The end of 2021 is a historic moment for the NHS. And it’s nothing to do with the souped-up spike protein of its latest foe, Omicron.
No, now is the time hospitals were supposed to end their use of pagers.
When Matt Hancock, the former health secretary, set the deadline in February 2019, a single pager could cost hospitals up to £400. This was because only one provider was left in the UK for the outdated devices – which were so often seen bleeping away on doctors’ belts in medical dramas.
Other archaic technologies, such as fax machines, were also destined for the metaphorical incinerator by an earlier, equally poignant deadline: April 2020, a week into the country’s first national lockdown.
The Department of Health and Social Care’s campaigns to “axe the fax” and “purge the pager” were prompted by the costs and inefficiencies of persevering with such relics. In 2019, more than one in ten of the world’s dwindling population of pagers were used by the NHS, at an annual cost of £6.6m. In 2018, the health service was the world’s largest buyer of fax machines.
Both deadlines appear not to have been met, though the New Statesman hasn’t yet had a reply from the Department of Health and Social Care on the matter.
Yet the intended bonfire of such totems within our health service – which is so often characterised as creaky and bloated by its political detractors – is symbolic of the government’s relationship with the NHS. In their quest for efficiency (Hancock is the politician to thank if you’re fuming about your GP popping up on a private e-consult service), ministers have forgotten what the health service needs to function day to day.
Hancock may have wanted hospitals to do away with pagers, for example, but that very same year every major accident and emergency unit in England failed its four-hour waiting time target for the first time.
Since the coalition government embarked on austerity in 2010, cuts to local government (and, by proxy, social care provision that runs on council budgets) and underspending on the health service have stripped the system to the bone.
Now, the NHS is forever in crisis, and the government cannot simply blame this on the pandemic. The relentless focus on efficiency has meant there is now not enough slack in the system to absorb crises without the sacrifice of some services.
Planned operations were forced to be cancelled during the particularly bad flu winter of 2017/18, two years before Covid-19. A major story that dominated the December 2019 General Election campaign was that of a four-year-old boy with symptoms of pneumonia, sleeping under his coat on a hospital floor due to a lack of beds.
Most doctors, nurses, carers, paramedics and health leaders I’ve spoken to in the course of the pandemic have told me that it has only exacerbated and highlighted existing, longer-term problems.
The average number of available hospital beds in England has halved over the past 30 years:
Graph by Polly Bindman
The total number of NHS hospital beds in England fell from just under 300,000 in 1987-88 to around 141,00 in 2019-20. The UK has fewer acute beds relative to its population than many comparable health systems, with just 2.5 beds per 1,000 people, compared with Germany’s eight and France’s six, according to a report by the King’s Fund, a health policy think tank.
The number of beds for general and acute patients has fallen by 33 per cent in the past 30 years – from 180,889 in 1987-98, to around 120,794 in 2020-21.
Government spending on health has risen at a slower rate than it did during the preceding decade, leading to operations being cancelled more frequently (there was a 14 per cent rise in cancellations from 2009 to January-March 2020), and available overnight hospital beds falling by 11 per cent in the same period.
Graph and graphic by Michael Goodier
NHS waiting times were at a record high even before Covid-19. The total number of people waiting for treatment had been rising every year since 2013.
Graph by Nick Ferris
Although the pandemic’s disruption has led to tens of thousands fewer cancer diagnoses, and thousands of “missing” heart attacks, the NHS already had worse survival outcomes for cancer and heart attacks than most other comparable health services.
In fact, 2020 was the sixth consecutive year that NHS England missed its cancer waiting time targets – 2019 being the worst year since targets were introduced (the expectation is that patients should start treatment within 62 days of an urgent referral from a GP).
In 2018, the NHS performed worse than the average 18 equivalent developed countries in the treatment of eight out of the 12 most common causes of death – including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, according to a report by various policy bodies.
Graph by Michael Goodier
“I think this is quite forgotten now, given we’re in such a big crisis, but the NHS has had a decade of declining performances,” says an A&E doctor who works in a London hospital.
“Let’s try and make sure that that does not get lost, because the risk we saw was that the pandemic causes so much damage, everything is just focused on just getting the NHS back on track” – when being “on track” means a declining service.
Boris Johnson’s government has announced more funding to help the NHS. On 7 September 2021, the government announced plans to provide an additional £12bn per year for health and social care over the next three years through a new tax – a 1.25 per cent national insurance rise, which will take effect next April.
In addition, £5.9bn was announced in the Chancellor Rishi Sunak’s October 2021 Budget to help tackle the record backlog of people waiting for tests and scans (six million are now waiting for hospital treatment in England).
The latter is described as “capital investment”, as opposed to day-to-day spending: £2.3bn of it is for diagnostic tests, including community clinics (such as in shopping centres) where people can get scans, £1.5bn on hospital beds, equipment and “surgical hubs”, and £2.1bn to improve the health service’s IT.
Yet without plugging NHS staff shortages, who will operate these hubs and machines? One in ten nursing roles are vacant at the moment – meaning recruitment is not keeping up as waiting lists rise.
There is also a damaging GP shortage, with the government set to break its pledge to recruit 6,000 more in England by 2024. According to paramedics and GPs I've spoken to, this is pushing more people to immediately dial 111 or 999 instead of trying to access primary care, and therefore channelling an unsustainable number of patients to A&E.
The state of public sector pay doesn’t help with the health recruitment gap. The average pay of a nurse is now 5 per cent less than it was a decade ago, according to the Nuffield Trust. NHS staff have voted overwhelmingly to oppose the government’s offer of a 3 per cent pay rise for workers including nurses, paramedics, consultants, dentists and salaried GPs, deeming it inadequate compensation for pay freezes since 2010.
Graph by Kath Swindells
As hospitals rush to discharge patients to make room for the expected wave of Omicron admissions, the often overlooked heart of the NHS crisis is exposed: social care.
Patients who should be in residential care or at home with domestic care packages are “blocking” hospital beds, which means that ambulances are being delayed from handing patients over to hospitals.
The latest weekly stats show that every day on average 10,510 hospital patients no longer meet the criteria for a bed but are not discharged – that’s more than one in ten of all hospital beds taken up by those who do not need to be in hospital.
While the tax increase described above is also intended to provide money for the social care system, social care spending has been squeezed as local authority budgets have shrunk since 2010. The average council spend on adult social care per person fell 9 per cent in real terms from 2010 to 2019.
Chart by Michael Goodier
While Boris Johnson’s government did not choose to have to battle a pandemic, it is a political choice to run the NHS “hot” with no slack in the system for such disasters.