This winter NHS crisis was made in Downing Street

The NHS has been in the headlines for all the wrong reasons at the start of the year. Chronic underfunding by the government, and Prime Minister Theresa May’s inept refusal to bring forward a rescue package, have left health service staff and their patients under unprecedented pressure.

The refusal to pay the bills explains a large part of the challenge, but it’s not just about the money. It’s also because the Prime Minister doesn’t know what she’s doing with the health service—and doesn’t see it as a priority to understand the problems that are mounting up.

You’ve heard about the difficulties already. Ambulances being diverted and patients being treated in corridors. In December, 50 of 152 English hospital trusts called for urgent action to cope with demand in the run-up to Christmas; A&E departments have turned patients away more than 140 times; 15 hospitals ran out of beds in one day.

Almost a quarter of patients waited longer than four hours in A&E at the start of January, with just one hospital hitting its target. Since the start of December, hospitals have seen only 82.3 per cent of patients who attended A&E within the four-hour target. Health Secretary Jeremy Hunt’s local hospital, the Royal Surrey in Guildford, declared an alert after patients were left without beds and had to be treated in a gym instead.

But the government’s response has been one of utter complacency. Hunt said that things had been “falling over in a couple of places.” May told the Commons it was just a “small number of incidents.” Rather than confront the problems, Hunt’s response to the NHS crisis was to downgrade the four-hour A&E target. This is a startling admission of failure.

The Prime Minister says demand is greater than ever before, but doesn’t look for the reasons why. The NHS is experiencing the largest financial squeeze in its history and £4.6bn has been cut from social care provision since 2011. One in ten residential homes have closed since the Tories came to power and the total number of beds available in care homes has fallen by 19,490. It has got harder to see a GP, with up to one in four people waiting a week or more, or not getting an appointment at all.

A&Es are packed because cuts to other parts of the system have left patients with nowhere else to go. The truth is that this NHS crisis has been made in Downing Street. None of this is inevitable—it’s a political choice.

The top-down reorganisation in the 2012 Health and Social Care Act wasted billions that should have been spent on frontline care. Research by the Joseph Rowntree Foundation found that during the last parliament, social care spending fell by 14 per cent per person in the most deprived areas, but rose by 8 per cent per person in the least deprived areas. And now the government has chosen to refuse extra funding for health or social care.

It is clear that May doesn’t want to prioritise the NHS in the same way as David Cameron said he would. And while the government is consumed by Brexit, her refusal to engage with the health service means her decision-making has become increasingly questionable. By the end of first week of January, the government hadalready blamed Simon Stevens, the chief executive of NHS England, GPs and patients themselves for the crisis.

Blaming Stevens, who has publicly clashed with the government on funding, points to the root of the problem. Most people in the NHS are still mystified by reforms in the 2012 Act. The Tories spent three years pushing through changes that no one really understands and few think can be made to work. May and Hunt were in the cabinet throughout those years.

But having given NHS England a degree of independence from the government, No 10 now attacks its chief executive for speaking out. It seems the Prime Minister just doesn’t understand the reforms her own government pushed through. Ultimately, Simon Stevens is right—the health service needs more money and it needs to be spent in the right way too.

The Prime Minister could act now to ease some of the pressures. Labour is calling on the government to bring forward the £700m of social care funding planned for 2019/20 and to pledge a new funding settlement for health and social care in the budget in March. May’s honeymoon period can’t last forever. As standards for patients continue to deteriorate, it won’t be long before the incompetent handling of the NHS crisis is laid at her door.