After Brexit, turning around the NHS is Theresa May’s most urgent task

The Prime Minister cannot rely on a weak opposition to save her from the wrath of the people if she fails to reverse the health service’s current disastrous path

Theresa May couldn't preach a 'clean slate' while retaining Jeremy Hunt as Health Secretary (PA)

The National Health Service is in trouble. Statistics on ambulance response times, accident and emergency waiting times and delayed discharges, published on Thursday, are all markedly worse than over the previous year.

Ambulances reached critically ill patients within the target of eight minutes less than 70 per cent of the time in the year to June, down from 75 per cent the previous year. The proportion of patients at accident and emergency seen within four hours fell from 92 per cent to 86 per cent. The number of days lost to delayed discharges rose by a quarter from 91,000 to 115,000.

These are, bluntly, terrible numbers. They suggest that the NHS as a whole is now eating into the gains made during the Blair and Brown governments at an alarming rate.

For all that it has become fashionable, especially in parts of the Labour Party, to be rude about the New Labour period, the revival of the NHS was a huge and important achievement. It is a tragedy that David Cameron was allowed to fritter it away in Andrew Lansley’s pointless reorganisation, and it has needed urgent action to recover the situation for two or three years now.

This week’s report that Grantham and District Hospital will shut its A&E department at night, and the news that NHS deficits are running dangerously high, are patchwork evidence that the health service is under strain. But these latest statistics are the most rigorous evidence of the depth of the crisis.

It is worth pausing to note that, again, it was briefly fashionable, especially in parts of the NHS and the Conservative Party, to be rude about a “top-down targets culture”. But now we are seeing the true value of objective benchmarks for assessing the state of the NHS. Never mind all those glib criticisms about targets “distorting clinical priorities”, it is reasonable to expect ambulances to turn up within eight minutes more than three times in four.

If the new Prime Minister – may she enjoy the mountains of Switzerland and clear her mind: we approve of politicians taking holidays – wants to build on her promising start in the job, she must deal on her return with the NHS. After Brexit, it is potentially the most important question for her Government.

The two subjects are linked, of course, by the Leave campaign’s “promise” that the UK’s net contribution to the EU, about £9bn a year, would be devoted to the NHS. We do not know yet what kind of Brexit deal Theresa May will negotiate, but it is possible that we will continue to make some contribution to EU funds in return for some access to the single market. Even if we did get all that money back, the gain would be offset by damage to the economy caused by Brexit.

Ms May starts her challenge, therefore, destined to disappoint those Leave voters who expected an immediate cash boost for the NHS after the Brexit vote. She must know that her present popularity could wear off quickly if the winter becomes dominated by negative stories about the health service. All the more political pressure, then, to get a grip on the crisis.

The Prime Minister’s first decision about the NHS did not augur well. She kept Jeremy Hunt as Health Secretary in her new Cabinet. He personally has become a hate figure for thousands of doctors, and it is hard to see how the dispute can be resolved without the “clean slate” advantage of a new Secretary of State.

As ever, though, the first thing the NHS needs is more money. Philip Hammond, the new Chancellor, faces a tough challenge in the Autumn Statement this year, in making more money available while the economy appears to be heading into a post-Brexit slowdown. At least Ms May did the sensible thing in another of her early decisions and allowed the Government to borrow more over the next few years.

However, the important questions for the longer term are how to guarantee a higher level of NHS funding that will not fall victim to the political-economy cycle as Labour’s advance of 1999-2010 has done, and how to achieve structural reform that would ensure that more resources are used more efficiently.

Owen Smith has made one of his pitches for the Labour leadership a plan for a “wealth” tax to raise £4bn a year for the NHS. He was right to say: “This is no way to run the NHS and with a weak opposition we are letting the Tories get away with it.”

But Ms May knows she cannot rely on a weak opposition to save her from the wrath of the people if she fails to reverse the NHS’s current disastrous path.