Once armed police are being sent to help people calling 999 with heart attacks, it's fair to say that the NHS crisis is deepening.
Almost everywhere in the system, things are truly, madly, deeply in the brown stuff. This Financial Times summary of the depth of the trouble is good.
The NHS RTT waiting list rose again, by the usual 100,000, to 6.7 million in June. Of the 356,000 patients waiting over a year, the NHS's new key target is eliminating 78-week waiters by March 2023. There were 54,000 78-week waiters in June, down from 58,000 in May.
To what I'm sure will be universal surprise, it doesn't quite seem as if Steve 'The Banker' Barclay's "urgent hackathons" have done the job on fixing the longstanding ambulance/A&E crisis:
This excellent Tortoise piece looks at the ongoing NHS patient safety and workforce crisis from a junior doctor's point of view.
And data leaked to Health Service Journal's James Illman revealed that "the number of patients waiting three months or longer following referral for suspected cancer remains at just over 10,000 patients last month ...
"The unpublished data shows 10,189 of the 327,395 people on the national cancer waiting list – around 3 per cent – had waited 104 days or more, with a further 28,406 having waited between 62 and 103 days as of the end of July".
But hurrah for NHS England, whose grounding in The Real World is best shown by its exhortation for the service to do a 'Super September' of accelerated elective recovery plans, focused on outpatients.
How will this work, I hear you ask? More staff drafted in from overseas?
Don't be silly! 'Super September' will encourage "creative options that can free up resource", according to the message leaked to HSJ.
Oh, and given that this two-week waiting list initiative starts on 26 September, how apt it is that most of 'Super September' will be in October.
Winter is coming
If there were a worse title than 'Next steps in increasing capacity and operational resilience in urgent and emergency care ahead of winter', I'm confident NHS England would have found it. They didn't, so BOHICA.
It's hard to disagree with a word of GP Nick Grundy's entertainingly disgruntled analysis: I commend it unreservedly:
Accentuate the positive
This chimes with another bizarre trend: I'm getting a disturbing number of reports from well-informed sources that NHS England's leadership is counselling against focusing on the negative about the NHS and its current performance and state, "because that makes it difficult to focus on all the positive progress we are making".
Mmmm. If not mmmmmmmmmm.
An almost-end to two-year waiters (for now)
NHS England and the Department For Health But Social Care celebrated the near-achievement of the eradication of two-year waits.
It's worth noting that, as waiting times expert Dr Rob Findlay of Outsource has written repeatedly, without an ongoing increase of elective capacity, very long waits will soon build back up, with the ongoing arrival of new or belated demand. The elective waiting list is tending to rise steadily by 100,000 a month.
Indeed the latest RTT data linked to above shows a 7% rise (24,000) in those waiting more than a year and a 5% rise (129,000) in those waiting over 18 months.
As HSJ's Jack Serle also pointed out, "3,000 people waiting 2+ years for treatment is not "a very small number"."
Would Secretary Of State For The Next Few Weeks Steve 'The Banker' Barclay tweet something really stupid about it?
How did you guess?
Sigh. Here we go again with, actual facts and stuff. The elective waiting list was already 4.4 million people in January 2020, before Covid. Today it's 6.6 million, and rising by about 100,000 every month.
It's largely not anything to do with Covid.
So it's foolish to talk about "Covid backlogs".
And for a post-Banker Secretary Of State For Health But Social Care?
How about Nadine Dorries?
1. She’s Team Surgical - the probable winner.
2. It’s obvious that NHS and social care are nowhere in either candidate’s thinking.
3. The current and foreseeable-future performance of the NHS will require a Secretary Of State who’s got more front than Blackpool, and who is inordinately happy to lie.
4. She’s been a Health Minister, and used to be a nurse.
There are concenrns that the hackers behind the cyber attack that I mentioned last week may have accessed patients' medical data. The hack affected Adastra, Caresys, Odyssey, Carenotes, Crosscare, Staffplan and eFinancials: all softwares "so old, they make you look like a Millenial", as my charming cybersecurity contact told me.
Although it's still too early to be certain, it is suggested by credible figures in the cybersecurity industry that ten years of patient data may have been taken.
If that proves to be correct, then anyone who has called NHS111 or NHS Direct in the last decade may have had their details stolen.
