Conservatives leave NHS in intensive care

After fourteen years of Conservative rule, the NHS is in serious trouble. Waiting lists are at record highs, public satisfaction is at record lows and life expectancy is falling. But Labour’s two flagship policies to restore the NHS – increasing GP visits and doubling the number of CT and MRI scanners – will not be enough to restore its health, it says Andrew’s Street.

The NHS celebrated its 74th birthday on 5 July, the day Labour returned to government. At the end of the last Labour government in 2010, the NHS was 60 years old and in good health. Public satisfaction was at a record high, waiting lists and waiting times were the shortest they had ever been, life expectancy was improving and the UK’s healthcare system was ranked among the best in the world. Fourteen years later, all that had been reversed: public satisfaction is at an all-time low, more people are waiting for treatment than ever before, and life expectancy is falling for the first time in peacetime.

Having peaked at 60, at 74 the NHS has collapsed and is now more like a patient in intensive care. The state of the NHS in England is particularly poor, almost entirely as a result of the policies of the Conservative Westminster government. The Scottish, Welsh and occasionally Northern Irish governments have looked after the NHS better in their countries, but nowhere in the UK is it in great shape. As the dominant political force, it will largely be up to Labour to fix things. Their two flagship policies will not be enough.

Just getting the striking doctors back to work will be a major challenge, let alone taking additional action.

Additional meetings

The first is to tackle waiting times by creating an extra two million operations, scans and appointments a year. Two million sounds like a lot, but it’s just 2 per cent of annual activity, probably not enough to eliminate long waiting times. The plan is for existing staff to deliver these extra appointments by working extra hours. That doesn’t seem very realistic: it will be hard enough to get striking doctors back to work, let alone take on more. Staff are still burnt out from the pandemic, so much so that many have decided to leave the NHS: there are now 125,000 vacancies. That means that remaining staff are already having to work longer hours to replace those missing colleagues; there is little, if any, scope for those staff to take on even more work.

This workforce crisis has been building for a long time. From 2010 to 2023, first the Coalition and then successive Conservative governments abandoned workforce planning. This is extraordinary, given that the NHS is one of the world’s biggest employers. We haven’t trained enough doctors and nurses; Brexit and increasingly stringent visa rules have made recruiting from abroad even harder; and wage erosion is encouraging existing staff to seek work elsewhere.

It’s not just scanners that we lack. There aren’t enough hospital beds, again fewer per capita than in most other European countries.

More scanners

Labour’s second flagship policy is to double the number of CT and MRI scanners to speed up diagnoses, especially for cancer patients. The UK is near the bottom of the European league in terms of scanners per head of population, and this is one reason why our cancer survival rates are worse than those of comparable countries.

But it’s not just scanners that we lack. There aren’t enough hospital beds, again fewer per capita than in most other European countries. So if you’re unlucky enough to be admitted to hospital, you could end up sleeping on a trolley in the corridor rather than in a bed on a ward. There’s a record backlog of repairs that need to be done in NHS buildings. Computer systems are outdated and easy targets for cyberattacks. A ransomware attack on 3 June meant that staff in south London still don’t have access to diagnostic tests electronically, so they have to share test results with each other using pen and paper. We’re a long way from the promised digital transformation that aims to make better use of healthcare technology.

Once again, this reflects badly on previous Conservative governments who oversaw under-investment in NHS buildings and equipment. This happened because money earmarked for capital spending was regularly diverted to cover current spending. The cuts in capital spending may not be immediately obvious, but they become very apparent after fourteen years. We simply do not have the physical or technological infrastructure that is fit for purpose in the 21st century.^saint age.

Care plans are needed to support recovery

Given how long it takes to train doctors and nurses, it will be many years before we finally have the numbers and mix of NHS staff we need in the UK. A priority for Labour will be to start implementing the 2023 jobs plan. At least the promise to train 8,500 more mental health workers is a start.

It will take much more than Labour’s manifesto promises to take the NHS out of intensive care and into rehabilitation, let alone restart it

As well as addressing the workforce crisis, the new governments in Belfast, Cardiff, Edinburgh and Westminster will also need to develop the NHS estate and infrastructure. Capital spending guidance has tended to focus more on how much money is (or isn’t) available than on how best to spend it. It is essential that the new governments develop coherent investment plans for the NHS estate and infrastructure, including equipment and technology, so that we have the right buildings in the right places, with modern resources to meet the needs of each country’s ageing population.

As the NHS enters its 75th anniversary,^t year, it desperately needs a recovery. But it will take much more than the Labour manifesto promises to take the NHS out of intensive care and into rehabilitation, let alone restart it.

All articles posted on this blog express the views of the author(s) and not those of LSE British Politics and Policy or the London School of Economics and Political Science.

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