Johnson must act quickly to shore up the creaking NHS – and tackle waiting lists first

The prime minister made promises of greatness on the campaign trail – now he must deliver and ‘get it done’

Boris Johnson has won his coveted majority and, though Brexit was his mantra through the campaign, this parliament has a lot more to deliver than that.

The NHS was by some distance the most important election issue after our future relationship with the European Union. Politicians across the spectrum clearly thought it would swing more “undecided” voters than anything else, with representatives of all parties tucking their ties into their shirts to wander round hospitals and promise a better future. For the Conservatives, their promise of 40 new hospitals came under great scrutiny, and professionals and patients alike now expect to see the bricks and mortar to match the press releases and warm words.

My colleagues and I, as surgeons, see at first hand what a chronic shortage of capacity in the NHS is doing to the service. When the NHS was first established in 1948, it took on a waiting list of 476,000 patients. No monitoring took place until 1951, when the number had increased to 504,000. Figures released in recent days show that the list – albeit with a very much higher population than in the 1950s – now stands at 4.45 million people.

However, the bald numbers give us little real insight into the significant deterioration in patients’ condition while they wait for surgery. Those languishing on lists are not just figures on a spreadsheet: they represent real lives which are being damaged day in and day out. The NHS does not offer surgery unless you really need it. If you’ve been offered an operation, you may well already be in significant pain, possibly with substantial mobility impairment. What matters to patients is not how many people are also in the queue alongside them, or whether their wait is at, above or below the average. If you’re in pain, you want to know the maximum period of time that you personally will have to wait.

It is for that reason that all three main political parties have, at different times, expressed a commitment to an 18-week maximum wait for individuals. Labour did so by introducing the target in 2004, and the Conservatives and Liberal Democrats reinforced this by enshrining it in legislation as a patient entitlement. By law, 92 per cent of patients are supposed to be seen within 18 weeks. Yet, for 45 months in a row, that legal limit has been breached. As things stand, only 84.7 per cent are receiving the treatment they need within this statutory maximum time – the lowest level for 11 years.

With an ageing population, increased life expectancy and growing demand, the system is creaking every bit as much as some of the joints people are waiting to have replaced. The future of the maximum waiting time is itself now in doubt. It was omitted from the health secretary's “mandate” this year, and one NHS Trust published papers in November which showed they were considering shifting to an “average wait” measure instead.

Professionals want to see an early signal from this new government that they understand that scrapping the maximum wait, without any clear clinical evidence to support such a move, would be bad news for patients. When we think of waiting lists, we think first of those who need surgery on vital organs. Yet many more are waiting for surgery on their backs, or for hip and knee replacements. It is easy to underestimate the deleterious effect these elongated waits have on the patients concerned. Their physical condition continues to deteriorate while they wait to reach the top of the list. In elderly patients this often results in a loss of independence, while younger people may have to give up their employment. The economic consequences are far reaching, both for the individuals concerned and the country as a whole.

During the campaign, the Royal College of Surgeons (RCS) joined forces with leading patient charity Versus Arthritis to call on the leading political parties to renew their commitment to the 18-week maximum waiting time. At the RCS we also set out a ‘Manifesto for Surgery’, calling for urgent action to reduce waiting times. The NHS needs at least 3,000 more beds, the flexibility to employ doctors and nurses from overseas to fill workforce gaps, and sustainable, legal changes to the NHS pension scheme. Unbelievably, the present system encourages experienced clinicians out of the operating theatre and into early retirement.

We also need ministers to end a ricochet effect where focus shifts from secondary care (hospitals) to primary care (GPs and community health care) and back again. The recent NHS Long Term Plan zeroes in on primary care. It is absolutely right that as much care as possible should take place in the community. After all, nobody would choose to be admitted to hospital and undergo surgery. But the NHS cannot afford to under-prioritise secondary care, precisely because patients are only admitted when it is really necessary.

For all of the discord of the past six weeks, voters of all political persuasions want an NHS which can offer them effective, timely treatment, free at the point of use. If there is one issue on which the government could unite the country, it is in taking a holistic approach to investing in the service. This would mean a radical expansion of the role of GPs and community nursing, alongside more beds and more staff in hospitals, and fundamental reform of the social care system.

None of these measures will work in isolation, but together they would transform the 18-week maximum wait from a flimsy promise to a real expectation. This government promised great things for the NHS during the campaign. Now is the time to “get it done”.

Susan Hill MA FRCS is vice president of the Royal College of Surgeons of England