country would celebrate’.
Now, having lurched to the Left, he appears to be pandering to the unions rather than fighting for patients, as he positions himself for a possible post-election leadership battle. Is it any wonder voters turn away from the traditional parties when scaremongering Westminster politicians behave in this mendacious manner?
Far from seeking solutions, Labour leaders are said to talk privately about using the health debate as a weapon against the Tories. So they say they will use the silly mansion tax — designed to exploit envy of London and the ‘rich’ — to help fund the NHS, even though it will raise a pittance compared with the sums needed.
Meanwhile, the NHS in Labour-run Wales lags behind England on almost every measure.
The fact is that Britain is far from the only country facing the kind of challenges we have seen in several hospitals this week — and there are suspicions some trusts suddenly waving the red flag are playing political games. After all, the NHS has been in almost permanent crisis since its foundation in the Forties.
But we need to find ways to salvage the service as costs and demands soar. In the past decade alone, for instance, the number of operations performed has risen from 6.5 million to 10.5 million.
Use of more private providers to drive efficiencies has a role to play. This is shown with great clarity by Hinchingbrooke hospital in Cambridgeshire, the first privately run NHS hospital, which cut £11 million in waste in two years while improving services.
Even according to the Academy of Medical Royal Colleges, more than £2 billion a year is wasted on needless treatments. Billions more go on pointless layers of poor managers, red tape and shoddy computers that impede rather than improve work.
Ironically, a couple of independent-minded Labour figures have made tentative proposals to start plugging the financial black hole.
Lord Warner, a health minister under Tony Blair, suggested charging £20 fees for every night spent in hospital. Meanwhile, veteran Labour MP Frank Field proposed a 1 per cent rise in National Insurance contributions to help fund the health service, plus removal of any political control over the NHS.
Cutting costs, driving efficiencies and introducing controversial new charges will help — but whoever wins the election will be scrabbling around for cash, since it would take an income tax rise of almost 7p to plug a £30 billion gap if these alarming predictions turn out true.
Clearly, this is impossible. My preferred prescription is to convert National Insurance — which raises roughly the budget of the NHS — into a dedicated NHS tax and hope this forces the nation finally to face up to the real cost, funding and provision of modern healthcare.
Regardless, we need more than shroud-waving from professionals and puerile point-scoring from Labour. The NHS is in too sickly a state, and too essential a service, to be used as a political football.