Now is the (earlier than usual) winter of our discontent

“The NHS’s winter crisis has begun early this year; it’s begun in August,” I saw a frazzled hospital doctor write the other day.

It’s an old joke, I realise, but nothing wrong with old jokes if they can still make you laugh as well as cry. The service has recently been lucky with milder winters, but luck runs out in the end, as David (who he?) Cameron can confirm.

Why has the foreboding mood of crisis suddenly intensified to the point where there is again talk of the NHS tottering on the cliff edge as it did in the pre-Blair 90s?

The 38 Degrees lobby’s shrewdly publicised research showed that NHS England’s 44 sustainability and transformation plans are close to completion (in theory) without the public being informed of cuts and closures ahead, also raising the collective blood pressure.  

Lifestyle problem

The blast from the King’s Fund and Nuffield Trust highlighted social care’s postcode lottery, as demand and resources move in opposite directions; hardly news.

But like the “Three H’s” of infrastructure – Hinkley, Heathrow and HS2 – it reminds us all of problems too long shelved.

In my family circle this month we are having a lot of medical activity. An old friend was mortified to have occupied an NHS bed for 10 days over what I will politely call a lifestyle problem.

Another, exhausted by two major operations (the elective one generated an emergency one on a Saturday night) at 75, fretted over summoning an ambulance when her husband felt chest pains near his stents at 3am.

Why has the foreboding mood of crisis suddenly intensified to the point where there is again talk of the NHS tottering on the cliff edge as it did in the pre-Blair 90s?

The paramedics did their stuff: a pulled muscle, not a heart attack.

Like my daughter-in-law’s imminent caesarian (the docs insist) it all cost money at a time when accumulated years of belt tightening take their toll.

So I am delighted to report that friends and family all say they received excellent treatment and warm care.

Lucky them. It isn’t always the case, is it? Another friend who moved from a well-run NHS hospital in the Midlands to nurse in London has been shocked by the harsh world of agency nursing in private hospitals. He’s not thrilled by management attitudes at his new NHS hospital either.

What assistance can NHS supremo Simon Stevens and his management teams at health HQ and their outposts expect from Theresa May and the political class as winter looms? Not a lot, I fear.

When NHS Providers’ point man, Chris Hopson, complained that trusts cannot guarantee standards on current funding levels (“something has to give”), the new home secretary, Amber Rudd, replied that Mr Stevens had asked for £10bn by 2020 and “we’ve delivered on that money”.

Rudd is smart, a fast-tracked May favourite, but inexperienced despite having the City PR guru, Roland Rudd, for a brother. Rudd may not know enough to realise that’s not really what’s been happening on the NHS money front.

Stevens does, but he plays the resourceful bureaucrat’s long game. As so often, the secretary of state is not noticeably visible, a tactic that has often served Jeremy Hunt well.

He seems to have seen off the junior hospital doctors’ poorly led militancy (as we predicted here), though at some long term cost to NHS cohesion. The row over his “11,000 avoidable weekend deaths” claim rumbles on like the Iraq war.

Far more effective in deflecting public anger away from the funding crisis, the Daily Mail has been running colourful extracts (précis?) from MP Margaret Hodge’s memoirs of her years as hawkish chair of the Commons public accounts committee.

Hunt seems to have seen off the junior hospital doctors though the row over his “11,000 avoidable weekend deaths” claim rumbles on like the Iraq war

The usual NHS targets, procurement, IT, outsourcing (take a bow, Serco) took the usual drubbing.

The senior executive salary roundabout? We should all flinch.

I wish I could report that health ministers are being held better to account by the other Jeremy. But on STP secrecy and rip-off prices being charged by cowboy firms buying up out-of-patent drugs, the 38 Degrees lobby, working with The Times, have done a better job than Labour in pricking Whitehall’s passive complacency. Hunt this week moved to close a loophole.

But the leadership civil war distracts Labour MPs from their day job. In August both Jeremy Corbyn and his rival, Owen Smith, laid out plans to stop “NHS privatisation” and/or “renationalise” the service (and pharmaceutical research too, Jeremy?).

Backbench rebels

That suggests neither remotely understands the issues beyond platitudes which were outdated when their health spokesman, Diane Abbott, was first elected in 1987.

As for paying for their promises, Westminster reporters are told “if they can borrow to rescue the banks, they can borrow to rescue the NHS.’’

Oh dear. Heidi Alexander, who resigned as Corbyn’s health spokeswoman, says he just can’t lead. So wake us up when those backbench rebels have found someone who can lead – and win.

Michael White is a former political editor of the Guardian