There is almost universal agreement that the NHS needs to spend more time focusing on developments in community and primary care, but with a growing focus on hospital performance it will be harder than ever

It would be a major irony if the fears stoked by Labour that the NHS is being privatised are used by the supporters of Scottish independence to win the day next Thursday - thereby increasing the chances of England having a Conservative government once the nations had split.

‘Whitehall briefings are stressing NHS performance poses the greatest threat’

However, it is the coalition parties whose more immediate fortunes are connected to public perception of the NHS.

High level Whitehall briefings are stressing NHS performance poses the greatest threat to the government’s standing as the election nears.

Specifically, the concerns fall into two areas: the impact of the better care fund on NHS providers; and the hospital sector’s waiting times performance.

The honeymoon is over

The better care fund’s honeymoon period is definitely over.

Plans are now being crawled over to ensure they do not endanger the stability of providers, while trusts can soon expect to have their influence over such plans strengthened through closer involvement in health and wellbeing boards.

‘Anecdotal evidence suggests hopes have not been realised’

Of more pressing concern is the NHS’s record on waiting times - specifically the attempt to clear the backlog of elective work the NHS started the summer with.

While health secretary Jeremy Hunt gave the service until the end of the year to do the work, those involved knew the back of the problem had to be broken well before then to make the deadline practical and to avoid the dangers of early winter pressures derailing the push.

Anecdotal evidence suggests those hopes have not been realised. With the catch up slowed by a combination of staffing shortages, capacity constraints (in the private, as well as public, sector) and the speed of response over the summer months from a service that has been flogging itself since winter.

It’s make or break month

Now the message has gone out to trusts and clinical commissioning groups that September is the make or break month.

Frustratingly for those at the centre it is still very hard to determine exactly how big the problem is. The proportion of “phantom waiters” is thought to be high - but nobody knows how high or how they are spread across the service.

‘It is still very hard to determine exactly how big the problem is’

But even if audits do bring the number down new problems continue to emerge, as HSJ’s revelation of Barking, Havering and Redbridge’s 90,000 strong waiting list reveals.

Whatever the exact numbers, if the NHS fails to make enough progress this month the government will face a stark choice.

Find some more money in the knowledge supply constraints may mean it has little impact, or hope the NHS has a quiet winter and can continue to chip away at the backlog.

The government was so sensitive to allegations of an impeding crisis over spring’s £250m bung to clear the elective backlog they initially refused to allow the numbers to be added up - insisting communications only included specific amounts allocated to individual trusts.

They will be well aware any further funding injections will be seized on as a panic measure.

Wishing for an act of God

When the service’s commanders gather at Number 10, Richmond House or Skipton House, tongues will only be partly “in cheeks” as they “wish” for an act of God such as a serious flu outbreak that means “all bets are off” and funding can be pumped into the service in a way appreciated by press and public.

‘NHS performance poses the greatest threat to the government’s standing as the election nears’

It is easy to be cynical in periods of intense political pressure - and to forget rising elective waits is an issue worthy of focus and action at any time.

However, there is no doubt the problem arrives at a very unhelpful time for the NHS’s development.

There is almost universal agreement that in terms of quality, capacity and role the NHS needs to spend more time focusing on developments in community and primary care. But doing this among a snowballing focus on hospital performance is likely to be harder than ever.

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