As a heart doctor, I’ve always taken a special interest in what happens when a heart stops, what we would call a “cardiac arrest”. The most dire of medical emergencies, the reality is only 2-3% of patients ever survive to go home. For all intents and purposes the patient is dead, until resuscitated. Believe it or not, there are “good” cardiac arrests and “bad” ones, which paradoxically is not necessarily linked to the final result. A “good” cardiac arrest is one of clear leadership, quick and coordinated action amongst the team, and a smooth, continuous rhythm that comes from a large group of people following a single plan to achieve a single purpose, to literally save a life. A “bad” cardiac arrest is messy, disorganised, with people working at cross-purposes and vital life-saving seconds are wasted through miscommunication and divided efforts.

Most cardiac arrests can be predicted, by the marked if not sometimes subtle decline in the hours or even days before. The deterioration is often obvious in retrospect, which makes the terminal event only more tragic.

By every objective marker, the National Health Service, that great human institution forged in the post-war era, is now flat-lining. In England, A&E waiting times are their worst since records began, trolley waits are 5 times what they were in 2012 and this winter will be the fifth successive “worst in NHS history”, behind 2015,16,17 and 18. Cancer target waiting times for referral and treatment haven’t been met for months, and 4.56million people are waiting over 18-weeks for elective treatment. Financially, the NHS in England is well-beyond fiscally sound, with half of trusts in the red and the cumulative deficit around £3bn (compared to a £500m surplus in 2010). The NHS England infrastructure backlog is £6bn. There is nothing political or biased about this: these are the government’s own statistics. It is exceptionally clear to those of us on the frontline, breaking bad news in linen closets while patients die in the back of queued ambulances, that this cannot go on. The eventual crash is coming, or perhaps, in an institution the organisational equivalent of a supertanker, it has already begun.

I felt, as did many of my colleagues, this election was perhaps the last chance to definitively change the course of this country, particularly the crisis in health and social care. That opportunity has now slipped by, and we are left with the same team that lead us here in charge of the crisis they created.

So what do the Conservatives plan for the NHS? Their campaign was blighted with false promises and sleight-of-hand, loud catchy slogans without the vital substance to back them up. What we can decipher from a famously light manifesto is this: there is a promised 3.4% annual increase (Adjusted for inflation) every year until 2024, which is below the historical average, and will likely just about cover the current deficit. Six new hospital buildings have been given the greenlight “pending business case approval” to be built by 2024 again, and up to 38 (including a variable number of community hospitals) have been given development money for further building between 2024-29. So, no shot of adrenaline, no boost to the system for many years yet.

In terms of staff, the headlines were full of promises of 50,000 more nurses, 6000 more GPs. A contentious figure, given only 14,000 new placements are planned, EU nurse recruitment has flat-lined as have nurses trained domestically, and 12,000 more will be recruited abroad. Worse, the current nurse vacancy in England is 43,000, meaning full recruitment of and retention of these nurses will only bring us back to zero by 2024, and no further. Given the number of nurses/patient is directly linked to hospital survival, we needed radical action, and it isn’t coming.

As for the GPs, 1 in 2 GPs plan to retire in the next 5 years, 10,000 GPs are currently required to meet demand.  Next week we will enter 2020, the year we were supposed to have 5000 more GPs in the NHS. Since Jeremy Hunt made that promise in 2015 the number of NHS England full time GPs has actually dropped by 1600.

From a government of broken promises I hold little hope of solutions to the vast and deep crisis the NHS is in, and will continue to be in. The crash alarm is blaring. Beyond the NHS the country is in deep trouble; economically we have the weakest growth in the G7 and wage stagnation since 2015. Socially, violent crime and hate crime are on the rise, inequality has never been greater, and the safety net for the most vulnerable people is eroding away. Foodbanks, homelessness, child poverty, police numbers, pupil funding…the list of ailments is long, and none of these emergencies have gone away. Not while we debated Brexit, not during two snap election campaigns. All of the organs of our great country are in failure.

When I look at how the opposition has organised itself over the past few years, I am reminded of all the “bad” cardiac arrests I have been to. Working at cross-purposes, loss of situational awareness, a lack of mutual focus. Not enough leadership, and nowhere near enough followership. What was an urgent need for a change of government has become a dire emergency, and in this there needs to be a change as profound and reflexive to match.

The Tories now dominate one side of the political spectrum, while the other is splintered across parties and even inside parties. This must end. Ideology that cannot compromise is not politics, it’s fanaticism. Worse, if it cannot carry sufficient weight in the ballot box to reach political office, then it is pointless as well.

I’m sick of the labels of Left and Right, of Marxist and Bennite and Blairite and more. They are just endless reasons to misunderstand and disagree with each other. They can only divide. In the end, we do have a single mutual purpose, but disagree on the means to get us there. We want working hospitals, good schools, universal financial security and safety. The stakes are real: people’s livelihoods, the values of our society, the future of our children. We must be laser-focussed on our goal, and ruthless in our pursuit of it.

And I say “we” in the realisation that the crash alarm is blaring out across this country, and there are only two responses to it. Ignore it and attempt to close our eyes and ears to the crisis around us, or run towards it. I left the Labour party in 2017, and yesterday I re-joined. I want a say in what happens next, a voice in what remains the only viable route out of this mess for so many millions of people. Perhaps you do too.

 

Juniordoctorblog.com