Missed waiting targets are only part of the picture of an ailing NHS
Dr Kailash Chand
Thanks BBC for reminding the nation what most of us already know: the NHS is at breaking point and isn’t reaching its targets.
The fact that the NHS in England hasn’t reached a target since February 2016 is unacceptable and points to an NHS on the brink, even before winter pressures hit the system.
The present administration has closed nearly 10,000 NHS beds and 16% of A&E wards over the past seven years. Debt is at an all-time high, soaring numbers of the sick are waiting on trolleys in A&E, and key targets for treating cancer patients are being woefully missed. Real-term GP funding has declined £987 million and the number of unfilled GP vacancies has quadrupled. Acute trusts are running a £2 billion deficit. In addition, social care services have suffered a £2.6 billion real terms cut. This expected deficit could mean the loss of more than 20,000 nurses, and 9,000 trainee registrars.
In view of the above, delays will only worsen unless we address the underlying funding shortfall in health and social care and staffing problems in the NHS.
Delays in accessing care are also not limited to hospital care – many patients are waiting longer to get a GP appointment, so patients are facing delays earlier on in the process. There are now 8,000 GP practices in England – one in 20 has disappeared since 2010. The rate of loss of local surgeries is increasing by the day. General practice is the bedrock of many NHS services and the gatekeeper to the rest. Decline in general practice directly reflects massive pressure on A&E services. A combined financial and staffing crisis is causing chaos in the NHS for years and ultimately, if not addressed, will kill off the NHS for good.
A&E is often described as the barometer of the NHS. The significant decline in performance in recent years is not due to a single cause – rather it is the result of a combination of factors that reflect the huge pressures on the health and care system.
The causes of the problems in A&E, and the solutions to address them, are complex. It is often assumed that performance against the four-hour standard has deteriorated due to an increase in attendances, including by some people who could be better treated elsewhere. However, for many hospitals this is not the primary factor impacting on waiting times. A&E is in constant interaction with other hospital departments, for example, to request diagnostic tests and/or to transfer patients to beds in other parts of the hospital. A&E performance is therefore dependent on processes and capacity in other hospital departments, primary care and other parts of the health and care system.
While there are a number of factors driving bed occupancy rates up, delays in discharging patients from hospital and back into their homes or another more appropriate setting (such as social care) are a particular concern.
The NHS is now at a more pivotal point than it has ever been since I became a GP more than 30 years ago. The financial squeeze on health services will get much tighter over the next five years, with spending per person on the NHS falling by 9%. The dire prospect is that the NHS will have to ration treatment, shut hospital units, close GP surgeries and cut staff if it receives no extra money soon.
Targets are just one measure of how the NHS is performing, and clearly from these figures it is not performing well. There are many other measures on which the NHS is also falling short – from investment relative to other leading economies, to staff and bed numbers, to how the health service treats patients suffering from mental, as well as physical illnesses. The British public deserves nothing less than a well-financed and functional health service with happy and productive staff.
I call on Theresa May to instruct Phil Hammond, the Chancellor to provide immediate clarity on the fiscal health of the NHS and to announce in the November budget that spending on the NHS will rise to match that of other leading EU economies. We need this for the NHS to fund thousands more GPs, hospital doctors, nurses and other NHS staff, thousands more beds and to reverse damaging cuts to public health and social services.
Dr Kailash Chand is a retired GP from Tameside and is honorary vice-president of the BMA