It is a stretcher with little first aid: there is a welcome temporary splint for the pension problem that pushes experienced doctors into retirement too young. (This is another Labor plan that has been scrapped.) Extra assistants and greater use of pharmacists as prescribers are welcome, but even if this provides a million more GP appointments, that’s still only 1% more. The Tories long ago broke their 2019 manifesto promise of 6,000 extra doctors and there are now 1,850 fewer fully qualified full-time doctors than in 2015, with 16% more patients per doctor, according to Professor Martin Marshall, president of the Royal College. Doctors of doctors. He says the NHS is losing more GPs than it can recruit. Coffey is threatening to name and shame practices with long appointment waits, but doctors need “protection not punishment”, says Royal College of GPs president Clare Gerada. Too many already quit smoking under pressure. Social care is being ignored, once again. With 13,000 NHS beds blocked by people waiting for care, an extra £500m doesn’t begin to come close to the £13bn Liz Truss promised the Local Government Association for social care during her election campaign. What is missing is any serious workforce plan to train and recruit for the growing NHS and social care jobs. The Treasury is blocking anything that would be committed for years to come, funding only a fraction of the well-qualified medical school applicants who urgently need the NHS. What’s a Tory health secretary to do when faced with the fallout from her own governments 12 years of the worst ever underfunding of the NHS? Funding is always cut under every Conservative government, until the all too rare Labor governments lead to the bailout. He knows the NHS won’t get significant new money, so he does what everyone else does and shifts the blame back to the miserable staff. In a state of early ignorance, the first reaction of Tory health secretaries is always the same. Why can’t all of the NHS be as good as the best? Why can’t every hospital, clinic, doctor and nurse be above average? It calls for data on “unwarranted variation” to manage the performance of backlogged doctors and hospitals. But it will avoid looking at the UK’s “unwarranted variation” in OECD health spending, with fewer doctors, nurses and beds per head than similar countries. The new ministers ignore complex differences between regions, populations, facilities and the difficulty of recruiting staff. For example, Tory politicians enjoy pointing out lower health outcomes in Wales (run by Labour), without admitting that Wales has a population with the same profile of ageing, poverty, disease and frailty as the North East of England, which has similar results. Upgrading society and NHS outcomes would have less ‘undue variation’. The new health secretaries are eagerly looking at the levers on their desks, rolling up their sleeves and coming up with all sorts of whizzy ideas that none of their predecessors have considered, let alone top doctors, top managers and NHS executives who are among the most smart people in the country. Refusing to accept that the problem is funding and manpower, they blame staff, further discouraging exhausted doctors and nurses who are leaving early in alarming numbers. Or they might lay the blame on the whole state socialist model of the NHS itself: just listen to the background political rumblings and the spate of commentary in the right-wing press. If Liz Truss really wants to court unpopularity, she could start calling for private insurance schemes to alienate the large majority of the public who firmly support the founding principle of the NHS. Although concerned about current failures, voters retain unwavering faith in the system itself. It tops the list of what makes them proud to be British, even when they are aware of the current crisis situation. There is a risk in the long term if passionate supporters of the NHS, angry at this government, continue to cut it to the point where people might actually start to think it’s done. The remarkable truth is still that millions and millions are getting excellent and immediate treatment with which they are very happy. They tend to believe that the NHS ‘out there’ is far worse than the local NHS they personally experience. As the Royal College of GPs says, on a typical day 1.3 million people visit doctors and 45% have asked to see them that day. Politically, Labor will attack and attack again: the NHS is the main weapon against Tory governments. Labor left it in 2010 at its best for wait and cures. However, the NHS alone as an issue was never enough to win Labor an election. This time, however, the Tories have good reason to fear that they will be a major contributor to their defeat at the next election. They have no chance – and no real intention – of fixing it before the election, when the state of the NHS will stand as a miserable symbol of all the rest of the disaster they’ve wreaked on the country.
