Tuesday 25 May 2021 7:00 am

We stayed home, now we have to protect the NHS with structural reforms

Dr Robert Sutton is a junior doctor in Wales.

If a single line has permeated every facet of the government’s communications during the Covid-19 pandemic, it has been the cultish imperative to “protect the NHS.” This instruction has been, implicitly or explicitly, the justification for every restriction implemented.

By reducing transmission, we would prevent the NHS from being overwhelmed by patients with coronavirus and ensure there was still capacity to treat other seriously ill patients. If the NHS had been rendered impotent by the sheer weight of patients on ventilators, the deaths from other diseases would have been vast. Everything was done in the name of sustaining this institution of the state. It is, of course, a convincing argument. What it fails to recognise is that for all intents and purposes, the NHS has been overwhelmed. 

As outlined in a new report by the Adam Smith Institute, we have ceased to provide the necessary treatment for a range of vital services. Serious conditions – heart attacks, strokes, cancer – were neglected in the frantic push to free up more capacity to handle Covid. Primary care referrals to specialists have plummeted, including urgent and 2-week-wait referrals for cases of suspected cancer.

This exposes an uncomfortable truth that British politicians have consciously avoided confronting for decades: the NHS is not always there when you need it, and it is getting worse. Politicians, management and healthcare professionals constantly have to make choices on which treatments to offer or deny. They have to regularly decide who is most urgent and who can be pushed to the back of the queue.

This is a necessity in a world with limited resources and effectively unlimited healthcare needs, and it has been acutely exacerbated by the surge in demand caused by the Covid-19 pandemic. Yet this is at odds with the picture of the NHS that is sold to the public by politicians across the political spectrum – one of virtually unlimited service capacity able to meet whatever healthcare requirements the British public have.

The NHS Constitution sets out the standard which can be expected: “a comprehensive service, available to all,” access based on “clinical need, not an individual’s ability to pay” and to aspire to “the highest standards of excellence and professionalism.”

The vagueness of the language gives some wiggle room. However we define “clinical need”, it is hard to imagine urgent referrals for cancer investigation and treatment would not be included. 

Yet these services have been effectively denied during the pandemic, ground to a halt by the very actions taken in the name of “protecting the NHS.” Considering the bloating of waiting times prior to the pandemic, it seems unlikely that the vast backlog of cases deferred over the last year will be dealt with at any point soon.

Business as usual will not suffice to tackle this backlog, nor will pumping lump sums of cash into the NHS when we cannot simply buy more of the rate limiting factors in providing treatment at a moment’s notice (namely healthcare professionals and hospital space). 

Attempts at structural reform are politically risky, if not impossible. The NHS’s positional in our cultural mythos is firmly entrenched, and this reverence has prevented any serious attempts at reform.

This gives the impression that some would rather sustain in its current form an institution that is demonstrably falling short of its constitutional obligations, rather than risk the political perils of sticking one’s head over the parapet and arguing the case for reform. Public debate has become deeply toxic.

Kristian Niemietz, a leading voice in economic and healthcare policy, was derided earlier this year after he was critical of the NHS’s performance during the pandemic. The backlash was predictable and harmful. Politicians such as Angela Rayner appeared unable to distinguish between the functioning of the NHS as a healthcare system and the noble efforts of NHS staff. The Deputy Labour Leader demanded Matt Hancock criticise the “disgraceful attack”. The level of hysteria sows further political inaction poses a far greater threat to the health service than the pandemic. 

There must be an honest evaluation of the state of healthcare in the UK. Throughout the pandemic, the NHS has struggled to meet its constitutional obligations by neglective non-Covid conditions. This, of course, does not undermine the work of doctors and nurses. They worked in the face of a sluggish system. 

Whether the NHS can meet those obligations in a post-Covid world depends on our willingness to engage in a sincere and frank discussion of how delayed our healthcare is, who is being given treatment and who is missing out. We stayed home. Now it’s time to protect the NHS.

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