New waiting list targets will achieve nothing if the government refuses to commit to workforce planning People in the waiting room at Milton Keynes University hospital in England. ‘The problems in the NHS of under-resourcing and lack of long-term planning predate Covid.’ Photograph: Hannah McKay Mon 7 Feb 2022 19.12 GMT 217 The NHS has some catching up to do. With 6 million people in England currently on waiting lists, and another 1.5 million in Northern Ireland, Scotland and Wales, the mismatch between demand and supply in the health system is one of the most serious problems facing the country. This means it is also one of the biggest challenges for ministers, who know that NHS delays, and the problems including deaths that these cause, will be a huge issue – perhaps the single biggest issue – in the next general election. So it is no wonder that the government is trying to force NHS England’s bosses to fix the problem quickly. Publication of a recovery plan for elective (non-emergency) hospital treatment has already been delayed once. Over the weekend it emerged that a sticking point in negotiations is the deadline that will be imposed for reducing waiting times. Waits of more than two years will have been dealt with by the end of March. But ministers’ demand that waits of more than one year should also be eliminated by March 2024 has met with resistance. That is because the length of time that a person has been waiting is not an indication of their level of need. And if people who have been waiting for a long time for non-urgent treatment are prioritised, then those who are more ill but have been slower to come forward will suffer. Advertisement The extent of the delays is nothing short of a scandal. Being told that you may have cancer is highly distressing; the two-week maximum waiting time for patients in these circumstances to see an oncologist exists for a reason. For half-a-million people in England to have waited longer than this, as new research suggests that they have done over the past year, is a sign of a brewing crisis. So are lengthy queues for operations such as hip replacements, which have left thousands of people who ought to have been fitted with new joints trapped in pain and disability. But the NHS is right to push back against unrealistic commitments. Political expediency must not be allowed to trump clinical judgments. And ministers must be prevented from passing the buck, and blame for departmental mistakes, to the NHS. The pandemic has dramatically worsened conditions on the ground, putting unprecedented pressure on primary care and hospitals. But the problems of under-resourcing and lack of long-term planning predate Covid. A health and social care workforce strategy was promised in 2019, as an adjunct to a long-term plan that placed staffing front and centre. But the work done in this area by Dido Harding at NHS Improvement was feeble, and the plan is yet to arrive. An amendment to the health and care bill proposed by Jeremy Hunt, who chairs the health select committee, would have increased transparency by requiring regular updates on vacancies and training places – but the government voted it down in November. Labour should maximise pressure on this point and others, both in the House of Lords and when the bill returns to the Commons. The truth is that Tory resistance to forward planning, as well as insufficient spending, lies at the heart of the NHS’s difficulties. With 100,000 job vacancies, and worrying reports about burnout among staff, Sajid Javid and his colleagues should be listening carefully to health bosses. Instead, they combine a high-handed approach to NHS management with over-enthusiasm for big business – as was illustrated by Mr Javid’s recent decision to force through a deal with the private sector despite warnings about costs. Overall, the conduct of the government suggests that the problems of most interest to it are not those facing the NHS. They are the problems facing ministers and their party.