Back in October Sajid Javid insisted: “We don’t believe that the pressures currently faced by the NHS are unsustainable.” It was a statement that did not age well. It led to snorts of derision from senior doctors and hospital bosses, some of whom wondered what planet the health secretary was living on.
Days later Roland Sinker, the chief executive of Cambridge university hospitals NHS trust, gave a vivid insight into how easily NHS hospitals can get overwhelmed. He told a staff Zoom meeting that the loss of 150 out of 900 beds at the trust’s main hospital – Addenbrooke’s, one of the NHS’s finest – meant that “we could barely function before Covid”. With “150 beds out of 900” unavailable, “this is ceasing to function as a hospital”.
Days earlier a patient had died in the back of an ambulance outside the hospital. Its inability to cope with demand was so worrying, Sinker said, that it might have to send patients to London or Birmingham. “I’m much more anxious and scared now” than when he took over in 2015, he admitted, adding: “You’d have to be asleep to not realise the profound nature of the crisis we’re in.”
Fast forward two months and a growing number of NHS trusts in England, struggling in the face of an Omicron-driven surge in staff sickness, are now having to declare a “critical incident” – an admission that they cannot cope with the extreme pressure they are facing. “Unfortunately this does mean postponing some non-urgent operations and outpatient appointments to accommodate those patients with the most urgent clinical need,” Aaron Cummins, the chief executive of the university hospitals of Morecambe Bay trust in Cumbria, explained in a statement on Monday. It is easy to see such situations as proof that those places are overwhelmed.
On Tuesday it emerged that the NHS ambulance service covering the north-east of England has begun asking friends and relatives of people who have dialled 999 to bring them to hospital themselves, even if they are having a suspected stroke or heart attack, because it cannot guarantee that paramedics will reach them in anywhere near the expected response times.
Ministers prefer to trumpet the record funding the NHS is now receiving, and that the largest number of people ever now work in it in England, than hear such stories of the inability of the nation’s most important service to do its job.
At Tuesday’s Covid press conference Boris Johnson declined to define what an “overwhelmed” NHS looked like. He denied suggestions that it was already in that state, though did concede that “there will be a difficult period for our wonderful NHS in the next few weeks because of Omicron”. The reality is that today’s pileup of problems shows that much of the NHS is already overwhelmed.
As the NHS Providers boss, Chris Hopson, points out, while the service’s current difficulties are the result of “an exceptional Covid surge”, years of government decision-making have left it in this weakened state. “Recent winters and NHS performance pre-Covid show that, after [a] decade of longest/deepest financial squeeze in NHS history, NHS has serious capacity/demand mismatch and broken workforce model,” he said.
The NHS in England has had close to 100,000 vacancies for years now, including for about 40,000 nurses and 10,000 doctors. The price of persistent understaffing is paid daily by health personnel routinely working extra hours to ensure patients get good care; that goodwill helps keep the NHS from falling over. Patients experience it in the form of delays in getting help or having a diagnostic test. And it is also felt by a service which, in some parts, too often teeters perilously close to falling over, usually under the extra strain winter brings, but sometimes in summer too, and certainly as a result of Omicron.
Analysis by Stephen Rocks of the Health Foundation thinktank shows that the UK has only 3.93 hospital doctors per 100,000 people – the lowest in Europe. It also has just 2.42 beds per 100,000 people, the second lowest in Europe after Sweden, which has only 2.07. And it also ranks low down the international league table for its supply of nurses, CT scanners and MRI scanners.
The size of the NHS budget is important. But providing high-quality healthcare involves more than that. It also involves giving the service the staff it needs and taking firm action to reduce illness.
Today’s immediate, escalating NHS crisis has long roots, which are also political roots. Years of decisions by David Cameron, Theresa May and Boris Johnson, especially their inaction on staffing, left it enfeebled and woefully underprepared for this level of extreme pressure, which the critical incidents and unavailability of ambulances dramatically illustrate. The service’s many supporters can only hope that it does not break altogether in the coming days.