Can Rishi Sunak heal the NHS?

Rishi Sunak’s big pitch this weekend is to grip the NHS waiting list crisis. It makes political sense, given the terrifying size of these lists now, with some trusts declaring their waits ‘unmanageable’. By the time of the next election, the crisis in the NHS is going to seem monstrous.

The former chancellor is worried that the surge in people seeking private treatment is ‘privatisation by the back door’. James and I discuss the wider context of this on our latest Coffee House Shots podcast, agreeing that if people feel forced to go private, the underlying public consent for the NHS itself will start to erode. That’s not something any government, particularly a Conservative one, really wants to contemplate as it tends to rebound politically on whoever is in power rather than on the health system itself.

So what is Sunak proposing? He’s been talking to the Times and the Sun about a ‘backlogs task force’ along the lines of the setup that delivered the vaccination programme. He wants waiting times falling by the end of the year and to eliminate 12 month waits entirely by September 2024. Trusts will have to contact anyone waiting more than 18 weeks for treatment within 100 days. There are also plans for more diagnostic hubs in empty shops and to ‘cut red tape blocking doctors and nurses from other countries plugging the staffing black hole’.

This is all well and good, but it rather elides Sunak’s own role in a long-term failure to deal with the ‘staffing black hole’. There hasn’t been a proper workforce plan for the NHS for 20 years, and as chancellor, Sunak resisted calls to improve the staffing situation. The rationale for this from the Treasury is that accepting the changes proposed to legislation by figures such as former NHS England boss Simon Stevens would tie a government’s hands, would be hugely costly, and would create a stick by which oppositions could beat ministers whenever the government failed to meet the workforce forecasts. Now, even if he had accepted this particular amendment, Sunak wouldn’t have solved the NHS workforce crisis, and neither would his immediate predecessors because as we know, it takes a long time to train up the staff needed to fill those black holes. Which is why Sunak is having to talk about making it easier to hire healthcare professionals from overseas. There are of course ethical problems with the NHS continuing to do what it always has since its inception and rely on other countries to find enough doctors and nurses to keep the lights on in operating theatres and wards. But strangely those ethical concerns tend to end up fading whenever a government has failed to do the long-term planning it could have done. 

Targets are more complicated. The New Labour era showed that they focus attention on problem areas and make politicians put their money where their mouths are. But they can also lead to gaming the system and a bullying culture when enforced poorly. It’s worth asking, though, whether this context of a health service that already had rising waits before a pandemic which stretched its staff to breaking point is one that necessarily calls for staff to just work harder now. The NHS isn’t meeting its current targets, and in some cases hasn’t been for a number of years. There doesn’t seem to be much enthusiasm for asking why that is, which is a bit like ignoring an athlete’s injury that’s making her run slower times and instead just telling her to target an even faster pace. And is this the system that really needs fixing – or is there another one that’s even more broken that is contributing to the backlogs too? Does it make much difference to have a stringent target for waiting if one of the reasons patients can’t get into hospital for their treatment is that the necessary beds are being occupied by someone who is medically fit for discharge but does not have a social care package meaning they can safely leave the ward? Presumably the ‘backlogs taskforce’ will end up reporting regularly that the problems aren’t quite as simple as Sunak suggests.