But there was one glaring omission. There was not a single mention of the NHS in the hour-long debate – despite it being mired in its biggest ever crisis. The NHS now shares the same characteristics as many of those who rely on it to keep them alive and well: he is elderly, has multiple co-morbidities and is in immediate need of urgent care. Summer has brought it to its knees. Worse is expected this winter. “The new prime minister will inherit an NHS at its worst,” says Matthew Taylor, chief executive of the NHS Confederation, which represents the health care system in England, Wales and Northern Ireland. “There is no escaping that the NHS is in a state of crisis.” The facts, he says, speak for themselves. “There are 105,000 vacancies. A&E is overcrowded. About one in seven hospital beds are occupied by patients who cannot be discharged. Some patients had to wait over 40 hours for an ambulance. Care is compromised by neglected buildings due to underinvestment. And then there are the waiting lists, which run into the millions for elective care, mental health and community care.” Jeremy Hunt, the chairman of the health and social care committee, is equally worried. “The new prime minister will inherit an NHS facing the most serious crisis in its history,” he warns. “A&E, ambulance, GP and social care are at serious risk across the country.” The overriding problem for Downing Street’s new owner is that, whereas in previous years problems in the NHS were concentrated in specific areas, today the whole house is on fire. “The NHS has never been more challenged than it is now,” says Alastair McLellan, the editor of the Health Service Journal. “There is not one area of NHS provision that is not really struggling… There is literally nowhere that is not bad, and in some cases very bad.” Ambulances outside a hospital in London. A record 29,317 people had to wait more than 12 hours in English A&E departments in July. Photo: Andy Rain/EPA In the short term, says Robert Ede, head of health and social care at thinktank Policy Exchange, the key task will be to prioritize. “Almost every light on the dashboard is flashing. The single priority for this winter should be to ensure that patients can access essential services.” One light that has been on all summer has been urgent and urgent care. A record 29,317 people had to wait more than 12 hours in English A&E departments in July since the decision to admit they were admitted. This was up 33% from 22,034 the previous month and is the highest for any month on record dating back to August 2010. “Patients are facing extremely long waiting times,” says Dr Adrian Boyle, vice-president of the Royal College of Emergency Medicine, who says many are in a serious condition or have serious injuries. “We know that long waiting times for patients can cause harm or worsen conditions or injuries. The sheer number of patients waiting for treatment is alarming.” Ambulances in England took an average of 59 minutes and seven seconds last month to respond to emergency calls such as strokes, up from 51 minutes and 38 seconds in June – well above the target of 18 minutes. “If you call an ambulance in the Southwest … there’s a reasonable chance you’ll die before it shows up,” says McLellan. “As bad as the NHS was in the past, this was not the case.” Richard Murray, the chief executive of the King’s Fund thinktank, agrees. “While the waiting list that has passed the 6.7 million mark may seem irritating enough, the depth of the challenge in urgent care – seen in ambulance and A&E waiting times – is worse. The NHS’s plans for recovery have been hampered by repeated waves of the Omicron variant and, more fundamentally, by acute workforce shortages that have long since begun.’ General practice has been particularly affected by the failure to recruit and retain adequate staff. “Too many patients are saying it is difficult to get a doctor’s appointment, even though colleagues in primary care are working normally,” NHS England chief executive Amanda Pritchard admitted in a note to staff this month. In 2015, the government pledged to recruit 5,000 more GPs over five years, but the number has fallen rather than increased. In 2019, the government promised 6,000 more GPs by 2024, but progress has been very slow. “The new Prime Minister must make general practice a top priority if he is serious about ensuring the NHS remains viable for providing care to patients now and in the future,” says Professor Martin Marshall, president of the Royal College of GPs. “We are doing more consultations every month than before the pandemic and the care we provide is becoming more complex, but the number of fully qualified, full-time GPs is falling.” Christina Pagel, professor of business research at University College London, says Covid-19 has “significantly exacerbated” the NHS crisis, but not caused it. “Essentially, we entered the pandemic with a health service that was already cut to the bone, with severe staff shortages, morale problems and underfunding.” Nigel Edwards, the chief executive of thinktank Nuffield Trust, agrees. “The pandemic has added fuel to the fire, but the root of these problems has been going on for decades.” Dr Subramanian Narayanan, president of the HCSA, the hospital doctors’ association, says the NHS is in a worse position to deal with a pandemic now than it was in 2020. “Staff shortages are more severe than at the start of pandemic and there is no evidence that the drivers of this issue are being addressed.” The labor crisis is the main problem. “Warnings about the lack of a plan for the health care workforce have been around for years,” says Pagel. “Brexit made it much worse, particularly in the cities, as we lost so many EU staff who chose to go home.” Archie Bland and Nimo Omer take you to the top stories and what they mean, free every weekday morning Privacy Notice: Newsletters may contain information about charities, online advertising and content sponsored by external parties. For more information, see our Privacy Policy. We use Google reCaptcha to protect our website and Google’s Privacy Policy and Terms of Service apply. Pat Cullen, general secretary of the Royal College of Nursing, which will vote its members on industrial action next month, says the key to solving the NHS crisis is through “recruitment and retention – and that starts with fair pay of the staff”. In 2019, the government promised 6,000 more GPs by 2024, but progress has been very slow. Photo: Hugh Hastings/Getty Images With a renewed focus on ambulance delays and care delays, other areas of the NHS are slipping. Mental health is a troubling example. “Mental health has, in recent years, come up on the agenda,” says McLellan. “And the investment pattern for mental health, while not perfect, actually more money was spent on mental health. Mental health had gotten there… my feeling now is [it’s] it actually goes backwards.” Saffron Cordery, the chief executive of NHS Providers, says mental health services have become overstretched. The Royal College of Psychiatrists is warning that waiting lists are at record levels and care is at “crisis point”. The charity YoungMinds says thousands of young people are attempting suicide as a result of long waits for treatment. “The NHS has never faced such a deep crisis and there doesn’t seem to be any political will to face the reality and deal with it,” says Boyle. “It is deeply worrying that neither the Prime Minister nor the leadership candidates have grasped the gravity of this crisis, the scale of patient harm and how much worse it could get this winter.” Since its absence from the Stoke-on-Trent debate, the NHS has barely featured in the leadership race. It did so only recently when Truss said it would divert £13bn of NHS funding to social care. In theory, it’s a good idea, McLellan says, but it should have happened years ago. The problem is that now is a “dangerous time to do so.” “Does social care need more money than the NHS? Yes. But now we are in a situation where they have let the NHS go into crisis as well as social care. So they both need money.” Tough decisions have to be made, says Edwards. “The new Prime Minister will need to move quickly and make tough choices to address the interconnected challenges in health and care if she hopes to reverse declining performance, declining public satisfaction and growing inequalities of access.” That means urgent action, Murray stresses. “What can be done? Winter is always by far the hardest time for the NHS and time is desperately short to do anything, but what can be done should be. “This includes supporting Covid and flu vaccination campaigns. producing a quick fix to the pensions issue which is driving senior staff out of the service; and being ready for emergency support in social care which can also help the NHS by getting patients out of hospital quickly when they are ready. Beyond that, sustainable recovery can only come from addressing the workforce crisis.” Hunt says: “A horrendous winter lies ahead and a serious, funded NHS workforce plan is the only way to avoid a rise in avoidable deaths in the coming months.” Ede argues that urgent investment in NHS capital such as new kit and facilities “has the potential to deliver a much greater return: solving problems such as late diagnosis”. Meanwhile, the NHS crisis and the choices facing the new prime minister come at the worst possible time, says Edwards. “These decisions will be made…
