Firstly, may I wish you a happy and healthy New Year.

The new year appears to be fraught with difficulty - strikes, inflation, energy costs, mortgage interest hikes and migration, to name but a few.

In particular, however, I wanted to ask you about the NHS and the extreme delays which we are seeing at A & E. The best estimates tell us that the delays in treatment are causing 300 to 500 unnecessary deaths each week.

According to interviews with senior members of the medical profession, the difficulty is mainly a simple lack of beds. In this country we have approximately 2.5 beds per 1,000 members of the population. In France, they have around 5.75 per 1,000 members and in Germany 7.8. Of course, this lack of beds is compounded by the fact that, of the beds we have, many are occupied by people (mainly elderly) who are fit enough to be discharged.

According to NHS England, 13,364 people who were fit for discharge were nonetheless in a hospital bed at the end of November 2022, up a quarter on the same time in 2021. And the situation has since deteriorated. Their discharge, however, depends on there being either a care package in place which could allow their transfer back to their own homes, or the money to allow the payment to care homes able to provide the level of care required to allow their discharge.

According to the Association of Directors of Adult Social Services (ADASS), however, 81,000 people had been waiting for an assessment of their needs for at least six months as of August 2022, almost double the number in November 2021. Some of these are at home, but a significant proportion of them are spending their waiting time in hospital beds. Rising numbers of social worker vacancies in councils are amongst the reasons for this.

As well as the obvious delays in the assessments needed for care packages there is and has been for a long time a lack of funds to enable care to be provided. Which takes us to the question of one of the main cost elements - the amount paid to care workers.

Often they are paid at or only slightly above the minimum wage and so there is a shortage of people willing to do what is demanding and skilled work. This is a result of the limits on the funding provided for Local Authorities to be able to pay for social care.  The median hourly wage for independent sector care staff was £9.50 as of March 2022, below over 80% of all job roles in the economy. When we hear of care workers leaving the sector for better paid jobs stacking shelves, then clearly something has gone very wrong.

You will no doubt tell me that Jeremy Hunt as Chancellor of the Exchequer announced in his Autumn statement that another £7.5 billion was being put into the care service over the next two years: so then £3.75 billion per year. That however is only slightly more than half of the extra £7 billion per year that the same Jeremy Hunt had said the sector needed when occupying his previous role as chair of the 'Health and Social Care Select Committee'.

So then, the question is what steps are going to be taken to deal with what can, without exaggeration, be called a crisis. And it is worth pointing out that although we have seen a number of governments since 2015, particularly last year, they have all been Conservative, with a Tory/LibDem coalition for the previous 5 years. So then your party has been in charge for a very long time.

I await your explanation of why we are in this situation and your proposed solution to what is an obvious long-term failure of governance, one now requiring immediate attention.

Kind regards,

Paul Buckingham

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