Wednesday briefing: What really ails the NHS at 75 – and three ways to treat it | UK news

Good morning, and a heartfelt happy birthday to the NHS, which was launched by Labour health minister Nye Bevan on this day in 1948. Don’t hold your breath for champagne and cake on your local hospital trust’s budget, though – you will be waiting almost as long as a typical queue at the nearest A&E.

The NHS may be profoundly cherished for its millions of dedicated staff and the still astonishing cradle-to-grave principle that underpins it, but there is no question that the UK’s healthcare system is very sick. More people are dying waiting for ambulances. Waiting times for treatment have almost tripled since 2020. GP surgeries and mental health services are at breaking point. Staff are leaving in droves, and nurses, junior doctors and even consultants are striking – once an unimaginable prospect – over pay and patient safety.

It’s a desperate diagnosis. But is it a terminal one? Is the NHS really locked in a “death spiral” that could even see it cease to exist before its next major anniversary?

For today’s newsletter, I have been speaking to Siva Anandaciva, chief analyst at the King’s Fund, a specialist health thinktank, which last week published a major report into the state of the NHS. His findings were undoubtedly troubling, but in some respects, he says, he feels optimistic. So I asked him: how can we save the NHS? Read what he had to say after the headlines.

Five big stories

  1. Climate | The government is drawing up plans to drop the UK’s flagship £11.6bn climate and nature funding pledge. A leaked briefing note to ministers seen by the Guardian, lays out reasons for dropping the UK’s contribution to the fund for developing countries. The Foreign Office initially refused to comment on the leak, before describing it as “false”.

  2. Partygate | Scotland Yard is reopening its investigation into potential Covid breaches at a lockdown party at Conservative headquarters. The force will also scrutinise an event in parliament that the Tory MP Bernard Jenkin – a member of the privileges committee that produced a highly critical report into Boris Johnson – is said to have attended.

  3. Jenin | Israeli forces have withdrawn from the Palestinian city of Jenin, military officials have said, after carrying out one of the biggest operations in the occupied West Bank in years. Twelve Palestinians and an Israeli soldier were killed in the operation.

  4. UK news | Private bank Coutts has reportedly shut Nigel Farage’s bank account after he fell below the prestigious lender’s wealth requirements, raising questions over the Brexiter’s claims that the bank was targeting him over his political views.

  5. Scotland | Mhairi Black, the SNP’s deputy Westminster leader, will step down at the next general election, blaming the “toxic” environment in Westminster. Black became the youngest MP in 350 years when she was elected in the SNP landslide of 2015 at the age of 20, described the Commons as “one of the most unhealthy workplaces that you could ever be in”.

In depth: More staff, more money – and a push for ‘quiet radicalism’ in NHS management

A London ambulance service crew in 2022
NHS England has announced a staffing push to take pressure off the system. Photograph: David Levene/The Guardian

Of course, saving the NHS is not merely a question of money. And yet, Anandaciva told me: “I would say it definitely is a [question] of money. That’s a huge part of the story.”

The figures on NHS funding are stark: the 2010 Tory-Lib Dem coalition government sharply reversed the big boost to health service budgets introduced under New Labour, from an average real terms growth rate of 6.7% under Blair and Brown to a paltry 1.1%. All complicating pressures aside, it is demonstrably the case that political decisions have directly led to the current crisis.

That said, the way you spend money also hugely matters, says Anandaciva. Patterns of NHS funding can look “volatile and lumpy, and – for lack of a technical term – weird”, where a gush of cash is suddenly injected after massive underinvestment, with no promise of it being sustained. Just knowing what was coming would help significantly with budget planning, he says.

“But for the most part, it’s a political choice over how much we spend on our health care service. And that choice often changes all too quickly.” Britain spends lower than average on healthcare as a proportion of GDP, and its per capita spend is well below the EU as a whole.

Inside the NHS at 75: ‘Used and abused, overworked and underpaid’ – video

Not even doubling spending tomorrow could instantly fix the NHS’s problems – it takes years to train and recruit staff, build hospitals and invest in new facilities. But a new government with different priorities could make a huge difference. And that’s before smaller changes, such as “sin taxes” and other prevention measures, which don’t cost a lot and can have much quicker impacts on public health.

