Whether or not the NHS is, as Nigel Lawson said, the closest thing the English have to a religion, its ethos and staff hold a special place in our hearts. We cut it slack that few institutions enjoy—and boy, is it going to need it. The corollary of the heroic emergency work during the pandemic is waiting lists swelling to over five million, the longest since records began. Eventually, the pain and anxiety of waiting for treatment may sour the national mood: James Forsyth, a journalist with unmatched contacts in the Tory Party, has described rising waits as the biggest threat to its re-election.
Things will get much worse before they get better. Waiting lists have grown by far less than routine NHS activity has declined, because of a huge pandemic dip in numbers seeking treatment—people were put off from seeing their GPs, not wanting to “bother” the NHS or fearing infection. Some may have ended up with an emergency hospital admission or worse. But most will seek treatment as the pandemic eases. In a service already missing waiting-time targets before Covid, delays will only lengthen as new patients arrive.
So how can the backlog be cleared? Fixing waiting times is simple in principle—just treat more patients—but incredibly hard in practice. It means more skilled staff, working smarter not harder, with a sustained increase in NHS funding to pay for them. It requires relentless focus at every level of the service.
And after the toughest decade for funding in NHS history, the price tag will be enormous. But the public understands this, and may be ready for extra taxes if they flow straight to the service. Gordon Brown’s 2002 National Insurance hike “for the NHS” was described as the “most popular tax rise in history.”
So perhaps the cash can be found, but what about sufficient skilled clinicians? Compared internationally, the NHS is relatively efficient, running with little spare capacity: it makes do with less diagnostic equipment, fewer beds and fewer doctors and nurses. Managers struggled to fill vacancies even pre-pandemic, so there is little slack for ramping up activity. The private sector can offer additional beds and theatres—but most of its doctors are already NHS doctors working a couple of extra shifts. More training places, though useful, offer no immediate relief because training takes years. The NHS has always depended on clinicians trained overseas, but Brexit and a worldwide shortage will make it difficult to scale-up such recruitment today. Ministers must, somehow, retain existing staff and encourage others who have left to return. Below-inflation pay rises look like an own goal here.
Improving efficiency by working smarter is even tougher. Don’t imagine you can produce content patients (or voters) if under pressure managers massage the statistics. Ignore siren voices using the crisis to dust down their favourite quack cures, whether private insurance or more top-down reforms. Better care comes from clinicians redesigning it around patients’ needs. Create the space for them to do that and forget all reforms that don’t support them in the task. Invest in better community services to limit winter crises, which distress patients and clog up the system.
Whitehall must avoid writing prescriptions, but also summon anew the relentless focus of Tony Blair, who chased progress every month to drive waits down. Nor, given the umbilical links with social care, can government hope to speed progress by postponing the fixing of that yet again.
With the resources and the will, waiting times should be fixable—eventually. But recall Aneurin Bevan, the NHS’s founder, who thought its costs would eventually fall as the backlog of untreated disease was cleared. For that, we’re still waiting.