Going to RAAC and ruin
A ministerial question from Lib Dem health spokesman Daisy Cooper elicited the response that 34 NHS hospitals are now at risk of roof collapses due to reinforced autoclaved aerated concrete roof materials.
According to Nadhim Zahawi's co-creation YouGov, Rishi 'The Brand' Sunak doesn't appear to be enjoying the same commanding lead among Conservative And Unionist Party members against their longstanding sweetheart Liz 'Surgical' Truss that he did among MPs in the Parliamentary knockout stages.
(Although other smaller pollsters read it less clearly.)
The rather more serious and respected Ipsos finds that The Brand's perceived advantage of electability is slipping in the public's view.
That poll also looks at public perceptions of how Keir Starmer's Labour would do on a range of issues, which make interesting reading. Ipsos director of politics Keiran Pedley observes that "the public are more likely to think a Starmer-led Labour government would reduce the cost of living and improve Britain’s public services – both key priorities for voters moving forward".
Nonetheless, promotional clips such as the above suggest that The Brand's awareness of CAUP members who might prefer to be treated like adults is perhaps not all that it might be.
The Brand's 10-point plan is also a masterpiece of random capitalisation:
The calibre of the leadership forums/debates is actually getting worse as the contest goes on: a remarkable achievement.
Isabel Hardman's summary of the latest in The Spectator is (as usual) worth reading.
Isabel reports that Liz 'Surgical' Truss "thought the NHS needed more money (while effectively pledging yet another reorganisation of the health service before the latest, enacted only in legislation this year, had any chance to bed in – something that will be costly both financially and to the ability of the service to get on with the job).
"Sunak was clear he didn’t think it should get any more cash, not even to deal with the squeeze caused by inflation and meeting the pay rises for staff from the existing budget.
"Truss then declined to say whether she would appoint Sunak as Health Secretary (he would be one of the first in its 74 year history to argue that the service didn’t need more money), but insisted she would appoint someone who was ‘really good’ (which doesn’t bode well for Steve Barclay)".
Inflation, inflation, inflation
The Institute for Fiscal Studies' Ben Zaranko's briefing on the impact of the current very high inflation on the public sector is a bracing read.
He notes of departmental spending plans that "higher inflation is expected to wipe out more than 40% of the planned real-terms increases. For the Department of Health and Social Care (DHSC), the planned growth rate drops from 4.3% to 2.9% ... plans for public service funding have become considerably less generous than originally intended".
Inflation has effectively cut spending on public services by £44 billion over the next three years.
Zaranko's conclusion is worth quoting in full: "choosing not to compensate departments for unexpectedly high cost pressures would be a deliberate decision to cut spending in real terms, at a time when many public services are showing signs of strain.
"An unfortunate series of global shocks have made us poorer as an energy- and food-importing nation. Dividing that economic pain between households, businesses and public services is the unavoidable and unpalatable task facing the next government.
"Choosing to accept a reduced range and quality of public services is one possible response to becoming a poorer nation. But if the next prime minister does choose to cut rates of corporation tax, National Insurance or income tax, and chooses to leave public services worse off heading into a difficult winter, they should be honest and transparent about the choice they have made". Amen.
There Will Be Blood (well, possibly)
The longstanding problems at NHS Blood And Transport burst into the wide open this week, with chief executive and alleged bully Betsy Bassis resigning on the eve of a damning CQC report into the organisation.
NHSBT's supply failures have been national as well as NHS news since December 2021.
The Alan comeback
Alan's quiet. Too quiet.
Recommended and required reading
George Stoye's new working paper for the Institute for Fiscal Studies on 'The distribution of doctor quality: evidence from cardiologists in England' is an important contribution.
I've never been very convinced by Norman Warner, as I said when reviewing his book for HSJ, but this contribution for the Social Market Foundation is quite sensible.
The ONS has published the latest Covid19 antibody and vaccination data by UK country and regions in England.
Fascinating analysis of just how badly Babylon Holdings' business is doing, and why (because they've become an insurer, working for a fixed price). See also Chris Salisbury's comments on trying to evaluate GP At Hand:
Decent and up-to-date mythbuster from the Kings Fund.
Ugly-looking private sector healthcare discrimination case at an Employment Tribunal.