Why Rishi Sunak’s NHS pain could become chronic

Figures from NHS England present a mixed picture of progress in dealing with the post-pandemic backlog of cases across the NHS. Rishi Sunak has made the reduction in waiting lists one of his five key pledges for progress in 2023, but what success actually means isn’t entirely clear.

What’s the good news?

The prime minister was so pleased with at least one of the metrics that he tweeted: “I promised I would cut NHS waiting lists and we are delivering. Reducing 18-month waits by over 90 per cent is huge progress. We still have work to do, but backed by record government investment and the ongoing efforts of the NHS, I am confident we will get patients the care they need more quickly.”

Of course, there are two ways of looking at that perfectly correct and fairly presented statistic. One is that it compares very favourably with the ugly peak in delays in routine care such as knee or hip replacements of more than 18 months, which reached nearly 125,000 in September 2021 (against some 10,000 now). But critics say it is still a scandal that the NHS target to eliminate such long queues has still been missed, that it should never have grown so large in the first place, and the government is failing on other key metrics.

What’s the less good news?

Most of the other data. The Independent reports the disturbing revelation that hospitals are failing to tackle spiralling children's surgery waiting lists as the backlog hits more than 400,000 for the first time. Leaked documents show children’s waiting lists for both inpatient and outpatient care are “increasing at double the rate of adults”. Overall, those waiting to begin hospital treatment at all (in England) actually hit a record high, at more than seven million.

Even where there has been progress, there remains much room for improvement from a low base. The latest figures indicate an improvement in typical response time for ambulance call-outs to emergencies – of 8 minutes, 7 seconds. That was the shortest since June 2021 – but remains above the 7-minute benchmark.

The response time for call-outs to incidents such as strokes and heart attacks is 28 minutes 35 seconds – the shortest since May 2021 – against a target of 18 minutes. The proportion of patients in A&E getting seen within four hours rose from 71 per cent in March to 75 per cent in April.

On the other key indicator, cancer, the NHS already acknowledged it was going to miss the goal of returning the number waiting more than 62 days for treatment to pre-2020 levels of 14,200. Now, more than 19,200 are enduring such waits, compared to the peak in September 2022 of more than 33,000.

What did the prime minister promise, exactly?

His personal, political target is distinct from the much wider range of performance indicators adopted by NHS England. His keynote “five pledges” speech in January gave plenty of wriggle room: “NHS waiting lists will fall and people will get the care they need more quickly.”

So Sunak can pick and choose which of the data supports his claim to be fulfilling this promise, while the opposition can also point to trends going in the wrong direction. Given that the pandemic is over, and barring any wave of new infections or massive disruption through strike action, the NHS ought to make some progress in returning to normality by the beginning of 2024. A mild winter would also help.

How does he propose to meet the pledge?

Money, for a start. In his autumn statement, Jeremy Hunt promised a further £6.6bn, a figure he said NHS chief Amanda Pritchard had described as “sufficient”.

Sunak is also making more use of the private sector to accelerate the effort to reduce backlogs, and, his January speech, Sunak also signalled a longer-term commitment to this, marketisation and patient choice: “We’re comfortable with the NHS using more independent capacity – if that’s what it takes to get patients quicker and better care. Where patients can access more information and data, allowing them to make more informed choices and hold services to account.”

The most recent eye-catching initiative is to give community pharmacies a bigger role in diagnosis and issuing prescriptions; and more funding to improve telephone systems in GP surgeries to help eliminate the 8am rush for an appointment.

Why are the queues so long?

Covid has a lot to answer for, but the NHS was “running hot” before it went into the pandemic, with post-Brexit staffing shortages and a long-term funding gap exacerbating longer-term unfavourable demographic trends. Since the autumn industrial action by nurses, ambulance crews, junior doctors and others have added to the immediate pressure on hospitals and clinics. Long covid presents an uncertain new challenge.

What is the outlook?

Staff shortages are set to persist, as are strikes by the junior doctors and Royal College of Nurses, and these will necessarily impede immediate improvements in patient care. The NHS funding gap might grow wider if significantly higher pay awards eat into NHS trust budgets. Recently the Health Foundation, a health charity, said the NHS is likely to remain on a “crisis footing” for the foreseeable future. As the election approaches, Sunak should be able to claim some success on improving patient care but the general impression will still be of a system too close to crisis for comfort and Conservative governments tend not to get much credit for improving the NHS even at the best of times.