Al, or to give him his Russian codename ‘Boris’ Johnson has gone on record as saying that the reason he is proposing ‘investing the record ever amount’ in the NHS is because it is ‘facing massive demand’ (interview with BBC Breakfast).
The interviewer, Naga Munchetty, did a good job of challenging this, on the grounds that the amount proposed is not even enough to make up the shortfall in funds to the NHS since 2010, and it is spread over five years, so the increase will be slow to have effect. And it is far from a record amount.
She also compared spending under the Coalition and Tory governments with a range of more generous regimes, including that of the late Margaret Thatcher. The video has been quite widely shared, and has even appeared on the Daily Mail website, although they didn’t discuss his skewering over the NHS.
But even so, I think this only really addresses part of the story. Why is the NHS ‘facing massive demand’?
I think there are a number of related answers to this question, which throw additional light on the impact of Tory policies. (Sorry people, this is going to be another long one).
Often, NHS pressures are seen in the context of rising attendances and the ongoing failure to meet A&E performance targets, and the similar failure to meet cancer treatment targets, to name but two. Or, more nuanced, to this is added the much-reported difficulty to get a GP appointment in many parts of the country, and the exceptionally long waiting times being faced by people in need of support from mental health services.
All of these are, of course, related. If you can’t see your GP, it is quite possible that the condition may exacerbate, or you may become desperate, and so you will head for A&E. People with untreated mental health problems may well also end up in an emergency setting. Because it is always there to help when the other systems fail.
And if A&E is overwhelmed, as it has been in the last few winters, it affects the whole hospital – elective appointments, and scheduled surgery are cancelled, because the staff, beds and other resources are being used to deal with the urgent cases.
So, each of these measures, and many other figures that show a system being severely challenged, are closely related, and demonstrate that the NHS is a system, which has to work as a whole. It also illustrates why a plan which merely focuses on capital refurbishment of hospitals – which was the Johnson government’s original idea – so woefully misses the mark.
But is demand increasing as the man claimed? Well, yes it does appear to be, but this too should be unpicked a little.
Often there is talk of an ‘increasing number of older people requiring care’ – yet actually life expectancy in the UK has stagnated in the UK in the last ten years. And, traditionally, those who are very frail or elderly would be cared for in care homes or nursing homes, which would normally mean they needed less treatment from the NHS, apart from thoughtful medicine review (the figures are robust about this).
There is also sound evidence that – particularly in more deprived areas – there have been more unnecessary deaths in the last 10 years than previously. In those areas, particularly, people have been living less long. Attempts have been made to test whether this is linked to austerity by researchers, and there does appear to be some connection in the data.
One attempted rebuttal of this came from a professor who should have known better, who said it was probably due to ‘increasing multimorbidity’. But, as is well-known, areas with higher deprivation usually also have a population which acquires chronic conditions earlier than is normal, and on average become multimorbid at a much earlier age. This was a finding of the Marmot Report, and I’ve personally seen this effect when working in population health analysis and management over the last few years. So, identifying increasing multimorbidity may well actually be a measure of increasing deprivation.
Or, rather, deprivation which remains unaddressed. If other services work well, this trend can be ameliorated (I've seen this too).
And this is the crux, I think. Just as the NHS is itself a system which should be seen as a whole, so it in turn must be seen as embedded in a network of social and community services which provide a network of support, aimed at helping the most disadvantaged in our country through early intervention. These services also provide safety when patients leave hospital, making discharge safer and helping prevent readmission.
The exceptional and massive reduction in local authority funding over the last ten years has drastically undermined this environment. Whether considering the deep cuts to social care, sure start, housing support, benefits, or the myriad of other necessary services and support structures, it is clear that the net effect is create more life stressors, remove help, and put more pressure on individuals and thus the already-overstretched and stressed NHS. Difficult life events now often leave those in most need of help with nowhere else to go.
So has demand increased? I would say yes, but mostly because of the policies pursued by successive governments over the last ten years.
This really ought to be emphasised. In a period which has seen the lowest level of funding increase to the NHS in 70 years (which actually results in real-term cuts), at the same time as the government has presided over massive staff reductions in the service, the funding for all the other allied services which keep the pressure away from the NHS have been slashed more heavily than ever before. So that despite an increase in early deaths, and there being no substantial increase in overall life expectancy, the pressure on the service of last resort has become, and continues to be, exceptional.
And to be honest, something similar has occurred with the police.
