At the final PMQs of 2017, Theresa May boasted of her political survival: “Not that long ago, he [Jeremy Corbyn] was saying that he would be Prime Minister by Christmas. Well, he was wrong; I am”. But, I warned at the time, the NHS crisis (the issue on which Corbyn challenged May) would return to “haunt her”.
On the third day of the new year it has. Under the greatest strain it has faced for decades, the NHS has been forced to delay all non-urgent surgery until 31 January (around 55,000 operations), cancel outpatient and day surgery appointments and deploy consultants in A&E units to turn away cases deemed non-emergency. Ambulances are forced to wait outside hospitals at full capacity; patients on trolleys in corridors (14,000 beds have been lost). A tweet by Dr Richard Fawcett, an emergency consultant at the Royal Stoke University hospital in Staffordshire, distilled the mood of despair: “I personally apologise to the people of Stoke for the third world conditions of the department due to overcrowding”.
And yet none of this is surprising. Though the Conservatives like to boast that NHS spending has been “protected” since 2010, the health service has in fact endured the longest period of austerity in its history.
Since 1950, health expenditure has grown at an average annual rate of 4 per cent; over the last parliament it rose by an average of just 0.5 per cent. An ageing population, the rising cost of drugs and technology and the growth of chronic conditions, such as obesity and diabetes, all mean that the NHS depends on above-inflation increases. The £4.5bn cut to social care funding has only intensified the pressure on the service (with the NHS acting as a provider of last resort).
Before last November’s Budget, health leaders warned that this fiscal famine could not endure. Simon Stevens, the NHS chief executive, requested a minimum increase of £4bn in 2018 (far below the £18.2bn – or £350m a week – promised by the Leave campaign). “2018, which happens to be the 70th anniversary of the NHS, is poised to be the toughest financial year,” Stevens warned. After nearly a decade of austerity, he noted, Britain was underfunding the health service by £20-30bn compared to comparable countries such as Germany, France and Sweden.
But Philip Hammond offered just £1.6bn for this year – less than half the amount Stevens demanded. In response, Chris Hopson, the chief executive of NHS providers, warned that “tough choices and trade offs” would need to be made. “It is difficult to see how the NHS can deliver everything,” he added. Those “tough choices” are now clear: delayed operations, cancelled appointments.
The NHS is cyclically prone to winter pressures (influenza and cold weather) but they have been amplified by a structural crisis: the chronic gap between needs and resources. Not since the 1990s has the health service been so vulnerable.
In 2002, Gordon Brown rose National Insurance by 1p to pay for the largest-ever increase in NHS funding (£40bn). In the years that followed, patient satisfaction reached record levels. Nearly two decades later, as the service daily declines, the need for a new financial settlement has never been greater. But an enfeebled Prime Minister, consumed by the epic task of Brexit, is in no position to deliver one.
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