Could you get a more ominous warning than emergency doctors saying they are as busy now as they were at the height of the Covid crisis?
Accident and Emergency departments haven’t been in good shape for years, with ambulances queuing up outside for hours, and patients increasingly having to accept that being treated in a corridor is a better result than still waiting to be seen.
But then came the warning this week from NHS national medical director Professor Sir Stephen Powis that “some staff in A&E [are] saying that their days at work feel like some of the days we had during the height of the pandemic”.
Health Secretary Wes Streeting has said patients are “receiving unacceptable standards of care”, and that the situation in A&E makes him feel “ashamed”.
That’s all very well from Streeting, but at the same time the Government is making clear that its priority isn’t A&E, but elective care, with Keir Starmer announcing an elective recovery plan at the start of this week. That plan will allow the Prime Minister to meet one of his “measurable milestones”, which is “ending hospital backlogs to ensure that 92 per cent of patients in England wait no longer than 18 weeks for elective treatment”. This is not an easy target to meet in and of itself, and as a result Streeting has been trying to work out which parts of the NHS are less of a priority in order to have a chance of meeting the milestone. Is A&E one of them?
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Read MoreStreeting doesn’t seem to think so – and he would be foolish to take any other stance, as A&E is one of the most tangible ways the public measures the health of the NHS.
He has just rejected a request from the NHS to drop its target for 78 per cent of patients to be seen within four hours. The overall target is for 95 per cent within four hours, but that hasn’t been met for more than a decade, so 78 per cent was seen as a more realistic aim for this winter.
The NHS was managing 74 per cent when it went into the winter, so now 78 per cent is looking unrealistic in and of itself. Sources close to the Health Secretary insist that “there is no world in which we are going to accept urgent and emergency care stagnating from this point,” and that emergency care is impacted by failures and delays in elective treatment. People waiting 18 months for a hip replacement, for instance, are more likely to have falls and need emergency admission to hospital, so speeding up elective treatment does still relieve some of the pressure on A&E.
There is also a reform plan for A&E due at the end of February or early March which will aim to make sure that the next few winters are progressively less bad. The problem for Streeting – and the health service – is that it takes a very long time for the health service to improve. It has long been the case that the department of health is doing the planning for the next winter when it is still in the middle of the current winter crisis, showing how long it will take for any reforms in that plan to have an impact – as well as the fact that “winter crisis” is an annual reality in the NHS, rather than an unusual experience.
The public has long known that A&E is in a terrible mess, and so it may be the case that next winter Streeting is still able to say he is “ashamed” of the health service, safe in the knowledge that voters will agree with his blunt language and blame the Conservatives rather than grumble about what Labour is doing. But there still needs to be a sense that reforms are moving the service in the right direction.
Rumbling under all of this is the worry that unless A&E starts to feel like a functioning part of the NHS, rather than a canary in a dangerous coal mine that stopped singing some time ago, the public may stop believing not just in Labour’s ability to reform it, but in the NHS itself.
Another striking comment made by Streeting this week was that the Government needed to bring the health service “into the 21st century so the NHS doesn’t go the way of Woolies and collapse, but is actually a service fit for the 21st century”. The problem with Woolworths was that consumers couldn’t see how it fitted into their present lives, no matter how nostalgic they were about buying penny sweets there on a Saturday morning in their youths.
The NHS is facing a similar precipice where, if it doesn’t seem to be improving tangibly by the next election, voters will start to conclude that nostalgia isn’t enough to keep it going. That’s not something Labour can contemplate.
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