only 85% of emergency-department visitors were seen within four hours, against a
target of 95%.
The reality of the NHS is very different from popular perception. It is good at keeping
costs down; England spends less than the rich-world average on health care. But it also
produces middling to poor health outcomes on many measures, including deaths within
a month of a heart attack, or within five years of being diagnosed with various cancers.
This historical stinginess will cause problems in 2021. The government has given the
NHS an injection of cash to do things like paying for the use of beds in private hospitals.
But as an analysis by the Nuffield Trust, a health think-tank, notes, England has less
capacity than most other rich countries. Many hospitals are decrepit, lacking single-
occupancy rooms and the sort of open common areas helpful when keeping patients
apart.
As one of the world’s biggest bureaucracies, the NHS is normally cumbersome. Yet it
displayed a rare agility when covid-19 struck, transforming overnight to a single-
minded focus on the pandemic. Now the task is to try to capture efficiencies revealed by
this transformation. For years, ministers tried to get doctors to embrace digital
technology. The need to minimise the risk of infection means that 44% of family-doctor
consultations now happen by phone or online. Matt Hancock, the health secretary, has
said there will be no going back.
Yet these changes can only make so much difference. The need for personal protective
equipment and clean rooms reduces the number of patients who can be seen in a day.
Lots of treatment was paused during the worst of the pandemic. Even in the summer,
during a lull in covid-19 cases, the number of elective in-patient treatments was still
below half the pre-pandemic level, and the number of diagnostic tests were at three-
quarters of the normal level.
The result will be long queues for treatment. By August 111,026 people had been on
waiting lists for longer than a year, compared with 1,643 in January 2020. Some 2m had
been waiting longer than 18 weeks. At first, there was little outcry, with people seeing
queues as a cost of covid-19. But patience has its limits. Politicians will funnel extra cash
to the NHS, but will also seek greater control over what it does, to be quicker to respond
to disquiet. Above all, their aim will be to avoid the charge of betraying Britain’s beloved
health service.
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