How long would you wait?

By Grace Fletcher-Hackwood

So I’ve been thinking a lot about waiting lists just lately.

On Thursday I went to an event called ‘A Smith Institute Inquiry into the strengths and weaknesses of the NHS reform programme’, in Manchester Town Hall. Apparently the Smith Institute have held several of these and are going to be making a report, from the outcome of the discussions, and give it to Andrew Lansley, when he attends an institute event in London next month. (I imagine that’ll be worth going along to.)

I went along because, if I’m honest, I’m confused as hell about the NHS reforms. I don’t work in the NHS and, until Friday night when I cracked a tooth while eating chewy sweets, I hadn’t had to use it for a while. (I still haven’t. I’m scared of dentists. If there isn’t a post here from me next week, it’s because I’ve died of terror in a dentist’s chair, or just been murdered with a drill. I have dreams where this happens.)

In Julie Hilling MP’s office I’ve had hundreds of letters and emails about NHS reform. On Tuesday I had to tear up and rewrite my draft ‘update on NHS reforms’ letter when the screeching sound of the government’s U-turns hit me. Before that, a resident of Fallowfield – my Manchester council ward – got in touch with me because he had been referred to hospital for surgery in February and had now been told he could be waiting for treatment until October or longer. This is why I’ve been thinking a lot about waiting lists. He wanted to know whether the target of being treated within 18 weeks of seeing your GP still applied. His friend who works at the hospital where he was to be treated wasn’t sure. Neither was I.

NHS reform is, it seems to me, the new swine flu: the news and forecast changes every day and none of us are quite sure who to believe, how bad it is, how far it’s going to spread or how worried we should be.

So I went along on Thursday because I wanted to learn from the much more experienced and more qualified people in the room: John Healey was one speaker but so was the Charity Director of Age UK, Michelle Mitchell; and the discussion included health and social care professionals, representatives from unions, disability groups, local authorities around the North West and many others including, of course, the Socialist Health Association.

John Healey started by reiterating his description of the NHS reforms – including the ‘new’ Health Bill – as reforms we “didn’t want, didn’t need, and were promised we would not get.” No arguments there – unless he was arguing that the health service had not been in need of reform, in which case almost everyone present was keen to disagree. Andy Ramwell from the Manchester Institute of Sport and Physical Activity felt that the problem with the entire system is that the NHS is used to mop up failures elsewhere – with the obesity crisis, to use one example, apparently treated as both completely unexpected and entirely the responsibility of the health service to resolve.

This theme of integration of health with other services was the biggest area of consensus. It seems to me that the waiting list issue demonstrates more than just the public confusion over NHS reform: it also serves to highlight how the government is paying no attention to how its various reforms – and various cuts – are affecting one another.

The biggest issue here is social care – hence Age UK’s interest in NHS reform. Adult social care is not so much the elephant in the room as the elephant in the hospital bed, who can’t be sent home because the local authority can no longer afford to make the adjustments she needs to live independently in her elephant-house; or because the changes to welfare reform mean her carer can no longer afford to look after her full-time.

And as more of Britain’s most vulnerable people (although probably not many elephants) are reduced to ‘bed-blockers’, waiting times will continue to go up for people like the man in my ward, who I will call Aloysius. (His name isn’t really Aloysius. I think if you’re going to pick a pseudonym you should make it interesting.)

Aloysius has a job which involves a two-hour walk in every shift. In his current condition he can’t walk to the bus-stop around the corner from his house without stopping for a rest; even when he’s at home he is occasionally doubled up in pain. His employers assessed him and have said they wouldn’t allow him to come to work in that state, and of course his GP agrees; so he’s been on statutory sick pay since February.

At some point his SSP is going to run out and he’ll have to claim Employment Support Allowance; and then at some point he will be assessed by someone from ATOS, with the risk that they will decide he isn’t sick and stop his income.

Because he isn’t sick. He needs surgery and a couple of weeks to recover, and then he needs, and desperately wants, to go back to work, because sitting at home all day taking tramadol is depressing the hell out of him.

If the government genuinely wants to stop paying sickness benefits to people who could be in work, sorting out waiting lists for non-acute surgery would be a hell of a cleverer way of going about it than to continually up the macho posturing (started under the last government) against people who cannot work.

And if they’re serious about sorting out waiting lists – and dealing with the scandal of adult social care – they need to get serious about incorporating social care in the NHS. That’s not something that necessitates ripping up our health service and starting again – it certainly doesn’t invite exposing healthcare to competition law. And maybe that’s why it’s not happened so far – John Healey admitted on Thursday that when it comes to the NHS, politicians of all colours can be ‘too ready to reorganise’.

But it needs doing. The National Care Service that was in Labour’s 2010 manifesto was a good idea that came massively too late – but the problems of care are part of the problems of healthcare, and vice versa. We need an integration of care services within the NHS: for our wasted workforce stuck on growing waiting lists, for our aging population, and for every vulnerable person and every carer, let down by successive governments time and time again.