Liz Truss and Rishi Sunak need a dose of realism on the NHS

The author James Baldwin once said that people can cope with almost anything once they know where reality is. Yet people are not being given a realistic account of what is happening in the health service and the pressure cooker it is working in. There is an ill wind in the lack of realism the government is allowing into public discourse about the challenges the NHS faces.

As Britain continues to swelter, and as emergency services battled wildfires and extreme heat to continue providing services across the country earlier this week, NHS staff are once again struggling to deal with day-to-day pressures in the middle of July that are worse than many mid-winter crises.

"People can cope with almost anything once they know where reality is"

James Baldwin

And let’s be clear, the challenges faced by the NHS are big. Austerity and underinvestment over the past decade have left over 105,000 staff vacancies at the last count, as well as crumbling buildings and an NHS estate ill-equipped to deal with 21st-century healthcare demands.

There is also now a huge gulf between the levels of patients’ healthcare needs and the capacity to efficiently provide for those, as well as a social care system in desperate need of repair and far from being fixed as the current prime minister would have us believe.

So as we wait to discover who will next lead our country, NHS leaders are urging the remaining candidates to level with the public. They want to see them come clean about the multiple burdens facing the health service and set out how they will support this most valuable of public institutions to ensure patients get the care they need.

We need both short-term targeted action and a long-term vision and clear road map

We need the government and future Prime Minister to be honest with the public about the scale of the challenge facing the NHS and social care, and to do away with the myths and political rhetoric. This must include a proper acknowledgement of where the lack of investment during the 2010s has left the NHS, and the huge gulf between levels of demand and capacity.

And if the health and social care levy, allocated to the NHS to support its recovery, is facing the axe, then this also means levelling with the public about the knock-on effect for reducing the waiting lists, for improving social care and generally making sure people get the standard of care they have every right to expect.

To properly navigate our way through these challenges we need both short-term targeted action and a long-term vision and clear road map which spells out how the future government will support the NHS to ensure patients get the care they need.

What the NHS and the public really need and truly deserve from politicians right now is a realism reset and a promise of honesty from now on.

We need them to do away with the myths and political rhetoric. We need them to admit that 40 new hospitals will not have been built by the next election and that social care has not been sorted and that instead our colleagues in social care are in desperate need of extra support. We need them to be candid and state that the NHS is not awash with money, as they would currently have us believe.

We can only build a bridge to that future if we are honest about where we are now

Soaring inflation and additional costs confirmed by new NHS Confederation analysis means that the health service is this year facing a real-terms cut in funding of anywhere between £4 billion and £9.4 billion, depending on which measure of inflation is used.

This is a far cry from the planned 3.8 per cent annual real terms increase in NHS funding up to 2024-25, outlined in the government’s spending review last October. Combined with ongoing covid costs, which are unlikely to subside any time soon, this means the NHS will have much less money to spend than the government continues to claim it has.

What this all really means is that we have very little resilience left to deal with crisis situations and the weight of patient need and public expectation.

Yet the thing is, it doesn’t have to be this way. It is only a decade since waiting lists were short and targets being met.

With the promise of innovation, the NHS can be part of a major improvement in our nation’s health. But we can only build a bridge to that future if we are honest about where we are now and what must be urgently done to get back on track.

NHS leaders stand ready to work with a new Prime Minister to address our immediate challenges. But we cannot build a bridge on delusions and lies.

Ultimately, we all want a brilliant NHS that ensures a healthy population and in turn a healthy economy. But for that wish to become real, we are going to need a serious dose of political honesty and for our political leaders to be brave enough to tell the truth. It is time for a reality reset on the NHS.

Matthew Taylor is chief executive of the NHS Confederation. You can follow Matthew on Twitter @FRSAMatthew

First published in The Times Red Box.