Government needs to get an urgent grip on healthcare crisis while we still have a service left to rescue, says Joseph Kelly

As the British winter starts to get a grip, our hard-pressed and under-resourced NHS is not only confronting its usual seasonal upswing, but an unprecedented logistical challenge caused by the Covid pandemic and its fallout.

This once-in-a-century pandemic has not only decimated our public health structures and their finances, but it has left a large percentage of the population with inexplicably severe and long-term ailments that is placing impossible pressures on the NHS.

It’s only late November and already we’re hearing worrying distress signals from within the NHS. Just today the Association of Ambulance Chief Executives (AACE) has reported that ambulance crews are facing crippling delays when they arrive at A&E with sick patients. Over the past week one in three ambulances have had to queue on arrival, and this waiting in turn impacts on the availability of ambulances and crews to respond to emergencies.

An analysis by AACE of its own data for ambulance delays during October has shown that some 44,000 patients may have come to harm because of the delays, and health chiefs are issuing a blunt warning that people are going to die this winter because ambulances and emergency staff either won’t be able to reach them in time, or get them offloaded and into medical care quickly enough.

Whilst the ambulance problem is desperate enough, this actually points to a far greater healthcare crisis behind the front lines. Alongside the unacceptable delays in 999 and A&E departments, one in ten hospital medical posts are unfilled, and it is reckoned that more than 500,000 people are now waiting for council-funded care. As to the number of us waiting for non-urgent and routine hospital treatments, the numbers have simply gone off the graph.

With winter closing in, rising Covid cases, flu hospitalisations and the backlog in treatments is not only putting increasing numbers of the public at risk of a fatality, it’s utterly demoralising for our healthcare workers. Understandably many of those who we clapped for enthusiastically from our doorsteps for putting their own health, families and safety at risk during the pandemic now feel they have been abandoned.

In much the same way that our government sleep-walked its way into the pandemic, and systematically responded with too little, too late, the end of the first Covid wave saw ministers all but abandon strategies and caution. Given the enormous amounts of money that were thrown at public health awareness campaigns such as “hands, face, space” (remember that?), the minute the infection graph was obviously dropping the podiums and the daily briefings were dumped and the sanitisers and face masks started disappearing from our supermarket shelves.

Prior to the pandemic the then Prime Minister Boris Johnson made no secret of the fact that he favoured the ‘herd instinct’ approach to what was coming, which was if nothing else an inexpensive and easily managed strategy. Others, it seems, spotted PPE contract and vaccine opportunities, so off we went on a public health debacle that caused more than 150,000 deaths, national family trauma, and an incalculable legacy of Covid-consequental health problems.

Excuses for the catastrophe have been legion, and the desperate wallpapering of the current deepening NHS crisis only confirms that our latest government is itself joining a long queue – of legislators who have ducked the whole issue of how our NHS is run and funded. At the core of this historic under-investment is a fundamental misunderstanding of the nature of a national, paid-for health system.

We know of course that successive Tory governments have viewed the NHS purely through the narrow window of free market economics, reducing its function to that of a complex, cost-heavy business, where sustainability is only achieved through cutting staff costs and people-focussed investment.

But some things are simply not intended to be an exercise in profitability, and isn’t that why we all pay taxes?

If you look under the surface of any major urban hospital you will see a curious irony – there are numerous examples of blatant inefficiencies and duplications, of unnecessary job roles and wasted hours, but set against this you’ll speak to a collection of highly diverse and immeasurably talented individuals with a quite unique and powerful, personal commitment to the betterment of the human race.

Of course everyone knows this, it’s what government ministers bang on about all the time, yet no-one seems capable of resolving what is actually one of the simplest economic problems to resolve – placing the resources needed in the hands of those people who can make best use of them.

At the root of this problem is a chasmic gulf between those business strategists who currently run the NHS, and the people who save lives. The health system is awash with managers and administrators, spread across numerous trusts, health boards and regions with little or no co-ordination between them, and a decision-making process that is desperately inadequate.

Of all the businesses and organisations I’ve dealt with over the years, none suffers more from the ‘pyramid of incompetence’ than the NHS. Those in senior positions have tended to recognise and promote lesser, and less threatening, reflections of themselves, which creates a time-progression of ever-less talented individuals moving up the promotion ladder until you have an organisation with the least talented and least visionary and radical at the top, and the most useful and potentially transformative people right down at the bottom.

The ultimate incarnation of the ‘pyramid of incompetence’ is that those critical to saving a business actually get driven out altogether, leaving the edifice to function purely for the purposes of self-interest, rather than any greater good.

It’s probably beyond the wit of most of those involved currently, but the NHS could be transformed quite quickly and efficiently into the kind of institution Aneurin Bevan dreamt of if something resembling the Catholic principles of subsidiary and preferential option for the poor were put in place.

Reversing the pyramid and rebuilding our NHS from the bottom up, starting with a commitment to public service and the needs of medical staff to be able to do their jobs, would actually not only resolve the current public health emergency, but would also gradually resolve the organisation’s financial woes. As spending became focussed on immediate priorities and far more responsive to the demographics of healthcare needs, budgets simply would not stretch to the kind of inefficiencies that are currently crippling the service.

That’s a solution, but it would require legislators to see frontline health workers as far more than just tokens of political propaganda, rather as the prime means to resolve the present financial difficulties of the NHS. It would also require them to take a far more active stewardship of a service that they probably use very rarely, but is of critical importance to the wider and far less wealthy public.

Joseph Kelly is a writer and political theologian, and is founder of