England’s National Health Service is mired in “perpetual winter” as the general election campaign begins, with performance sharply deteriorating against important targets such as waiting times for emergency departments and cancer treatment, according to Financial Times research.

Analysis of official data, which also shows an ominous rise in patients waiting more than 12 hours on trolleys after a decision has been taken to admit them to hospital, sheds light on the difficult backdrop against which Boris Johnson is seeking to make the case that the Conservatives are the safest custodians of the NHS.

For the past three years, the FT has analysed the state of the UK’s beloved taxpayer-funded service in February, to understand how well it has weathered seasonal pressures. This year the review has been brought forward to assess the state of the NHS as both main parties seek to claim an advantage on the issue.

Our conclusion is that the service is in the grip of strains that rarely let up, from summer heatwave to winter freeze.

Chart showing percentage of NHS patients seen within four hours (rolling four-quarter average)

Saffron Cordery, deputy chief executive of NHS Providers, which represents leaders of hospital, mental health, ambulance and community services, said: “‘Perpetual winter’ isn’t going away.” As the NHS enters the chilliest months, “we start in a worse position than we ever have”, she warned.

Official data paint a grim picture of a service under intense pressure, even as the first tranche of the government’s five-year cash injection starts to take effect.

Richard Murray, chief executive of the King’s Fund, a think-tank, pointed to the “deep fall through the summer and the autumn” in the number of people at emergency departments being seen within four hours, reversing a slowdown in the decline over the past couple of years.

Chart showing percentage  of NHS  patients waiting two months from GP urgent referral to a first treatment for cancer

He added that while it was “not completely clear what made those numbers look so bad, so quickly . . . a lot of fingers” were pointing towards changes in public sector pensions that have handed many senior doctors unexpected tax bills, reducing their willingness to work additional shifts.

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There was also “a deep nursing shortage and that’s certainly been one of the key drivers for bringing the A&E numbers down because you need nurses at the bedside when you’ve admitted somebody as an emergency”.

However, “the number of nurses working in the acute sector . . . isn’t quite as bleak as it was 18 months [or] two years ago”, Mr Murray said.

Chart showing  the shortage of nurses and midwives in the NHS remains acute. Number of full-time vacancies advertised (12-month rolling average)

NHS England was unable to comment because of general election restrictions. In the past, officials have emphasised greatly increased demand, including from patients who are sicker and with more complex illnesses. Hospital admissions have risen by 4.6 per cent in the year to date, or an additional 213,117 people.

The number of people starting routine treatment was up by 3.2 per cent in September 2019 compared with September 2018, an extra 2,000 patients per day. In total, 199,048 people were seen following an urgent referral for suspected cancer in August 2019, compared with 191,446 in the same month last year.

John Appleby, chief economist at the Nuffield Trust, another think-tank, argued that the service’s current travails had their roots in a decade-long slowdown in the growth of health expenditure, which has fallen from 7.5 per cent of gross domestic product in 2009/10 to 7.1 per cent over the past three years. But the retrenchment, introduced by the coalition in 2010, started to have a significant impact on NHS performance only around 2014, due to the careful stewardship of David Nicholson, then NHS chief executive.

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“From 2010 to about 2013-14 waiting lists were fairly flat. The A&E target was more or less being met,” said Prof Appleby.

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Around 2013-14, however, it had become clear that the funding squeeze would continue far longer than initially imagined. “The government said, ‘well, we’ve got to do it all again’. And the NHS couldn’t do it. It didn’t have another five years [of efficiencies] in it,” he added.

He also queried NHS England’s decision, announced in March, to pilot changes that would ditch the four-hour waiting time target in favour of a more flexible approach. It was intended to ensure the sickest people were treated more quickly but could mean longer waits for others.

Chart showing percentage of NHS patients waiting less than 18 weeks from GP referral to treatment

Prof Appleby also pointed to the rising number of people waiting more than 12 hours on trolleys after a decision had been taken to admit them to hospital. If the service continued on its current trajectory, he estimated, the number would hit 100,000 in January.

The funding shortage and lack of capacity in long-term care also emerge as a significant challenge, based on the FT analysis.

Chart showing Number of people waiting more than 12 hours in A&E from decision to admit (12-month rolling average)

Mr Johnson began his premiership with a promise to solve the issue “once and for all”. The urgency of finding a new approach emerges from the FT analysis. In February there were signs of a slight improvement, apparent testimony to a push by the NHS and local authorities to work more closely together to ease demand on the health service.

In the latest analysis, however, “delayed transfers of care”, when people have to be kept in hospital because there is no appropriate community care for them, are on the rise again.

Chart showing Patients are staying longer in hospital - Delays in transfers to community care are rising again

Ms Cordery said: “If you cut social care, then the NHS bleeds, and vice versa actually.”

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One of the most widespread frustrations voiced by Britons over the NHS is the time they have to wait to see a general practitioner, the gatekeepers to the wider system. Mr Johnson recognised the electoral significance of that particular metric when he pledged on the steps of Number 10 to ensure that “you don’t have to wait three weeks to see your GP”.

The most recent figures showed that on average 68 per cent of appointments happened within seven days of booking, leaving about one in three waiting more than a week to have symptoms checked.

The exact course that winter will take is unknown. However, if history is any guide, the NHS will demonstrate its customary ability to spring unwelcome surprises for the governing party over the course of the election campaign.



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