The press are turning up the pressure on waiting times and politicians promise to ‘save’ the health service and the election cycle is fuelling the fire

I flinched twice before breakfast on Tuesday.

Once when I read a tendentious “Mansion tax to pay for 1,000 nurses in Scotland” headline in The Times.

The second when Cliff Mann, engaging face of the Royal College of Emergency Medicine, told Radio 4’s Today that trusts don’t like to invest in accident and emergency because badly designed tariffs make it “a loss making part of the business”.

‘Labour’s “save the NHS” pitch is as traditional as a Christmas card with snow on it’

There’s logic to having someone in every hospital treating it as a business – they can’t run on good will and angels alone as so many people think, subscribers to the tree grown theory of money.

But it surely makes little business sense to starve a vital frontline service, especially one which, just like city banks, is desperately trying to recruit skilled foreigners to fill the staff gaps.

Daily déjà vu

The daily reality of pressure on A&E – “major incidents” declared by six trusts (and counting) even before the weather turns really nasty – was enough to overshadow the new year election launches (HSJ Live is on their case) by the major parties. No great loss there, I felt. It was pretty thin stuff and mostly very déjà vu.

‘Labour’s “save the NHS” pitch is as traditional as a Christmas card with snow on it’

Labour’s “save the NHS” pitch is as traditional as a Christmas card with snow on it.

It all seems ages ago (pre-Christmas, actually) since Jeremy Hunt was accused of sneaking out a consultation to relax ambulance dispatch times and the Daily Mail ran its “Queues that shame Britain” headline outside a Surrey GP practice (wealthy Surrey has A&E problems too).

But they are all part of the wider picture: a shortage of funds and NHS staff at a time of rising patient demand.

Fuelling the fire

The election cycle fuels the air of crisis.

Politicians find it harder to resist blaming each other, though Mr Hunt was more restrained on Today than Labour’s Andy Burnham, perhaps because he’s currently paid to carry the can.

The media piles eagerly in (“Maternity units spend millions on interpreters” was another none too subtle Times headline), egging on all sides.

Vested interests, unions and royal colleges join the fray to promote their own agendas.

Even NHS England lets it be known that it wants those pesky trusts to allocate more cash to A&E and mental health – but, of course, Whitehall gave away its powers to direct them, retaining only the power to starve.

In passing, it is worth noting that the devolved Celtic NHSs have similar problems, unmodernised Northern Ireland’s A&E problems being the worst.

But since it’s not Labour run, Fleet Street averts its gaze.

‘Vested interests, unions and royal colleges join the fray to promote their own agendas’

We all know by now that it’s what Mr Burnham might call a “whole system” problem: let GPs skip weekend care, cut town hall social care budgets, mess up NHS 111 and you build up pressure elsewhere, especially when demand from the old – those 4 million extra customers living in Britain – the “worried well” embracing preventive steps, festive drunks too, keeps rising.

Easy to see where 20,000 extra A&E visits a week have come from since 2013: the White family only narrowly managed to avoid adding to the swell during a nasty four hour drama on Boxing Day.

So NHS England chief Simon Stevens’ FT interview may be more significant than Mr Hunt’s soothing (“heroic efforts” by NHS staff) radio chats this week.

While sticking to his demand for steady cash increases from the next government (or else!), he stresses the need to redesign healthcare “in the round” with other public services and has his eye on new towns to pioneer a tech savvy new era in multi-use facilities.

So brace yourself for virtual online GP appointments and an A&E next to the police station (so they can lock up the drunks).

Michael White writes about politics for The Guardian

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