The NHS in the scariest position that it has been in my lifetime. I am incredibly worried about what will happen in the next 6 to 9 months – but worried than I have ever been. There are systemic problems across the whole healthcare systems, and the risk of increased mortality as the result of service pressures is very high.

It is worth reminding ourselves how we got to this point:

Money

From 2010 onwards there was a record low investment in the NHS. It has improved in the last few years and will increase by just under 4% this year, which is close to the long term average. There are however some massive problems with that:

1. that doesn’t catch up for a decade of under investment, and

2 . inflation is running at 12% – typically healthcare inflation runs a couple of %tage higher than general inflation, which means in real terms trust are getting a 10% a year cut right now

Lets put that bit in bold for the people who just skim through long blogs like this:

A 10% real terms cut to NHS core funding this year

Staffing

The NHS is in the middle of the biggest staffing crisis in it’s history. There are shortages across the board. Workforce is managed centrally and not be Trusts – Health Education England runs it all. Trusts can only place the most basic adverts and aren’t allowed to join together to form regional campaigns – i.e. it is forbidden to run a “come to the North East” campaign. DH for the last 12 years have generally favoured policies that recruit to the south of England at the expense of the north, but shortages are now nationally

There are lost of reasons for the crisis – Brexit and the hostile environment have had a huge impact, badly planned tax changes have made it attractive to retire early and not to take on over time, staff are burnt out from covid, poor and micro-managing leaders have sapped morale.

As an example of how dysfunctional the system is right now the Government increased the number of Medical School places, but didn’t increase funding for training places for junior doctors to match, which means there is a good chance that we will have unemployed medical school graduates in the middle of a staffing crisis.

This is existential – the NHS only exists because staff believe in it – if the NHS can’t retain the support of their staff it can’t continue.

Social Care

Social care is in a worse state than the NHS for funding and staffing. The number of ill over 70s has increased hugely, but funding in real terms is lower than it was in 2010. Social care was very dependent on EU staffing, and Boris’ deal was devastating to them. Private sector care home providers have very high levels of debt and the combination or rising interest rates and staffing shortages will put many of them out of business.

14% of NHS beds currently are occupied by patients awaiting discharge of social care. A wave of care home closures as winter bites will make this much much worse.

Demand

The NHS has a huge backload of cases to get through due to Covid. Right now 10% of the UK population are on an NHS waiting list – by the next GE that will have doubled

But over and above that demand is increasing – basically if you take a population and make it poorer, colder and hungrier you increase the rate at which they utilise healthcare services, particularly hospitals

This is driving a huge spike in demand. With lots of people in the UK about to get a whole lot poorer, colder and hungrier when we hit winter there is a tidal wave of demand about to hit hospitals the likes of which we haven’t seen before. The lack of action from Government is disastrous, not just for the people who will go cold and hungry but for the impact that will have on public services.

Australia

This may sound like an obscure point but what happens in Australia in their winter (right now) is normally a good predictor of what will hit the NHS in a few months – right now Australia is seeing a big increase in respiratory infections – it looks like people who have had Covid are susceptible to routine respiratory infections that normally they would fight off easily. We have scaled back our Covid response to zero right at the time when we are heading for a potential big increase in non-Covid respiratory illnesses.

No doubt you will start and see memes on social media blaming the crisis on feckless people who turn up at A&E with minor ailments. I am sure that they exist.

But this crisis has been a decade in the making. The NHS is built to withstand pressure, to continue operating when all else fails. We saw that magnificently during Covid. But we are reaching the point where patient care and clinical outcomes are being compromised because of systemic problems, problems that Ministers have ignored, or spun away for years.