Just what is a “crisis”? Well, if you have a stroke or serious chest pain these days, you’ll wait nearly an hour for an ambulance – and that’s the fast lane. In December 55,000 people waited more than 12 hours to be admitted to A&Es, which is by far the highest yet recorded. This has an excruciating cost. The Royal College of Emergency Medicine has estimated that up to 500 people are dying a week as a result of these delays. That’s the equivalent of two Lockerbies – the 1988 terrorist attack that downed Pan Am Flight 103. Or ten 7/7 bombings. Per week.
You might reasonably expect a government to class 500 of its citizens needlessly dying a week as a crisis, and therefore a situation that demands immediate intervention. This has not happened. Officially, there is no NHS crisis.
With no crisis, there has been no crisis action. No Cobra meetings have been called on the matter. On 7 January Rishi Sunak held a meeting with health leaders but called it a “recovery forum” – which hardly smacks of urgency. Earlier that week a spokesperson for No 10 refused to accept the assertion that the NHS was in crisis at all. An unprecedented winter NHS emergency had been talked of as a certainty as early as the summer, and was very clearly building throughout November and December, yet in January we are still dancing around the semantics.
As the weekly death toll grows, you might be forgiven for feeling as if it were early March 2020 again. At that point, remember, it was all too clear what was headed our way, yet it felt like the country was frozen to the spot. There was an emergency, yet there was no emergency. We did nothing but wait. The horrors we were seeing in other countries would soon be upon us but the government refused to do anything so hasty as treat it as a crisis. It was only later, when much damage had been done, that the interventions came.
It is not as if nothing can be done right now to help to save these people dying in NHS waiting rooms and ambulance queues. True, the problems are knotty and expensive: in a nutshell, the issue is one of capacity. The NHS has too few beds – a result of decades of underfunding, a threadbare social care system and Covid. There is no instant solution. Yet there are many emergency buttons at hand that remain unpressed.
The government could, for example, give hospital trusts funding to add some temporary capacity. It could pull the lever it did during the pandemic – booking out care home space into which to discharge elderly people who are taking up hospital beds but no longer require medical attention. As it did during the pandemic it could call on emergency volunteers – this time to act as carers to check on and support people discharged from hospital. An emergency public health campaign wouldn’t go amiss either: the uptake of flu vaccinations is still too low. Declaring a crisis is the place to start.
The government could also quickly come to a deal on NHS pay. Whatever their position on strike action, it is clear that unless they are paid more, nurses will leave the NHS, either for the booming private healthcare sector or a different profession altogether. This is a policy problem with only one answer.
With so many people dying, and solutions on hand, how has the Prime Minster got away with dodging the question? Why is this not a crisis?
Part of the problem is there is no objective measure. The rest of us can complain as much as we like – it is up to the government to decide whether what is happening in the NHS amounts merely to “unacceptable delays”, as Sunak said recently, or a full-blown crisis. There is also of course the fact that the NHS has been in crisis, one way or another, for as long as most of us can remember. There has never been enough money. Things in the NHS are unprecedentedly bad, but we have got used to things being unprecedentedly bad. The issues have been slowly getting worse for years.
The government is relying on something: humans are very good at adapting to bad situations. At the start of the Covid pandemic a journalist friend of mine tweeted a fairly accurate prediction of the number of people who might die. We might all know someone who died of Covid, he said. He was pilloried on Twitter as a scaremonger. By the time he was proven right we had got used to the idea. When a few months later the daily death toll passed a thousand it was almost taken as a matter of course. What was unthinkable as a sudden change was liveable as a gradual one.
Dramatic or unexpected change creates unbearable political pressure. Think of Liz Truss’s budget causing an instant ballooning of mortgage rates. In those situations the public reacts together and all at once, and politicians are forced to act. But in a slow-building crisis the body politic can act like the proverbial frog gradually boiling to death. We shouldn’t let ourselves forget how shocking the NHS crisis really is.
[See also: The sick man of Europe]