The NHS will make or break the next prime minister

Yet another hospital doctor has tweeted that he is leaving the NHS after 36 years, although he doesn’t want to, because of pension tax.

The political debate is focused on energy prices. But what will ultimately make or break the next prime minister is the dire state of the NHS. Whoever walks into Downing Street next week must focus on giving hope to the thinning frontline of staff who are the heroes of our time, but are losing faith.

Anyone who’s recently called an ambulance, waited for hours in A&E or dialled and redialled to get a GP appointment, knows how bad it is. With 6.7mn people — one in nine adults — waiting for treatment, we have soaring numbers going private.

And the NHS is losing the war for talent. There are over 100,000 vacancies in hospital and community care, and a shortage of 4,200 GPs. There has been a brain drain of Europeans since Brexit, but that’s not the only reason. Glitzy recruitment drives are pointless when demoralised staff are leaving faster than replacements can be hired.

Politicians are always tempted to tinker, and the NHS has a maddening profusion of titles, regulators, committees and acronyms. But hard-pressed staff cannot bear another restructure. What they need is fewer targets, better pay and an immediate focus on removing the obstacles that make their jobs increasingly frustrating.

I can’t think of any other line of work that treats highly trained, dedicated people so badly. In the past few months I’ve heard about junior doctors sleeping on the floor because they’ve been sent at short notice to a new post miles away, and others who’ve left for better pay and lifestyle in Australia. I’ve met nurses working 12-hour shifts who don’t even have a proper room where they can close the door to rest. And I’ve talked to GPs who almost never see the same patient twice, whose love of the job and respect from patients have plummeted as a result.

This is a colossal management failure. While other professionals eat in office canteens, clinicians and nurses are often left with a run to Costa or a midnight vending machine. Charity workers have modern IT; a district nurse is lucky if the software works at all. Multinationals look after senior staff; experienced doctors who don’t want to retire are downing tools to avoid losing money to pension taxation. These things dent productivity and demonstrate a total lack of respect for the people on whom our health depends.

“I’m going to start working my hours” is a phrase politicians should dread, in a service that depends on relentless overtime. Yet I have heard it several times recently from hospital staff who bore the brunt of the pandemic. They won’t keep trudging on unless they believe that things can and will get better.

Pay rises will be unavoidable. The latest NHS Pay Review shows that while a majority of general managers are satisfied, large majorities of ambulance workers and nurses are not. If the Royal College of Nursing ballots for strikes later this month, as it has threatened, the government will have to back down. It should get ahead of this now, with a generous offer that would offset some of the £6bn bill for agency staff.

Respect is almost as important, but it requires the authoritarian NHS to offer a modicum of sensitivity and creativity. If we could put up Nightingale hospitals overnight, why can’t we create canteens and rest areas? Why not emulate retail group John Lewis, and provide free meals in those hospital canteens this winter? It can’t be impossible to give junior doctors more of a say in where they train, nor to give nurses better career progression opportunities.

It would cost nothing to stop the Care Quality Commission regulating GPs, who are already accountable to the General Medical Council and could do without two streams of paperwork. In the medium term, there’s enough spare public sector land to launch an initiative to build homes for nurses in cities, where high rents are a huge barrier to retention.

Another challenge is social care. Liz Truss has been hammered for saying that she would spend more of the NHS budget on social care. But she is right. One in seven hospital beds is now taken up by patients who are fit enough to be discharged, but need social care. This blockage leaves ambulances piling up outside, lengthening A&E waiting times to what FT analysis has suggested is danger point. Nurses waste hours ringing around care homes to find places that don’t exist.

Where Truss was wrong was in pledging to reverse the rise in national Insurance, which was designed to help clear the NHS backlog and fund social care. Since she originally spoke out in cabinet against the increase, it has been redesigned so that it hits rich workers the hardest, not pensioners or the poor. Businesses also pay NI — but they would benefit far more from lower corporation tax.

None of these proposals are much more than a sticking plaster. And some progress is being made: on diagnostic hubs which will provide more scans, for example, on electronic patient records and better use of data. But while these develop, staff must also be taken seriously and shown that their conditions can get better, even as they treat an increasingly frail population through a grim winter.

What is intolerable is that people who risked their lives and worked all hours to save us from Covid are being expected to keep working at burnout speed, with no recognition. Warm words aren’t enough but language does matter. Several nurses told me they took it personally when Liz Truss declared that British workers needed “more graft”. They don’t need to work harder — they need the NHS and its political masters to support them.

camilla.cavendish@ft.com