The NHS needs more money – but that’s not all
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Version 0 of 1. We are not experiencing a hard winter and nor are we in the grip of a major flu outbreak. And yet the NHS in some places is stretched to breaking point, with A&E departments heaving, wards full of frail, elderly people and ambulances taking hours to get to those who need them. It looks as though the NHS is in crisis and yet this is not a sudden and acute emergency. Winter always shows up the cracks in the NHS, but these are cracks that have been widening for the last four years. The funding put in last year and this to cope with “winter pressures” has done nothing to paper over them. The extra £700m for this winter bought 700 more doctors, 4,500 more nurses and created more than 5,000 more beds, NHS England said in the first week of January. It was nowhere near enough. Demand on the NHS has been steadily increasing since before the last election, particularly among the growing elderly population. It is the same in every country in the world. People are living longer with more complex diseases. But it is not just treatment that is costly. Every political party promised to ringfence NHS funding and protect our national treasure from cuts. What was not promised was the preservation of social care funding. Large numbers of elderly people arrive in hospital, often via A&E after a fall, and once their immediate medical needs are sorted out, there is nowhere to send them for long-term care and insufficient staff to help them live at home. They block beds. Chris Ham, chief executive of the King’s Fund, says his worry is that the failure to address social care is having and will continue to have a knock-on effect. Elective operations – those planned in advance – are already being cancelled. It will get worse. “That will put under pressure the 18-week targets and the cancer targets,” he says. If that happens, the NHS will indeed begin to face crisis. This is certainly about funding but it is also about the failure to reorganise the NHS to deal effectively with the problems of today. Take urgent and emergency care, for instance. It is a good idea to have the twin track, but the system is fragmented and confusing for people, who do not know where to go. If in doubt, most will head for emergency. They may even call an ambulance. People who are worried and reluctant to wait to see a GP will also turn up in the emergency department, as will those referred by NHS 111, where call-handlers do not have medical training and so are likely to err on the side of safety. It is accepted by everybody that there needs to be a big shift to getting people out of hospital and treating them in the community. They are safer and happier in their own homes and it saves money. But the community services have not been put in place – in fact, they have been cut. There is a reduction in district nurses and a shortage of GPs. So the horror stories from paramedics in the south-west are not indicative of a temporary winter problem but the loudest warning signal yet of the crucial need not just for more money but to respond to the needs of today’s population and do things differently – in particular, by integrating health and social care and moving the focus away from hospitals and into the community. |