There is one important point to note cautions Anandaciva: “The last time we saw sustained investment [under New Labour], the economic conditions were very, very different.”


Staffing

Almost half of the enormous NHS budget is spent on staff, but today’s workforce is deeply disaffected, with skyrocketing vacancy rates (8% of the workforce as of March 2023, up from 2.1% in 2010).

The government says its long-trailed staffing plan for England, announced last week, is “the biggest recruitment drive in NHS history”, and Anandaciva agrees that “it really is significant”. That’s because, he says, it’s precisely the sort of long-term planning that is needed in the health service, but which all too rarely happens because its benefits will only be reaped by future governments.

The plan has a “quiet radicalism”, he says, “and I don’t underestimate the amount of political capital that would have been expended by the current chancellor [Jeremy Hunt] to get it over the line”.

There is, of course, one significant fly in the ointment, which is the deep unhappiness of the workforce, and the government’s adamantine position on NHS pay. Increasing staffing would make the NHS run much more smoothly – but it would also make it a lot more expensive, which may help explain the Treasury’s reluctance to move on pay, he says.


Management

An easy target for governments wanting to cut NHS budgets is to slash the number of managers. In fact, says Anandaciva, “We spend a relatively low amount on administration on our health service in this country” – and some of the individual organisations that make up the NHS are as large as major corporations, with enormous budgets and workforces.

But when you cut management too far, he says, that’s often when systems stop working. “All the little things that you may not see but which make a huge difference, like getting scans processed on time, having a functioning IT system, keeping the [hospital buildings] maintained. So [a surgeon is] not having to run up and down to find a working bathroom mid-surgery because nothing has been maintained.

“A new set of politicians come in and always seem to have an idea for how things could be organised differently. Some stability in management numbers, and recognising the role of management, would be incredibly helpful.”


Social care

Social care is central to the NHS debate.
Social care is central to the NHS debate. Photograph: Pixel Youth movement/Alamy

One of the knottiest problems in reforming the NHS is how seriously it is hampered by the equivalent problems in the social care system. Anandaciva recalls countless meetings with hospital chief executives who despaired that they couldn’t discharge into the community patients who needed only support at home.

Social care is particularly challenging nut to crack because its staffing levels are subject to the market and wider politics, it is reliant on private providers, and – crucially – there is no agreement over who pays for it.

Anandaciva feels cheered, however, that politicians now acknowledge the centrality of social care to the NHS debate. And while fixing the issue would require a fundamental national debate over who pays for old age, other countries, notably Japan and Germany, have managed to introduce reforms, he says.

“We had this debate 75 years ago with the NHS: Anyone can have a heart attack, so why don’t we pool our resources to mitigate the risk of being financially destitute if you do? We haven’t done that with social care. It takes a lot of [political] capital to have that debate with the public.

“But look how Nye Bevan is revered in this country. Who is willing to be the Nye Bevan of social care?”

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What else we’ve been reading

A hoarders home
Hoarding is not just a matter of too much stuff Photograph: Sipa US/Alamy
  • ICYMI: Samira Shackle’s long read about hoarding (pictured above) is fascinating. Shackle speaks to psychologists, social workers, firefighters and those struggling with hoarding themselves to understand this complex condition. Nimo

  • Cary Grant never told his daughter – or anyone else – much about his hardscrabble early life in Bristol; when Jennifer Grant rediscovered the extraordinary story for a new TV programme about his life, it was like “regaining a limb”. Her affection for him is palpable in this lovely interview by Emma Brockes. Esther

  • Ava Kofman’s report for the New Yorker (£) on the anarchic world of penis enlargement surgeries in the US left me speechless. Kofman interviewed men who went under the knife only to be left disfigured and in enormous pain. Nimo

  • Some women wear their baldness due to cancer treatment proudly, but as Sarah Standing writes: “I am not that woman.” A powerful account of how losing her hair was the moment that changed her. Esther

