Therese Coffey, new Health Secretary to new Prime Minister Liz Truss, is set to announce her “emergency plan” to fix the NHS today.
Looking at the stats, it’s clear that an emergency plan is needed, particularly with winter approaching. The NHS in England is recording historically poor performance on almost every assessable measure.
Figures this summer were worse than any winter on record and the health service is now failing to meet its own waiting time targets for any of A&E, routine operations or cancer.
The last prime minister to inherit a health service that met any of these targets was David Cameron, 12 years ago.
Ms Coffey’s plan will focus on what she calls her ABCD priorities – “Ambulances, Backlog, Care, Doctors and Dentists”.
The backlog of operations built up significantly during the pandemic, but on most indicators, there were already signs of decline before COVID-19.
In fact, each Conservative leader since Mr Cameron has been handed an NHS in a worse condition than their predecessor. Liz Truss is no different.
Accident and emergency
A&E waiting times now are twice as bad as they were when Boris Johnson became prime minister three years ago.
Mr Johnson inherited a health service for which waiting times were already five times worse than when Mr Cameron, his schoolmate, took over in 2010.
After a patient has waited to be seen in A&E, they may face another wait for a hospital bed to become available before being admitted. This is known as a “trolley wait”.
Trolley waits of more than four hours used to be rare, but became more common through the 2010s and have doubled since the pandemic.
When Mr Johnson took over, the number had already risen 15 times since 2010. Last month, there were 35 times more of these waits than when Mr Cameron became prime minister.
Waits of more than 12 hours used to be statistically non-existent. Now there are almost 30,000 a month.
It’s a similar story when it comes to cancer, one of the most time-critical diseases in terms of treatment.
The number of people who have to wait more than two months to start treatment after receiving an urgent referral from their GP is more than three times higher than it was when Mr Cameron became leader.
Like A&E waits, it slipped throughout the 2010s – nearly doubling in the time between Mr Cameron and Mr Johnson moving into No 10. It has nearly doubled again since the pandemic.
The “waiting list” – the number of people who have been referred for treatment by a consultant but have not yet started that treatment, is at an all-time high. No leader has inherited a waiting list shorter than their predecessor since Gordon Brown was replaced by David Cameron.
The number of people who have been waiting more than a year has multiplied by a scarcely believable 234 times since the pandemic began, having been virtually eliminated before.
The current figure is still lower than it was at the end of Tony Blair’s time in office.
But on this at least there are historical and recent precedents for improvement.
Since February, the NHS has managed to reduce two-year waits to close to zero after they rose above 20,000 for the first time. The next target is to remove waits longer than 18 months by April 2023 – NHS England says they are down by more than a third since January.
The waiting list is one of the few areas for which comparable figures go back beyond 2010, and we can see that under Gordon Brown great strides were made to cut the longest waits.
Adrian Kay, professor of government at the Australian National University, says that a combination of increased funding and “political commitment to aggressive target-based policy” contributed to the reduction in waiting times under New Labour.
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“Waits that had often been above 18 months in 2000 dropped to no more than 18 weeks by 2010,” he said.
“Hospitals that failed to achieve key targets were rated zero and publicly ‘named and shamed’ as failing. The possible sanction on hospital chief executives was losing their jobs.
“It was the first time in NHS history that there was a clear line of sight in accountability terms from the prime minister down to hospital chief executives in charge of delivery of medical care at the street level.”
Funding stalled when Mr Cameron was elected in 2010, having grown throughout the New Labour years.
It has ramped up again since the pandemic, though GDP contractions during the pandemic and during the 2008 financial crash mean that not as much extra money reached the NHS during those periods than it may appear in the chart below.
The number of staff recruited under Mr Johnson was higher than under his predecessors, though less so for ambulance staff.
Figures for ambulance waiting times don’t go back as far as some of the other figures we’ve quoted, but 999 callers who have had heart attacks or strokes are now waiting half an hour longer than they were pre-pandemic.
Miriam Deakin, director of policy and strategy at NHS Providers, said: “While staff numbers have increased, they haven’t kept pace with the scale of demand the service is facing and as pressures rise, more must be done to retain staff.
“There are severe staff shortages across the NHS with a staggering 132,000 jobs across the health system left unfilled, and many more across social care.”
NHS Providers speaks for every NHS hospital, mental health, community and ambulance service in England.
In Ms Truss’s first speech as prime minister, she said that fixing the NHS was her third priority, behind economic growth and protecting people from rising energy prices.
“I will make sure that people can get doctor’s appointments and the NHS services they need. We will put our Health Service on a firm footing,” she said on Tuesday on the steps of No 10.
Mr Johnson made similar commitments in his first speech as leader, on the same spot three years earlier: “My job is to make sure you don’t have to wait 3 weeks to see your GP… and ensuring that money for the NHS really does get to the front line.”
The number of staff employed at GPs increased under both Theresa May and Mr Johnson, but the number of GPs barely changed. The number of appointments has risen but it is harder to see a GP face to face, and access to GPs in the most deprived areas has declined.
If Ms Truss is going to deliver on her promises in time for the next election, she must turn around 12 years of decline in the next two.
And she must do this without the extra funding from a National Insurance rise announced under Mr Johnson’s leadership, which she has pledged to reverse.
Richard Murray, chief executive of the King’s Fund, an independent healthcare charity, said that Ms Truss and Therese Coffey, her new health secretary, have “a matter of weeks to decide what emergency short-term action to take to provide at least some additional support during what promises to be a terrible winter for patients and staff”.
“Without urgent action we can expect ambulance delays to get even longer and more and more people at risk of harm in overcrowded A&E departments as the rising cost of living and winter start to bite, which could drive further spikes in demand,” he said.
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Ms Deakin said: “The NHS has gone through a ten-year financial squeeze, the longest and tightest in its history, leaving a legacy of financial challenges.
“This includes significant care backlogs, with waiting lists growing before the pandemic and continuing to rise since with significant pressure across urgent and emergency care and ambulance services, and mental health and community services.
“The problems in an underfunded and overstretched social care system continue to have serious knock-on consequences for the NHS.
“The failure by successive governments to grasp the mettle on social care is coming home to roost with handover delays continuing to be a huge problem for hospitals unable to discharge patients who are well enough to continue their recovery at, or closer to home, largely due to shortages of staff and funding in social care.”
The Conservative Party did not respond to our request for comment.
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