Sarah Macken is the Founder and Director of Astute Strategies.
It’s becoming an almost weekly routine for a damning report to be issued about the NHS that highlights appalling levels of care and neglect. This week is no exception with more problems being highlighted at hospital trusts across England.
With every new report, the fear is that this is just the tip of the iceberg. But at least with the problems coming out into the open, it is providing some comfort to the families involved that they are finally being listened to. It is also allowing a turning point to be reached so that work can get underway to improve hospital care and culture.
There is also a worrying situation emerging in Wales, where Labour remains in charge of health service delivery and policy. Waiting times for basic treatment are not being met, the health budget has been cut and A&E admissions are higher than any other part of the country. How did it come to this?
The news that potentially thousands of people have died as a consequence of the policies, decisions and structures set up under the last Labour Government is breath-taking and demonstrates so clearly why well meaning platitudes are just not enough when it comes to delivering vital public services. It is a terrible indictment on the previous administration that allowed a deep rot to set in and admonished basic care and kindness to the bottom drawer.
I don’t doubt that Andy Burnham, the previous Health Secretary, is genuinely shocked and appalled at what has taken place, but there is no escaping that this happened on his watch. It was his failure to probe and listen to the genuine concerns of families and patients. It was he who presided over the Care Quality Commission, a regulator not fit for purpose because it does not have (nor ever had) the skills to carry out hospital inspections. All of this set the framework and culture that contributed to the scandals that have recently come to light.
The fact is, Labour took their eye off the ball and became complacent about health service delivery. This complacency was very evident during the election campaign, where Burnham boldly refused to rule out health cuts if Labour were returned to power. It doesn’t take a great leap of imagination to suggest that if Labour had been re-elected than the NHS budget would have been cut along with many other departments. Thankfully, the NHS was spared this assault on its budget. As we would be facing a far worse situation now if this policy had been implemented and it is likely that the culture of secrecy and cover-ups would have increased.
It is very difficult to understand what knowledge or experience that Ed Miliband feels Burnham has acquired since moving into opposition that enables him to be an effective Shadow Secretary of State for Health today. If he didn’t ask the right question whilst in power and presided over such a mess, why is he now competent to hold the Government to account? In fact, Burnham is just about the only Secretary of State to have kept the same job from Labour’s days in Government. More evidence, if it were needed, that Labour remains complacent about the NHS.
A ring fenced NHS budget
The events in the NHS that have come to light over the last few months are a vindication of the Government’s decision to ring fence the health budget.
If you have any doubts about this, then take a look at what is happening in Wales, where over 40,000 patients are waiting over half a year for hospital treatment and 9,000 of those patients had been waiting a staggering 9 months at the end of May. That’s double the target wait time in England of 18 weeks. Sadly, for those patients waiting for care, Welsh waiting times are consistently not met and with health budgets being squeezed (in Wales), by the Labour administration, this figure could soon get even worse. This is inevitably placing pressure on other health care services and it is not surprising that Welsh Accident & Emergency admissions, are higher than any other part of the country. If that isn’t problematic enough, isn’t there just a basic view that patients in Wales should simply not have to wait this long to access the care that they need?
A report out this week from the Wales Audit Office confirms this sorry state of affairs highlighting that:
“Waiting times for planned treatments have got signiﬁcantly worse over the past three years, with around one in ﬁve patients now waiting more than six months to be treated. Performance in emergency care has deteriorated – emergency departments are increasingly stretched meaning patients are waiting longer to be treated or admitted than in the past three years”.
So why is this happening? The running of health services were devolved in 1999 and since then administrations in Wales, Scotland, England and Northern Ireland have set their own health budgets, defined priorities and are responsible for delivery. When it set its budget in 2010 the Welsh Labour administration shocked many by implementing one of the most significant cuts to the NHS budget in history. Overall health spending was pared back by 8%.
This has left health spending as a proportion of public spending in Wales, at 20% now lower than in England at 22 per cent and compared to every other part of the country “England has consistently had the largest proportion of public spending devoted to health (22 per cent in 2011)”. According to the National Audit Office spending plans in Wales were predicting the lowest increase per person over the four years to 2014-15 – remaining almost constant in cash terms and equating to an average annual fall of 2.3 per cent in real terms.
The impact of cutting health spending without reforms
Spending cuts in Wales are having a significant impact on those needing care. To reinforce some of those key figures, maximum waiting times for treatment and diagnostic testing are much longer in Wales, at 26-weeks, compared to 18-weeks in England. A difference of two and a half months. But even these more relaxed waiting times are not being met in Wales (in England they are). By the end of May this year, 43,515 patients who had received a referral form their GP had been waiting over the six and a half month target for treatment with 8,928 waiting more than 9-months for care. Failing to meet these most basic of targets clearly poses risks for the patients concerned and causes distress and anxiety when it is needed least.
It is also extremely concerning that Accident and Emergency (A&E) admissions are higher in Wales than any other part of the country at 11,471 per 100,000 in 2009/10 compared to England 9,994 during the same time period. A difference of nearly 1,500. Part of this may be explained by Wales having a lower proportion of GPs compared to other parts of the UK. But with waiting times for referrals being missed, a proportion of this difference is also likely to be due to people waiting so long for treatment that their health deteriorates to such an extent that they are admitted as emergency patients. In short, lives are being put at risk. At the very least, this is worthy of further urgent investigation.
Delivery is what matters
Labour talks a good game when it comes to the NHS, but their record on decision-making and delivery falls way short. Leaving aside the many other scandals that have been reported elsewhere the situation in Wales, with longer waiting times as standard and a lower percentage of key waiting time targets being met, means patients lives are being put at risk.
It shows why the Conservatives were right in 2010 to insist on ring fencing the NHS budget and it also demonstrates in perhaps one of the clearest ways why when it comes to public services, it is not enough simply to cut spending and to carry on doing things in the same way. It is why reform must also be implemented and it is to the Labour party’s shame that they squandered their 13 years in office and failed to introduce the right changes in the NHS.