Halfway through the opening episode of BBC’s Hospital this week, we see an orthopaedic surgeon stand in the middle of an empty operating theatre. It’s 8.30am and the surgeon – dressed in scrubs and ready to work – is forced to stop for the day: without enough intensive care beds, there’s nowhere for his patients to recover after surgery.
Filmed at two Nottingham hospitals this winter, this scene takes place a few days after the government announced all non-urgent operations would be cancelled across the country because of mass bed shortages.
Watching Hospital is a scary, surreal experience: a sort of shot-by-shot chronicle of what feels like something historians may later use as evidence of the decline of one of the world’s greatest social institutions.
I happened to be in A&E at Nottingham Queen’s Medical Centre with breathing problems while the series was being filmed. As I waited to be seen, A4 posters stuck to the doors told me of my right to choose to be filmed or not, while an elderly woman behind a screen in need of a catheter repeatedly called out for a member of staff to tell her where she was. I was relatively lucky: I had several tests fitted into six hours, and the medical team were kind and efficient. A few days later, as I recovered at home, a respiratory nurse told me: “If you need to call 999, do, even if you see on the news we’ve got no beds.”
It’s shameful this would ever need to be said – that in someone’s most vulnerable moment, they would have to calculate whether the NHS could help them. But then, this all feels quite shameful, doesn’t it? There’s a moment in Hospital in which a 12-year-old boy, Keilan, with a spinal curve so severe it’s reducing his lung capacity – is shown quietly asking if his major surgery to correct it will be postponed. It has already been cancelled twice. He has waited almost a year for the surgery – and he’s so anxious that his dad tells the doctor Keilan can’t sleep. “As time goes on, his curve has gone from 35 to 80 degrees in less than two years,” his dad explains.
This is what happens when a vital public service is vastly underfunded. Scared children. Ventilator and oxygen shortages. Ambulance delays. Even deaths. A study by the University of Oxford this month found there were an additional 10,000 deaths in the first six weeks of 2018, with the authors blaming “sustained underfunding” by the government. (This is a level of underfunding so severe that NHS England will have a “funding black hole” of £22bn by 2020-21.) The researchers added that if non-urgent operations hadn’t been cancelled this year, the number of deaths would probably have increased even further.
It’s somehow easy to forget that these are people’s lives – people who paid into the safety net, and presumably expected that in their time of need it would be there to catch them. It’s not as if this human cost is actually making economic sense – as if, on the nation’s spreadsheet, suffering is worthwhile if it makes enough savings. Rather, this scale of underfunding is costing a fortune – one cut in one system creates pressure on another.
In Hospital, we meet 87-year-old Mavis. Mavis has dementia, and is physically ready to be discharged from the ward, but because there’s no care home to take her to, she has been stuck in hospital for six weeks. The crass term for people like Mavis is “bed blockers” – and with an ageing population and cuts to social care system, it’s a sight we’ll surely be increasingly seeing. It cost Nottingham Trust £380 a day to keep Mavis in a hospital space she didn’t need before she was eventually found a place in a nursing home.
Meanwhile, research by the University College London this month found abuse is taking place in 99% of care homes across England due to what it calls chronic underfunding. Did the government not see this coming? I’m continually amazed by the enthusiasm for short-termist thinking among our current cohorts of ministers – a paradoxical, long-standing refusal to think about the long-term consequences.
Cut working age benefits and decimate social housing stock – and then pay out millions in temporary accommodation for homeless families. Gut child centres and school funding, while making low-income parents poorer – and watch costly child poverty soar, and expensive intervention services have to step in.
And here, with the NHS, cut preventive care and services such as meals on wheels, as well as obliterating social care funding – and watch as the underfunded NHS strains to pick up the pieces.
On Tuesday, Theresa May pledged to accelerate a long-term funding plan for the NHS after pressure to ditch the piecemeal increases provided since 2010, though she stopped short of saying how much more money this would involve. The Office for Budget Responsibility calculates that it would need an extra £20bn more than is currently planned to even begin to get funding back to the level the NHS received from its inception in 1948 until austerity measures began to starve the service in 2010.
“We’ve never had it this bad before,” the surgeon tells the camera in Hospital as the camera spans out to the empty, now useless, theatre. If this shortsighted underfunding continues, it’s hard not to feel that the real question is, how bad is it going to get?
Frances Ryan is a Guardian columnist
- This piece was amended on 29 March 2018, due to a rogue zero inflating the number of extra deaths in the first six weeks of 2018 by a factor of 10