Life, the universe, and the NHS crisis

The NHS is in crisis like never before - but the political game ignores the real causes of the problem.

Carl Walker
8 January 2015

Accident and Emergency services have gone into unprecedented meltdown across England, health professionals tell us this week. Waiting times in A&E departments have plummeted to their worst levels in more than a decade. The NHS’s capacity to treat those with serious injuries and illnesses is in “crisis”. Hospitals across the country are declaring they simply can’t admit any more patients.

Is it the fault of frontline NHS staff? I popped into my local hospital in Worthing to check. I can confirm that there was no queue of doctors and nurses on prolonged cigarette breaks outside the hospital. No paramedics snoozing in their ambulances with do not disturb signs on the windows.

So why is it happening?

Fans of Douglas Adam's Hitchhikers Guide to the Galaxy will recall that the answer to life, the universe and everything is 42.

But the answer to the current A&E crisis is 35.

Yes, suspend your disbelief. 35 is the single number that explains the meltdown in A&E services across the nation this week. It’s the key number in the “supply and demand” game that our mainstream politicians indulge in during times of crisis.

The rules of the political game are quite simple. 

Rule one: you need an NHS crisis. Without this you can't play. Consider it the dice of the political board game.  

Rule two: if you are the party in power your role is to blame the crisis on “demand”. You say there is an overwhelming and unprecedented demand on NHS services that could not have been predicted. It is regrettable, you say. And you talk about the aging population - your trump card.

If you are the party in opposition, your role is to blame the crisis on supply. Supply of doctors, supply of nurses, supply of funding, supply of ambulances, supply of social care. You mention this a lot.  

Rule three: regardless of your current role, organise lots of media appearances where you look serious and concerned about the problems of demand or supply, depending on your current role. The rules change slightly in a general election year. Then, look very serious and concerned. Both Andy Burnham and Jeremy Hunt are good at this game. They have both looked on the verge of tears at times over the last few days. 

Rule four: get your 35%. If you get your 35% in the polls you win the election and you get to change position and be the “demand” team. The aim of the game is to stay the “demand” team for as long as possible. Your overall share of vote may diminish year on year and the number of people voting may diminish too. But that's okay because you just need your 35% to become the demand team. And so on. 

Patients and staff don't play the “supply and demand” game. They are instead the product of the game.  For staff, the results are fatigue, overwork, work stress, and demoralisation. Many are leaving the NHS. For patients it's being discovered at 7pm still holding their breakfast bowl and with soiled clothes. Or mourning the loss of a loved one who didn't make the journey to hospital because they were diverted by 20 miles because their local hospital couldn't take them. Or sitting confused in an ambulance while apologetic ambulance staff do their best to keep their wounds from deteriorating.

What has become obvious in recent days is the gulf between those suffering the A&E crisis and those charged with addressing it. Newscasts over the last two days have showcased the supply and demand game - and a genuine political failure, a disjunct between our tired two party political consensus and the real problems of our times.  

Few journalists have challenged politicians about their tacit support for closing more wards, A&E departments, and hospitals (whilst promising ‘care closer to home’).

Even fewer have asked how much NHS privatisation and ‘marketisation’ are to blame for the current NHS crisis.  

But privatisation and marketisation - pursued in reality by both main parties - have contributed to the current crisis in three key ways. Firstly, predictable (and thus potentially profitable) healthcare supply, from hip ops to diagnostic tests, are being quietly handed over to private companies under the NHS logo, draining money from NHS hospitals. NHS hospitals are left as the woefully under-funded provider of last resort for unprofitable services like A&E. Secondly, whether yet privatised or not, all parts of the English NHS are now set up as competing ‘providers’. Clinical considerations and co-operation are struggling in the face of a short-termist managerial desire to quickly offload the more expensive patients onto other ‘providers’, and to hire cheaper, less skilled staff (the half-privatised 111 service being a classic example). Thirdly, the bureaucracy required to run this inappropriate competition system itself drains at least £5bn a year from frontline services.  

We need real political plurality and new voices to enter the political fray, that aren't compromised by three line whips or party donors. Voices to drive forward real and meaningful change to our health service as their primary priority. It’s time to replace the supply and demand game. As an electorate we need to reject our role as pawns in the 35% obsession and instead vote for genuine change that supports our beleaguered doctors, nurses and patients.

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