From Theresa May, as from David Cameron, the message has been the same: the NHS has enough money. But reality is beginning to intrude. Today’s announcement that the health service is relaxing the 18-week waiting time target for non-urgent operations (such as hip or knee replacements) is the clearest signal yet of an NHS in decline.
Contrary to the claim that it has been shielded from austerity, the service is enduring the toughest spending settlement in its history. Since 1950, health expenditure has grown at an average annual rate of 4 per cent but over the last parliament it rose by an average of just 0.5 per cent. Demographic pressures, the rising cost of drugs and technology and the growth of chronic conditions, such as obesity and diabetes, all mean that the NHS depends on considerable increases. As well as longer waiting times, there will be “significant hospital bed closures” and a reduction in surgery deemed of “limited clinical value” (such as treatments for spinal conditions and back pain).
And there is no relief in sight. As NHS chief executive Simon Stevens warned in January: “In 2018-19, real-terms NHS spending per person in England is going to go down, 10 years after Lehman Brothers and austerity began. We all understand why that is, but let’s not pretend that’s not placing huge pressure on the service.”
Though the government wisely abandoned George Osborne’s budget surplus target, Theresa May and Philip Hammond have doubled-down on austerity. For most governments, squeezed services would be a political headache – Labour has traditionally thrived when the NHS is in crisis. Yet in Copeland, even the closure of a local maternity ward wasn’t enough to save the party from defeat (MPs believe the loss would have been even worse without this issue).
Shadow health secretary Jon Ashworth is one of Labour’s most effective operators but his party’s wider weakness inhibits his efforts. The Tories’ belief that the next election is unlosable gives them little political incentive to provide the NHS with the resources it needs. Their recently reaffirmed “tax lock” (prohibiting rises in income tax, VAT and National Insurance) also limits the scope for funding increases. Unless a tipping point is reached before 2020, the NHS appears set for years of decline.