The NHS “is a service, not a shrine,” Wes Streeting, the Shadow Health Secretary, remarks in his piece for this morning’s Sun.
Everything he writes in that piece, and has said in accompanying interviews, is designed to show that Labour can be trusted not merely to preserve but to reform the NHS.
Streeting assures us that “middle-class lefties” will not be allowed to block the use of spare capacity in the private sector to cut waiting lists.
What he does not do – no one can do everything in a single article – is to draw attention to the intense demographic pressures now facing the NHS. We are seeing vast increases in the number of old people, who are far more likely to have multiple medical conditions, a point made with his usual clarity by Neil O’Brien in his latest Substack, headlined “Something’s got to give”.
Something does indeed have to give. The Times today reports the effect of rising demand on admissions to Accident & Emergency departments, shown in statistics collated by the Liberal Democrats from Freedom of Information requests:
“More than 150,000 patients were forced to wait more than 24 hours in A&E before getting a hospital bed last year, a tenfold increase on 2019, new figures show.
“Elderly and frail patients made up the bulk of those forced to spend a full day in emergency units before a bed could be found for them. Medical leaders said that hospitals were now too full to give people the care they needed.”
Readers will be able to supply any amount of anecdotal evidence to support this. Long waits in A&E are commonplace. The paradox exists that in order to survive a visit to A&E one ought to be feeling rather stronger than normal, which of course one is not.
The NHS Confederation recently drew attention to figures which show, over the last ten years, a 13 per cent rise in attendance at A&E, from 8.44 to 9.55 million, but a 23.8 per cent rise in admissions, from 2.2 to 2.7 million.
So although one could cite any amount of anecdotal evidence of patients who go to A&E but ought to be treated by GPs, we also see that an increasing proportion of those who go to A&E are ill enough to require admission to hospital.
The Government recently announced that it has met its manifesto pledge to provide 50 million more appointments per year with GPs. This extra supply has been outstripped by extra demand.
If Streeting becomes the next Health Secretary, he will indeed need to find extra capacity wherever he can, and be ready to defy vested interests, not least those who claim to be upholding the pure socialist doctrine of 1948, which of course was not purely socialist, but had been proposed by Sir Henry Willink, the Conservative who served as Minister of Health in the wartime coalition, in the White Paper on Health of 1944.
There was then, as there is now, general agreement on the need for an NHS free at the point of use. The quiet, scholarly Willink, for the Conservatives, and the hysterical British Medical Association, on behalf of its members, opposed Nye Bevan’s plan for the hospitals, which enabled Bevan to paint the Conservatives as enemies of the whole idea of the NHS, and himself as a more thorough-going socialist than was actually the case.
The NHS inherited and has carried forward a great tradition of medicine, and has sought to bring it to everyone who needs it.
One hopes that amid calls for headlong modernisation, to meet the demands of an ageing population, the best of our medical traditions will be drawn on too.
No one used to suppose that every bed in a hospital should be full. There should in normal times be a reserve, ready to cope with epidemics and other emergencies. It was not a mark of efficiency to be operating at full capacity and full stretch all the year round.
If we still had some spare beds, we would not now be wasting time and money attempting to look after people on trolleys in A&E.
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Author: Andrew Gimson
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