Who is to blame for 12 years of desecration of our NHS? Doctors, says Thérèse Coffey | Polly Toynbee

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Hhere it is: yet another plan from yet another new health secretary, the fifth in five years. After just two weeks at the helm of a service close to collapse, Thérèse Coffey sets edicts, targets and expectations with, she says, a “laser-like focus on patients” – as if no one had bothered with them before. her “ABCD” mentions all the worst problems: Ambulances, backlog of operations, social crisis and doctors and dentists (nurses omitted). But spelling them out doesn’t fix them.

She is a stretcher bearer with a little first aid: there is a welcome temporary splint to the pension problem that is driving experienced doctors to retire too young. (That’s another Labor plan that’s gone.) Extra paramedics and greater use of pharmacists as prescribers are welcome, but even if it adds a million more GP appointments, it’s still only 1% more. Tories long ago broke their 2019 manifesto promise of 6,000 extra GPs and there are now 1,850 fewer fully qualified full-time GPs than in 2015, with 16% more patients per GP, according to Professor Martin Marshall, president of the Royal College of GPs. He says the NHS is losing more GPs than it can recruit. Coffey is threatening to name and shame practices with long waiting times for appointments, but GPs need to “protect not punish”, says the president of the Royal College of GPs, Clare Gerada. Too many are already giving up under the strain.

Social care is almost ignored, once again. With 13,000 NHS beds blocked by people waiting for care, the £500m extra is nowhere close £13 billion Liz Truss promised to the National Association of Municipalities for social care during her selection campaign.

What is missing is any serious workforce plan to train and recruit for the sky-high NHS and vacancies in the social sector. The Treasury is blocking anything that would commit to years ahead, funding only a fraction of the well-qualified medical school applicants urgently needed by the NHS.

What is a Tory health secretary to do when faced with the result of 12 years of the most severe underfunding of the NHS ever by her own governments? Funding always sinks under any Conservative government until all-too-rare Labor governments come to the rescue. She knows the NHS is not getting any significant new money, so she does what they all do and puts the blame back on the miserable staff.

In a state of early ignorance, the first reaction of Tory health secretaries is always the same. Why can’t it all NHS be as good as the best? Why can’t it every hospital, clinic, doctor and nurse be above average? She calls for data on “unjustified variation” to performance manage lagging GPs and hospitals. But she wants to avoid looking at Britain’s “unfounded variation” in OECD health expenditurewith fewer doctors, nurses and beds per per capita than corresponding countries.

New ministers ignore complex differences between areas, populations, facilities and difficulties in recruiting staff. For example, Tory politicians enjoy pointing to lower health outcomes in (Labour-ruled) Wales, without admitting that Wales has a population with the same profile of old age, poverty, disease and frailty as North East England, which has similar outcomes. Level up in society and NHS outcomes would have less “unwarranted variation”.

New health secretaries look anxiously at the knobs on their desks, roll up their sleeves and come up with all sorts of whizzy ideas that no predecessor has considered, let alone the top doctors, top administrators and NHS officials who are among the smartest people in the country. Refusing to accept that funding and workforce are the problem, they blame staff, further demoralizing exhausted doctors and nurses who quit early in alarming numbers.

Or they can blame the whole state-run socialist NHS model itself: just listen to the behind-the-scenes political rumblings and the flurry of commentary in the right-wing press. If Liz Truss really wants to court unpopularity, she can start calling for private insurance schemes to alienate large majority of the public who steadfastly support the NHS Fundamental Principle. Although concerned about the current shortcomings, voters retain an unshakable faith in the system itself. That tops the list of what makes them proud to be British, even knowing their current state of crisis.

There is a danger in the long run if passionate advocates of the NHS, angry at this government, keep running it down to the point where people can really start to think it’s done for. The remarkable truth remains that millions upon millions receive excellent and prompt treatment they are very satisfied with. They tend to believe that the NHS “out there” is much worse than the local NHS they personally experience. As the Royal College of GPs says, on a typical day 1.3 million people are seen by GPs and 45% have requested to be seen that day.

Politically, Labor will attack and attack again: the NHS is a primary weapon against Tory governments. Labor left it in 2010 at its best ever for waiting times and treatments. But the NHS alone as an issue has never been enough to win Labor an election. This time, however, the Tories have good reason to fear that it will be a major contributor to their loss at the next election. They have no chance – or real intention – of fixing it before an election when the state NHS will stand as a miserable symbol of the rest of the destruction they have brought upon the country.

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