The threat to NHS services is urgent and existential

The writer is an NHS doctor

The UK’s health and care system has been failed by successive governments and is now failing its own staff and the populations we serve.

I know this all too well. My 33 years working in acute adult hospital care, including throughout the pandemic on Covid wards, has been affected by both the experience and the illness. Even before this crisis the system was struggling. We have now hit peak pressure at a time when many of us are broken and burnt out.

On July 12, every ambulance trust in England declared a major incident. It was described as the “worst night ever” in acute care due to staff shortages, worsening response times and ambulances stuck outside rammed-full A&E departments. Waiting times within A&Es are higher because there are so few beds on the wards to admit patients. And those wards struggle to discharge patients because of sustained cuts to social and community healthcare. The short-term Covid “hospital discharge fund” was closed in March.

In elective care, there are now 6.5mn people on waiting lists for outpatient appointments, investigations, procedures or operations and likely several million more “hidden waiters”. Delays are lengthening.

Primary care in England is dealing with record numbers of consultations this year. But there has been no increase in the number of full-time equivalent qualified GPs since 2015, despite rising demand. At least 100,000 NHS clinical posts are also unfilled while the social care workforce crisis, partly due to immigration rules and competition from other low wage sectors, is even more pressing.

Staffing is central to any NHS recovery, but the government refused calls for a statutory duty to publish regular workforce plans and numbers as part of this year’s Health and Social Care Act. It takes years to train skilled replacements: there is no magic reserve of the right people. And we are increasingly demoralised. Even NHS chief executives, usually shy of open condemnation of government, last week said they were “presiding over a failing NHS”. The last British Social Attitudes Survey found public satisfaction with services at a 25-year low (although with ongoing high levels of trust in the institution and in doctors and nurses).

There is, of course a wider, longer-term policy discussion to be had about design and funding of our health and care systems. But we need urgent action to get us through even the next year. As a minimum, this requires: a major uplift in terms and conditions well beyond current pay review body recommendations. Treat and reward staff better or more will leave. We also need an end to pension tax rules that penalise senior medics taking on extra work to help clear backlogs.

Immigration rules must be rapidly relaxed to allow overseas-trained staff to come to the UK and stay. We can worry about ethical recruitment and training home grown staff when we are through the immediate existential threat.

Social care requires an urgent injection of funds that goes well beyond the new levy. Both local government fundraising and National Insurance are regressive, unfair and further disadvantage those most in need.

Finally, there must be honesty, realism and public expectation management about what can — and cannot — currently be delivered, and about the time the NHS will take to recover.

After two years of pandemic medicine and then, finally, my own bout of Covid, I was signed off sick in May. I have had to give up the presidency of the Royal College of Physicians, a position I had just been elected to.

I’ve seen scant acknowledgment from the Conservative leadership contenders of the scale of the problem or the need for urgent action. We need politicians to face up to this crisis and the legacy of poor governance. But if you have been the party of government for 12 years, that is hard.