The cash trap that Labour can’t avoid – John Lister, Keep Our NHS Public


“If Labour is too cautious or timid to commit to precise sums and timetables, Streeting, Starmer and Rachel Reeves must at least make clear that there will be a very substantial immediate cash injection into the NHS to begin the process of recovery.”

By John Lister

With Labour hopes of a victory in the next general election riding high after the Rutherglen election, and the Tories hell-bent on leaving the largest possible mess and ripping off the largest possible number of lucrative contracts before they lose office, the questions over the future of the NHS are sharper than ever.

Since the Tories took office in 2010 the population, and the proportion of older people with greater health needs, have increased, but almost every year has seen a real-terms cut in the funding of the NHS while the nominal cash allocation has marginally increased.

The gap in funding has brought a growing gap in capacity. Recent figures from NHS Providers which represents NHS trusts and foundation trusts show how much the pressure on the NHS has grown since 2019, the year before the pandemic.

On ambulance services, August figures show a slight reduction on July, but there were still almost 30% more of the most serious Category 1 calls compared with before the pandemic. Attendances at A&E, likewise, were slightly lower than July, but 22% higher than 2019.

But there is no corresponding additional capacity to deal with these emergencies, and so the proportion of the most serious Type 1 A&E cases (most likely to require admission) treated within 4 hours dipped again to just 59.1% – compared with the 95% target.

August saw a 21% increase in number of patients waiting more than 12 hours from the decision to admit to admission compared with July, with almost 29,000 left on trolleys – a staggering 7,600% higher than the same month four years ago before the pandemic, when this number was 372.

Front line bed numbers in England have fallen below 100,000, and with 89,000 (92%) of them occupied, one in six is effectively unavailable for emergency patients. Over 12,000 are filled by patients who should have been discharged but can’t be, for lack of social care or community support, and 3,800 at the last count (October 1) were occupied by Covid patients as infections rise again.

Elective care by contrast has fallen back, not least because of the cynical government decision to provoke and prolong the industrial dispute with junior doctors. This has meant the waiting list has again increased to an all-time high of almost 7.7m, 70% higher than before the pandemic, which in turn was around double the number waiting in 2010. Numbers waiting over a year (of which there were virtually none in 2010) have risen again – to 390,000.

Cancer treatment continues to fall short, even after reducing the number of targets: the NHS has not hit the target to start treatment within 2 months of referral since December 2015.

Adult mental health referrals, with 425,000 in June, are a massive 37% higher than before the pandemic, while referrals of children and young people are 80% higher than 2019.

Yet official figures show a 24% reduction in mental health beds since 2010, and NHS England’s mental health director has warned of chronic under-staffing, with an average 20% of posts vacant. The gaps are all to often filled by poor quality private sector provision.

As if all these signs of chronic under-funding were not worrying enough, dozens of hospital buildings are increasingly unsafe because they are built with the same defective RAAC concrete that has just caused the big scare in schools, and at least seven need to be completely rebuilt. But this comes on top of a huge and growing £10.2bn backlog of maintenance that leaves half the hospitals in England with some parts of their buildings out of use and needing repairs. Of course Boris Johnson’s cynical promise of 40 new hospitals remains as the sickest of jokes, with not even one new scheme begun since 2019.

All of these problems will be worsened again as Rishi Sunak’s plan to recoup all of the “extra” spending during the Covid pandemic, echoed by Jeremy Hunt as chancellor, forces England’s NHS to generate “savings” of £12 billion by 2025.

Trusts and Integrated Care Boards are being bullied into making more “savings” and cuts this year as they struggle to balance the books, and resources are even more limited from next April.

So while we can see why Keir Starmer and his team don’t want to commit to any specific spending pledges in advance of the election, it’s quite clear that unless Labour increases NHS spending it will find itself in charge as performance in some areas slumps even further, buildings crumble and collapse and there is an exodus of burnt out and demoralised staff despairing of ever seeing their skills properly valued and fairly paid.

And while it may sound like a short term fix for Wes Streeting to say he favours using “extra” private sector capacity to treat more patients from the waiting list, the logic of such a policy is to drain even more resources – staff and funding – from the NHS, perpetuating the lack of NHS capacity, and undermining the staffing levels in front line services.

NHS Providers and the Health Foundation have pointed out that the very limited scope of most private hospitals (which average fewer than 50 beds) means they can handle only the simplest waiting list cases: so making more use of these hospitals would leave less resources to deal with the patients with the most serious health needs.

Nor of course does the private sector offer any emergency services: there is no private sector solution to the problem of so many patients needing emergency admission waiting hours and even days on end on trolleys until an NHS bed is available.

Ironically the majority of people stuck on trolleys are the older age groups more likely to have voted Tory – and perpetuated the very policies they suffer from. But to make this point convincingly, Labour must commit once again to rescue, repair and invest more money each year in the NHS – as the Blair government did from 2000.

But while Blair and Brown felt able to stick with Tory spending limits for three years from 1997, the situation now is so dire that a Labour government will be immediately confronted by the need to increase funding.

Promises of future recruitment and training of more doctors and nurses and vague talk of new technology (both of which require extra funds) are completely irrelevant in the context of the growing crisis in the NHS, which is consistently one of the top five concerns of the electorate.

If Labour is too cautious or timid to commit to precise sums and timetables, Streeting, Starmer and Rachel Reeves must at least make clear that there will be a very substantial immediate cash injection into the NHS to begin the process of recovery, and raised through progressive taxation. 

And while it may take a while to unwind all of the private sector contracts across the NHS, all of the new money must be invested in NHS buildings, services and staff.

Featured image: SOS NHS Demonstration held on March 12th, 2023. Photo credit: Keep Our NHS Public/Twitter

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