Once the Christmas decorations have been packed away for another year, it must surely be time for a winter crisis in the NHS and this year the media is full of it. This is no mean feat given the stiff competition offered by the alternating excitements of Brexit and Donald Trump. At least as regards the NHS, is there anything different about this year?
The short answer is yes. In England, December performance against the four-hour standard (which says that patients arriving at A&E must be treated, admitted or discharged within four hours of arrival), fell to 77.3 per cent in major A&E units, or to 85.1 per cent if we include other walk-in centres and other urgent care establishments. This takes us back beyond current data systems (2004) can record performance. Unfortunately, December is not usually the low point for the NHS in winter so these figures may yet fall further.
Surely winter is always tough? Another short answer: no, at least not like this. If we look back as recently as December 2013, the winter “crisis” led to performance in major A&E’s to fall to 92.9 per cent and, across all units, to 95.3 per cent—standards in 2017 that the NHS has come nowhere near to matching even in the “easy” Spring-Autumn period. It is winter all year round now. For the rather older amongst us, you may be a feeling a sense of déjà vu but if so this will be because you are remembering the 1990s, before the sustained investment of the last Labour government gave a long series of winters without a crisis.
Neither can we really point (yet) to the three usual winter villains: unseasonably cold weather; norovirus; and flu. December 2017 was colder, on average, than December 2016, but the Met Office tells us it was still above the long-run average. Norovirus has closed beds as usual this year, but nothing exceptional (yet) and, for all the fears of flu, December was again nothing remarkable and nothing like the last real peak (2010). Unfortunately, there are now the first signs that flu may be picking up—should it do so then we will be in for a much tougher time in the weeks ahead given the current fragility of the NHS.
It’s not hard to spot the most obvious reason behind the current problems: there were 520,163 emergency admissions to hospital in December, the highest ever monthly total and an increase of 4.5 per cent over December 2016. Against this simple fact, all the dedication of NHS staff and the undoubted planning that went into preparing for the winter simply could not stop the slide. However, while it may be understandable, it is also not surprising. The need for healthcare rises over time as our population grows and ages, and the intensive planning undertaken by the NHS only underlines the fact everyone was already frightened of an historically challenging winter period.
“Polling continues to show deep loyalties to the core principles of the NHS”The challenge for the NHS is that since 2010 it has faced this rising tide of demand with historically low levels of funding growth: instead of the (broadly) 4 per cent per annum real terms growth it has experienced since its creation in the 1940s, since 2010 it has had to manage with a bit above 1 per cent per annum. As each year goes by, the challenge gets harder.
To meet this challenge, the NHS—along with many other health services in high-income countries—is trying to change the way it works to adjust to the reality of an older population with more ongoing long-term conditions. Alongside this, more money will be needed if the NHS is to maintain current standards, yet some are asking whether the current difficulties mean the funding model for the NHS is broken at a more fundamental level.
Well, the public disagree. Polling continues to show deep (and largely unchanged) loyalties to the core principles of the NHS alongside a rising desire to spend more on it. Neither does the work of economists or analysts show any benefit from switching to a fundamentally different approach to funding, whether towards private insurance (which rarely comes out well), or social insurance.
However, it is true that the NHS has suffered from extended periods of boom and bust and, aside from the obvious problems this creates, it also makes essential workforce planning even harder (essential because it takes years to train doctors and nurses). Providing an independent assessment of what the health service needs and requiring government to at least provide a response if it chooses to ignore this advice, could help place the NHS on a firmer footing. To this end, an independent body should be given responsibility for proscribing a fix for our ailing NHS. There are precedents for this: think of the Office for Budget Responsibility.
This approach could maintain the current strengths of the NHS funding model while reducing the chances of Britain drifting into another “endless winter.”