  • In this week’s TechScape newsletter, Johana Bhuiyan looks at driverless cars in San Francisco. What was supposed to be a product that makes life on the road safer and more convenient is turning into a tool of surveillance, Bhuiyan writes. (For more tech news, you can sign up to the free TechScape newsletter here.) Nimo

Sport

Alessia Russo signs for Arsenal at Emirates Stadium on 4 July 2023
Alessia Russo signs for Arsenal at Emirates Stadium on 4 July 2023 Photograph: David Price/Arsenal FC/Getty Images

Football | Euro 2022 hero Alessia Russo (pictured above) has completed her move to Arsenal on a free transfer from Manchester United. The England forward has said that she is expecting to “grow as a player” at the club. Meanwhile, Arsenal men’s team are finalising terms for a £105m deal for West Ham’s Declan Rice, ending a protracted pursuit for the midfielder.

Tennis | Roger Federer was back at Wimbledon, watching with approval from the royal box, as Andy Murray breezed into the second round with a 6-3, 6-0, 6-1 victory against Englishman Ryan Peniston. “It’s been a long time since I have felt physically good coming into Wimbledon,” Murray said. “I’m fit and ready for a good run.”

Cycling | Jasper Philipsen of Belgium won stage four in the Tour de France, sealing back-to-back victories. In a finish described by Mark Cavendish as “carnage”, a spate of crashes on the Paul Armagnac motor racing circuit involved riders hitting the road, including the sprinter Fabio Jakobsen of the Soudal Quickstep team.

The front pages

Guardian front page 05 July 2023
Photograph: Guardian

A mix of stories across the front pages on Wednesday: the Guardian leads with “UK ready to drop £11.6bn pledge for climate fund”. The i has “UK mortgage crunch: four more interest rate rises in 2023 forecast”. The Financial Times reports “BoE considers forcing foreign banks to replace branches with subsidiaries”.

The Mail says “Boris’s Partygate accuser faces his own police probe”. The Telegraph leads with “US pushes for Von der Leyen to be Nato chief”, while the Times reports on an “Overhaul to tackle the scourge of rogue police”.

The Mirror carries comments from TV presenter Fiona Phillips: “It’s time to tell people… I have Alzheimer’s”. Finally, the Sun leads on a story about former tennis player Boris Becker with “Boris hid horse in bedroom”.

Today in Focus

File photo of a teacher and students in a classroom
File photo of a teacher and students in a classroom Photograph: Ben Birchall/PA

Why are so many children refusing to go to school?

The Guardian’s education editor, Richard Adams, explains to Nosheen Iqbal why more than 1.7 million schoolchildren in England and Wales miss class 10% of the time. His investigation has found that this figure has gone up 108% since Covid, but that the reasons are complex. Nosheen also speak to one young girl who explains what kept her away from class, while her mother talks about the impact of her daughter’s missed education.

Cartoon of the day | Rebecca Hendin

Rebecca Hendin cartoon
Illustration: Rebecca Hendin/The Guardian

The Upside

A bit of good news to remind you that the world’s not all bad

Activists rally before the Minnesota senate in April
Activists rally before the Minnesota senate in April Photograph: Stephen Maturen/AFP/Getty Images

For the first time in a decade, Minnesota secured a Democratic trifecta in last year’s midterm elections, meaning that Democrats had control across the legislature and the governor’s office. The last time that happened, Democrats were only in total control for one term, so this time around they have not waited to push through a raft of progressive bills – including a collection of laws to protect workers, abortion rights legislation and a number of laws designed to make voting easier.

A central part of their agenda is restoring the right to vote to formerly incarcerated Minnesotans. Now 55,000 people with felony convictions have gained the right to vote after the Restore the Vote law guaranteed that anyone not in prison can vote. Advocates of this new legislation pointed out that Minnesota’s former restrictions for people with felonies disproportionately affected Black residents. The point of these new laws is to make Minnesota more democratic and re-enfranchise marginalised groups.

Sign up here for a weekly roundup of The Upside, sent to you every Sunday

Bored at work?

And finally, the Guardian’s puzzles are here to keep you entertained throughout the day – with plenty more on the Guardian’s Puzzles app for iOS and Android. Until tomorrow.

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