The government casts this week’s strike by junior doctors in England as a cause of patient suffering, when it is better understood as a symptom of a health service in crisis. It is true that cancelled operations and delayed treatments diminish the service. It is also the case that failure to pay medical professionals properly is a long-term cause of systemic decline.
The public has noticed. Voters routinely cite the condition of the NHS as a top concern, second only to the soaring cost of living. Opinion polls show satisfaction with the service at an all-time low, which is hardly surprising when waiting times are out of control.
There are about 7.4 million people waiting to start treatment in England. The number has gone up in the months since Rishi Sunak pledged to bring it down. Last month, more than 500,000 people waited longer than four hours to be seen in A&E. Tens of thousands waited at least 12 hours.
Delays make sick patients sicker. Expectation of long waits causes people to postpone seeking help, when prompt intervention might prevent a moderate problem turning severe. This is a crisis that ministers cannot ignore; it should, at least, demand a lot more of the attention that Conservatives seem determined instead to spend on Boris Johnson’s resignation honours and other self-indulgent factional feuds.
Negotiating in good faith with striking doctors, and bringing the dispute to an end, would be a start. Refusing significant pay demands is a false economy when it drives clinicians to seek better terms abroad and depletes the goodwill – expressed as unpaid overtime – that keeps the NHS wheels turning.
A constant churn in staff is a significant factor in chronic low productivity in the service, despite relatively high levels of recruitment in recent years. Headline numbers of doctors and nurses conceal the departure of those with the most experience – and there is an excessive reliance on expensive agency workers who need time to get up to speed with overly bureaucratic hospital systems, often run on hopelessly outdated IT systems.
These problems were made much worse by the pandemic, but began long before it. The effort that has gone into clearing the Covid-related backlog involves the NHS running hard just to stand still, or to slow the slip backwards. There are simply too few hospital beds available, and too many of them are occupied by people who should be at home but can’t be discharged because the appropriate social care isn’t available.
New management, training more clinicians, innovation and a massive IT upgrade – all promised by the shadow health secretary, Wes Streeting, in a speech on Wednesday – would certainly help. But significant new capital investment is ultimately the gamechanger, and something the opposition is squeamish about pledging. Reform pays for itself in the long term, but it still requires new expenditure.
At least Labour are calling it a crisis. Mr Sunak’s approach combines denial and diversion, hoping that something will turn up or that blame will fall somewhere else. The government’s persistence in those failing strategies will cost them votes but, more urgently, it is costing lives.
