Sky Views: NHS may not change unless we do too

Paul Kelso, Health Correspondent

A wise journalist once said of taking on a new brief: know what you don't know, and steer well clear of it. The advice was passed on to me earlier this year when, after 15 years elsewhere, I took on the health beat.

Ever since, I've been on a crash course in a vast and varied field, capped by the calling of an election. Brexit may be centre stage but the fate of the NHS is not far behind as a pivotal campaign issue, shaping politics and policy as well as patients' lives.

:: Listen to the latest Behind the Headline podcast on Apple Podcasts, Google Podcasts, Spotify, Spreaker

So after a heavy prescription of reading and numerous consultations with the better-informed, here are a few observations from a new arrival on Planet Health.

Everyone knows the NHS is in crisis and no-one is afraid to say so

Journalists are often accused of hyperbole but when it comes to the NHS there is no need. The language from civil servants, public bodies and interest groups is universally apocalyptic.

In my first week, the head of the Care Quality Commission, the body that inspects hospitals, said the NHS was "standing on a burning platform". Rather than distance himself from the incendiary line, the chief executive of NHS England Simon Stevens quoted it in his plans for the future.

The baby boom began in 1948, the same year as the NHS was founded. Next year the service - and the baby boomers - turn 70.

The chief executive of NHS Providers, the body that represents hospital trusts, ambulance and mental health services, says meeting NHS targets on current funding is "mission impossible".

Staff representative groups, unions, think-tanks and Parliamentary committees all use similarly gloomy terms.

The service needs more money or patients will suffer

Seven years of austerity has come at a price. Demand, rising thanks to an ageing population living longer with more serious illnesses, has outstripped funding.

The current five-year funding settlement represents the greatest squeeze in NHS history. Even with pay restraint and a target of making £22bn in savings, two thirds of hospital trusts were in deficit last year.

The impact on patients is undeniable: longer waiting times in A&E and for elective operations, and some targets that have defined government policy being deferred until the end of next year.

Analysis suggests frontline services need up to £3bn a year to keep up with demand. Put another way, that's just two months' worth of the £350m a week Vote Leave promised to pass on once the UK left the European Union.

Jeremy Hunt may not be popular but he is not stupid

Received wisdom says the NHS is political poison for Conservative governments but Jeremy Hunt has worked hard to limit the damage.

There was some surprise when Theresa May kept him on, and while Brexit means she has got bigger things to worry about, he has helped detoxify the NHS as an issue and insulated her from criticism.

He's done it by positioning himself as the "patients champion", focusing on quality of care and vowing to prevent a repeat of catastrophic failures such as that in Mid Staffs.

Privatisation, the issue that dogged the Coalition reforms led by Andrew Lansley, is now barely mentioned. (The same goes for Mr Lansley, even if the service is still grappling with his deeply unpopular legacy.)

Mr Hunt has also installed his own firewall in Simon Stevens, the chief executive of NHS England.

A career health administrator with a model CV, Mr Stevens is one of that generation of super-smart smoothies who flourished under Tony Blair, advising the former prime minister in Downing Street and former Labour health secretary Alan Milburn.

Mr Stevens combines extreme competence and sensitive political antennae - think Mark Carney with a stethoscope - and is responsible for managing the service while taking some of the flak for its failings.

So it was Mr Stevens, looking every inch the man responsible, rather than Mr Hunt, who faced the cameras in March to spell out that waiting times are likely to rise for the next two years.

The NHS runs on goodwill but that has almost run out

For seven years NHS staff have borne the brunt of cost-cutting, with a 1% pay cap that amounts to a real-terms pay cut, all while working at close to capacity.

It is not new to hear that morale is low among doctors and nurses, but it's unprecedented for the biggest nursing union to consider industrial action.

On Sunday the Royal College of Nursing will reveal whether its members have voted in favour of striking. Even if they don't, the disaffection is undeniable.

Social care is the biggest challenge the NHS has ever faced

Rising demand is being driven by an ageing population with increasingly complex needs. ("Complex" is a euphemism for people living longer with multiple conditions that used to kill them.)

An individual's cost to the health service increases rapidly once they pass 70. The baby boom began in 1948, the same year as the NHS was founded. Next year the service - and the baby boomers - turn 70.

With no consensus on how this demographic challenge will be addressed or paid for, and the NHS already bursting at the seams, it may not be a happy birthday.

We have the NHS we deserve

Every survey says the public values the NHS above all other institutions, but we don't act like it.

We still clog A&E departments when we don't need to, eat and drink like there is no consequence to our choices, and expect instant internet cures from an over-burdened service.

The future of the NHS lies outside hospitals, with more treatment at home and in the community, or in fewer specialist centres.

Accepting some services, even hospitals, may close is a challenge to the public and the political class.

The NHS may not change unless we do too.

Sky Views is a series of comment pieces by Paste BN editors and correspondents, published every morning.

Previously on Sky Views: Sam Kiley - World liberal order is under threat