Ian Wilson: NHS is at a crossroads as winter piles on the pressure

Figures published recently showed that there were more emergency admissions to English hospitals in the second week of November than in any week in NHS history.

Frontline staff are working as hard as possible to meet rising demand, but the Government’s four-hour A&E waiting time target is being routinely missed and many hospitals are already at capacity, facing bed shortages well before the seasonal spike in demand has kicked in.

Already this year the emergency department at Rotherham Hospital has had to warn patients to stay away unless they’re facing a real emergency, and the Yorkshire Ambulance Service had to take patients to hospitals in Scunthorpe, York, Scarborough and Grimsby, rather than Hull, owing to overwhelming demand. This is incredibly worrying as we are still only in early winter, with demand set to significantly increase.  

These issues are the result of rising demand coupled with years of underfunding and, despite promises of more money for the NHS from across the political spectrum, the situation will not be turned around overnight.

While the Government’s recent announcement of an extra £2bn for the National Health Service is both necessary and welcome, it falls far short of what’s needed as costs are rising faster than investment, meaning the NHS will continue to face a funding gap of billions.

At the same time, an ageing population with increasingly complex medical needs means demand on the health system has never been greater. The fact that people are living longer and survival rates for diseases such as cancer have significantly improved should, of course, be celebrated, but it brings with it a new set of challenges for the NHS.

The figures speak for themselves. One in three people in the UK are aged over 50 and the number of over-65s is expected to increase by 50 per cent in the next 20 years.

A third of the population have a long- term condition but they account for £7 in every £10 spent in the NHS and £2 in every £3 spent on social care in England. It is predicted that by 2035 almost half the population will be obese, resulting a spike in cases of diabetes, stroke and heart disease and the costs of treating them.

It’s a tribute to the hard work of dedicated doctors, nurses and other front-line staff that, until recently, the NHS has coped well and the quality of patient care has been maintained, and even improved, despite increased pressure on the system. But the NHS has now reached a crossroads. Staff have done as much as they can without extra investment and the cracks are beginning to show.

Overstretched services are now desperately struggling to keep up with rising demand: patients are waiting longer to see their GP; A&E waiting times are the worst they’ve been in a decade, with targets are now being missed during the summer period when the NHS is not subject to seasonal spikes demand; waiting lists are at a six-year high with millions of people waiting for treatment in hospital; care is being rationed because the NHS simply can’t afford to do it all.

Doctors tell us that rising workloads are the greatest barriers to delivering the high quality patient care and staff shortages in emergency medicine and general practice – fuelled by gruelling workloads and a very challenging working environment – are part of a vicious circle, leaving existing staff working even harder and making a bad situation worse.

GPs are carrying out 40 million more consultations a year than in 2008, while one in four hospital trusts are in the red and in dire financial straits. Almost a hundred GP surgeries are at risk of closure because of changes to practice funding. Hospital wards are overcrowded, meaning patients are forced to endure long waits on trolleys, and moved between wards, and operations are often being cancelled because of bed shortages. The recent funding announcement of £300m to help the NHS tackle winter pressures is merely a diversion tactic. It’s not, as was implied, additional funding, but rather money taken from other over-stretched services – robbing Peter to pay Paul.

With the election looming, we need to avoid the NHS being used as a political football. We need an honest public debate about what our National Health Service can afford to deliver. We also need a long-term plan rather than short-term political promises.

No political party has so far come up with a meaningful plan to put the NHS on a sustainable financial footing for the future. Without this, our ability to maintain a health service which remains true to its founding principles – open to all and free at the point of delivery – will be under threat.  It’s not too late to turn things around, but if we don’t act now it soon will be.

Dr Ian Wilson is a consultant in West Yorkshire and chairman of the British Medical Association’s representative body.