Rishi Sunak’s bungled NHS plan leaves the system on life support

This much-loved patient will survive, but even if it gets a new doctor next year, the health service will probably take 10 years to recover from the underfunding it has received since 2010, writes Andrew Grice

The ‘fear’ among the public that the NHS’s creation in 1948 was designed to allay is back (PA)

This is “health week” on the Downing Street media grid – but for Rishi Sunak, it’s a familiar one step forward, one step back on the NHS.  Although the nurses have ended their strikes, consultants have joined junior doctors in walking out, so there will be a total of seven days of stoppages next month.

Sunak will trumpet a workforce plan for which the NHS has been waiting for years, saying the 15-year blueprint will give the service the certainty it needs. All very welcome, but the devil will be in the detail of the Treasury’s long-term funding commitment; it blocked previous calls for an independent forecast of the number of doctors and nurses would need to train in the future.

Jeremy Hunt, the chancellor, should take the advice of the former health select committee chair who supported this much-needed proposal – ie, himself.

The prime minister has already managed to undermine his workforce plan – designed to boost recruitment and retention as well as training – by dealing another blow to the already low morale of health workers. With some of last year’s wage disputes still unresolved, Sunak is warning he will block the pay review bodies’ recommendations for six per cent pay rises in the current year.

This is a clear example of double standards and moving the goalposts off the pitch, because during last year’s disputes, ministers repeatedly hid behind the “independent” pay bodies, hailing their findings as tablets of stone because it suited them at the time. Now the bodies’ proposals are not so convenient – even though they would mean pay rises lower than the current 8.7 per cent inflation rate.

Ministers would be on stronger ground if inflation had fallen further, but Sunak fears privately that he will not deliver his pledge to halve it this year. His warning about a wage-price spiral doesn’t stack up, because public sector wages have a very limited impact on inflation; they don’t raise the price of anything.

Tory MPs also fear Sunak will miss another of his five targets – to reduce NHS waiting lists, which stand at a record 7.3 million and rising. The continuing strikes will hinder attempts to clear the backlog, which began before the pandemic despite ministers’ constant references to Covid.

The government is not even negotiating with the two doctors’ groups. It should take these disputes to arbitration and accept the pay review bodies’ recommendations for the current year to head off another wave of damaging stoppages the NHS and the public simply cannot afford.

Dangerously for Sunak, public concern about the state of the NHS has merged with the cost-of-living crisis to create an “age of insecurity”. When More in Common asked people what, if anything, made them feel less secure about their future, the cost of living came top, cited by 45 per cent, with healthcare access a close second on 43 per cent, and care in old age third on 35 per cent.

While ministers will trumpet record amounts of spending and staff training numbers, the NHS needs more just to stand still because of our ageing population.

We get what we are prepared to pay for, as a study by the King’s Fund illustrated this week. Despite the public’s love of the NHS and our politicians’ love of calling it the “envy of the world”, that label is past its sell-by date. The UK “underperforms significantly” on the big killer diseases like heart problems and cancer after years of under-investment, the think tank found.

The “fear” among the public that the NHS’s creation in 1948 was designed to allay is back, as the journalist Isabel Hardman notes in her excellent new book charting the service’s history Fighting for Life (Penguin Viking). “Our health landscape today is returning to the two tiers of the pre-NHS days, where people who were rich could get excellent treatment [in the private sector] and the rest had to hope for the best,” Hardman writes.

She concludes that the NHS needs a new vision, not more “love-bombing from politicians too fearful or lazy to confront the truth about the state of the service and what it needs”. She rightly warns that until politicians deliver their repeated promises to reform social care, "the NHS will never be able to function properly".

True, money is not the only answer. Of course, the NHS needs reform, though the best one would not be the new funding model favoured by right-wingers – taxation will remain the least bad option – but a switch to prevention. Although this would eventually pay dividends, the Tories are not going to make the investment needed when they are scrabbling around to find room for pre-election tax cuts.

The NHS is sickly as it marks its 75th birthday next week. This much-loved patient will survive, but even if it gets a new doctor next year, will probably take 10 years to recover from the underfunding it has received since 2010. In the meantime, there will be a lot more muddling through, for staff and patients alike.