What’s the biggest threat to Boris Johnson this autumn? Another wave of coronavirus and another lockdown? Failure at the Cop26 climate summit? A row with Rishi Sunak over the level of public spending (or perhaps about which of their pets is Downing Street’s top dog)?
No. The issue that spooks many ministers is NHS waiting lists. The number of people waiting for treatment has risen to 5.45 million in England, the highest since records began in 2007. The record will continue to be broken every month. Officials believe about 7 million more people did not come forward for treatment during the pandemic even though they might have needed it.
When Sajid Javid, the health secretary, warned that the lists could increase to 13 million, he wasn’t painting it black to strengthen his hand in budget negotiations with the Treasury. The Institute for Fiscal Studies predicts the number could be 14 million by the end of next year. The backlog could take three years to clear; ministers worry that it won’t happen by the next general election, due in 2024 but likely in 2023.
The NHS is accustomed to winter crises but this year has a summer one, as my colleague Shaun Lintern has chronicled. Even though admissions in the current Covid wave are lower than expected, NHS bosses report that hospitals are busier than they have ever been, saying that exhausted staff cannot keep working at their current pace forever.
Chris Hopson, chief executive of NHS Providers, says every part of the service is under pressure. He lists six reasons: tackling care backlogs; the loss of up to 10,000 hospital beds due to infection control measures; the number of NHS staff self-isolating; the peak annual leave season; urgent and emergency care exceeding pre-pandemic levels and 5,000 beds still being occupied by Covid patients.
Ministers, who frequently grumble that NHS chiefs cry wolf, know they are not exaggerating this time. But the government is adding to their burdens. Although the NHS is already working out how to switch to a more preventative system next April to reduce hospital admissions, Johnson overruled Javid to press ahead with yet another shake-up.
The Health and Care Bill going through parliament will hand ministers more power to direct NHS England, diverting the service’s attention from the main public and political priority of the backlog. NHS managers fear ministers will use their new powers to block proposed closures in alliance with local Tories, disrupting sensible rationalisation plans.
Labour, which cut waiting times between 2004-10 through an 18-week target from GP referral to hospital operation, notes the irony of a Tory administration taking more nationalising, micro-managing measures when devolving power would give frontline staff more flexibility to tackle the backlog.
Although spare capacity in the private sector is rightly being used to reduce waiting lists, Labour is gearing up to accuse the Tories of ushering in a two-tier health service as more people without private health insurance opt for “pay as you go” private treatment. Not a good look to the Tories’ new working-class voters who can’t afford that luxury.
Voters instinctively trust Labour on the NHS, a recognition the party was its midwife in 1948. In recent years, the Tories have had some success in neutralising the issue. After David Cameron slept on hospital floors while NHS staff cared for his late son Ivan, the public trusted him when he promised: “I’ll cut the deficit, not the NHS.”
At the start of the pandemic, the Tories benefited from a “rally round the flag” effect and moved ahead of Labour when people were asked which was the best party at handling the NHS. Despite the successful vaccine rollout, the Tories now trail by 11 points.
The sheer number of people on waiting lists will make it very hard to turn that round. If we don’t already, we’ll soon all know someone on the list. “You can’t trust the Tories with the NHS” is a dangerous Labour attack line when the NHS is in trouble. At the next election, Labour will pledge to clear the remaining backlog. So the Tories have every incentive to do it by then.
However, that would require a massive investment – a top-up in the second half of this financial year to extend a successful scheme helping hospital patients to be discharged more quickly, and a big boost in three-year spending review this autumn. Initial revenue from a proposed one percentage point rise in national insurance will help to clear the backlog, but the money can’t be spent twice and will be needed to make long overdue social care reforms work.
With Sunak facing so many rival spending demands – such as other Covid catch-up priorities, notably schools; the cost of net zero and levelling up – the fear inside the NHS is that it will not get enough. That would be a real threat to the Tories’ electoral prospects.