As we sit here in the autumn of 2022, I am struck by the state of health in the UK. Here we are, only 30 months since the first UK national lockdown for COVID, and health and health policy appear to be an after-thought on the political landscape. How have we moved so quickly from where daily mortality figures were the mundane norm of the evening news to the point where healthcare and health provision barely merit any mention in the nightly media missives?
In part, the explanation must lie in the recent political upheavals in the UK. Since the first lockdown, we have seen three Prime Ministers and, even more incredibly, four Chancellor of the Exchequers. Does the unprecedented rapidity in Chancellor turnover give a clue to the health question? Is it the case that the economic crisis overtook the public health crisis, such that the imperative, post-COVID, was the need to develop an appropriate economic response rather than a public health one? This might be true if the current financial malaise in the UK were solely attributable to COVID, but BREXIT also has a major role to play in the current malaise, not to mention the situation in Ukraine.
We are also on our fifth health secretary in the same time frame. Matt Hancock co-ordinated the initial response to COVID (before having the whip suspended to pursue a TV broadcasting ‘career’), then Sajid Javid, followed by Steve Barclay, then Therese Coffey (who must be the shortest-serving Secretary of State for health with 49 days in office) and then back to Steve Barclay. Five Secretaries in the space of 30 months.
At the same time, the BMA tells us that more patients than ever are waiting for treatment. At the pandemic’s start, just under 4.5 million people were waiting for treatment. In August 2022, this number was 7 million. Of this number, 2.75 million patients are waiting over 18 weeks for treatment, with over 380,000 patients waiting over a year (pre-pandemic, the number of people waiting over a year was 1032). In addition, the BMA report the median waiting time for treatment is 13.8 weeks, which is significantly higher than pre-COVID times.
These numbers are just the visible waiting list. They also point to the growing ‘hidden backlog’, which covers all those patients who are ill and require care but have not presented yet, or patients who have had referrals cancelled due to COVID-related delays. The size and scale of these problems are unknown. Add to this the anticipated upsurge in COVID numbers, and the next few months look bleak, to say the least, and that’s not even touching upon the impact of the so-called ‘’cost of living’ crisis where many vulnerable people will have to choose whether to heat or eat.
Given all of this, a recent piece in the BMJ drew attention to the fact that COVID planning was strangely absent from then SoS for Health, Therese Coffey’s ‘Our Plan for Patients’. The sole UK strategy seems to be booster vaccinations, with little else being done to ready the population, and the already straining NHS, to deal with any COVID upsurge. Just as the economic policy in the UK appears jittery and unsettled due to internal disputes in the Conservative Party, so does it seem that health policy is suffering in the face of constant political churn driven by internal Tory party politics.
Where does this leave us? It leaves us worried and wondering how best placed we might be to respond to yet more pandemic-related morbidity and mortality in the face of an ongoing political crisis. It leaves me wondering how many political processes shape the news agenda. How might we, as a community of academics and researchers interested in the public health of the UK (and further afield), be best placed to get these real concerns about health on the political agenda? I mean this not in the context of successive health secretaries unveiling their strategic visions but rather in developing a mature and robust policy response to genuine and pressing issues.