The obvious corollary is that you can’t resolve the challenges the NHS is facing without also addressing the Coalition/Tory cuts to social care, public health, wellbeing, housing, benefits, and so forth.
We haven’t seen the manifestos yet, but the Labour Party and the Greens do seem to get this. I just wish we all did.
She also compared spending under the Coalition and Tory governments with a range of more generous regimes, including that of the late Margaret Thatcher. The video has been quite widely shared, and has even appeared on the Daily Mail website, although they didn’t discuss his skewering over the NHS.
But even so, I think this only really addresses part of the story. Why is the NHS ‘facing massive demand’?
I think there are a number of related answers to this question, which throw additional light on the impact of Tory policies. (Sorry people, this is going to be another long one).
Often, NHS pressures are seen in the context of rising attendances and the ongoing failure to meet A&E performance targets, and the similar failure to meet cancer treatment targets, to name but two. Or, more nuanced, to this is added the much-reported difficulty to get a GP appointment in many parts of the country, and the exceptionally long waiting times being faced by people in need of support from mental health services.
All of these are, of course, related. If you can’t see your GP, it is quite possible that the condition may exacerbate, or you may become desperate, and so you will head for A&E. People with untreated mental health problems may well also end up in an emergency setting. Because it is always there to help when the other systems fail.
And if A&E is overwhelmed, as it has been in the last few winters, it affects the whole hospital – elective appointments, and scheduled surgery are cancelled, because the staff, beds and other resources are being used to deal with the urgent cases.
So, each of these measures, and many other figures that show a system being severely challenged, are closely related, and demonstrate that the NHS is a system, which has to work as a whole. It also illustrates why a plan which merely focuses on capital refurbishment of hospitals – which was the Johnson government’s original idea – so woefully misses the mark.
But is demand increasing as the man claimed? Well, yes it does appear to be, but this too should be unpicked a little.
Often there is talk of an ‘increasing number of older people requiring care’ – yet actually life expectancy in the UK has stagnated in the UK in the last ten years. And, traditionally, those who are very frail or elderly would be cared for in care homes or nursing homes, which would normally mean they needed less treatment from the NHS, apart from thoughtful medicine review (the figures are robust about this).
There is also sound evidence that – particularly in more deprived areas – there have been more unnecessary deaths in the last 10 years than previously. In those areas, particularly, people have been living less long. Attempts have been made to test whether this is linked to austerity by researchers, and there does appear to be some connection in the data.
One attempted rebuttal of this came from a professor who should have known better, who said it was probably due to ‘increasing multimorbidity’. But, as is well-known, areas with higher deprivation usually also have a population which acquires chronic conditions earlier than is normal, and on average become multimorbid at a much earlier age. This was a finding of the Marmot Report, and I’ve personally seen this effect when working in population health analysis and management over the last few years. So, identifying increasing multimorbidity may well actually be a measure of increasing deprivation.
Or, rather, deprivation which remains unaddressed. If other services work well, this trend can be ameliorated (I've seen this too).
And this is the crux, I think. Just as the NHS is itself a system which should be seen as a whole, so it in turn must be seen as embedded in a network of social and community services which provide a network of support, aimed at helping the most disadvantaged in our country through early intervention. These services also provide safety when patients leave hospital, making discharge safer and helping prevent readmission.
The exceptional and massive reduction in local authority funding over the last ten years has drastically undermined this environment. Whether considering the deep cuts to social care, sure start, housing support, benefits, or the myriad of other necessary services and support structures, it is clear that the net effect is create more life stressors, remove help, and put more pressure on individuals and thus the already-overstretched and stressed NHS. Difficult life events now often leave those in most need of help with nowhere else to go.
So has demand increased? I would say yes, but mostly because of the policies pursued by successive governments over the last ten years.
This really ought to be emphasised. In a period which has seen the lowest level of funding increase to the NHS in 70 years (which actually results in real-term cuts), at the same time as the government has presided over massive staff reductions in the service, the funding for all the other allied services which keep the pressure away from the NHS have been slashed more heavily than ever before. So that despite an increase in early deaths, and there being no substantial increase in overall life expectancy, the pressure on the service of last resort has become, and continues to be, exceptional.
And to be honest, something similar has occurred with the police.
The obvious corollary is that you can’t resolve the challenges the NHS is facing without also addressing the Coalition/Tory cuts to social care, public health, wellbeing, housing, benefits, and so forth.
We haven’t seen the manifestos yet, but the Labour Party and the Greens do seem to get this. I just wish we all did.
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