Clapped-out kit, long delays, too few beds and staff: NHS enters 2021 in a sorry state | NHS

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Think 2020 has been awful for the NHS? Next year is shaping up to be far worse – and most of the huge hole it’s in was dug long before Covid. The virus has merely finished off the job.

The health service does not have the beds, staff or equipment to recover the ground it lost during the first two waves of the coronavirus pandemic, but the government is blocking desperately needed improvements, and another round of organisational upheaval is on its way.

Roughly one in 11 clinical posts are vacant, and it would hardly be a surprise to see many staff rush for the retirement door once the worst of the pandemic is behind us. The NHS can’t solve the problem without long-term certainty over funding for staff.

Around 140,000 patients in England have been waiting more than a year for surgeries such as a hip replacements, up a hundredfold from a year ago. With the whole system beset by delays long before we had even heard of coronavirus, the lack of spare capacity means it will take years to help many patients.

Unprecedented interruptions and delays to cancer tests and treatments have been exacerbated by the pitiful state of diagnostic equipment. Access to CT and MRI scanners is far behind countries with a fraction of our wealth, such as Slovenia and Slovakia. Yet the best the chancellor, Rishi Sunak, could manage in his spending review to turn this around was a commitment to replace the most clapped-out bits of kit.

In the midst of all this turmoil, the NHS in England faces another round of legislative and organisational upheaval next year, the likely arrival of a new chief executive, and a potential fight with Downing Street over the extent of political control.

The government looks set to support proposals from NHS England for legislation to undo the worst damage from the Andrew Lansley reforms that came into force in 2013. The plan is to abolish the circular firing squad of hospitals competing for business and establish instead some 40 integrated care systems to oversee services.

Many of these integrated systems have already started work and the rest will launch next April, but they have no legal foundations, which has necessitated nod and wink agreements between existing bodies to allow them to function. This is not a sustainable way to run a health system.

It is likely to mean one round of disruption next April and another a year later. Continuing with disconnected care wouldn’t be much of a plan, but the timing as we come out of the pandemic is horrible.

And with the expected departure of the NHS England chief executive, Sir Simon Stevens, after seven years, a new face is expected to be responsible for navigating a way through all this mess by next summer.

But as so often with the NHS, a political battle rather than patient care may well be the first item on the new boss’s to-do list. Boris Johnson and the health and social care secretary, Matt Hancock, have been frustrated at the operational independence enjoyed by NHS England under the Lansley reforms, a freedom Stevens used to extraordinary effect before the pandemic to force additional funding. A government working group has been investigating how to use the new legislation to curtail the power of the chief executive and bring them closer to Downing Street’s orbit.

As ever, the NHS will overcome the odds thanks to the frantic endeavours of its staff, whose success so often comes despite the systems in which they work, rather than because of them. But making do and muddling through will never deliver the quality of healthcare the country needs. Like many other public services, the NHS faces the spectre of perpetual crisis.

Hafta Ichi
Source: The Guardian
Keyword: Clapped-out kit, long delays, too few beds and staff: NHS enters 2021 in a sorry state | NHS

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