Hospitals are under such extreme pressure that they are in a state of “war”, a key government adviser on the NHS has admitted, in a frank assessment of the health service’s deepening crisis.

Patrick Carter, who advises the health secretary, Jeremy Hunt, on NHS efficiency, warned that the service, which has just posted its worst ever performance on A&E, cancer and other waiting times, is facing “a very, very difficult” time operationally and financially until 2020.

In a speech to leading doctors, Lord Carter said: “We need to be incredibly proud that our hospitals are running so hot, and yet they haven’t broken. It’s a staggering achievement. This is like being [in] a war actually and we should be extraordinarily proud of it. But you can’t continue on a war basis forever, as we know.”

Carter also said that an England-wide ban on what he called a “colossal” number of non-urgent operations, such as hip replacements, in December and January, designed to help avoid an NHS winter crisis, had been wrong, had forced surgeons to “remain idle” and had handed to private health firms £1bn that cash-strapped hospitals needed to stabilise their perilous finances.

“I don’t know how many of you have had elective surgery cancelled since before Christmas. My own sense, when I look at the numbers, [is] it’s absolutely colossal,” Carter told the Royal College of Anaesthetists’ annual dinner on Tuesday.

“If we aren’t doing the electives, how do we make the hospital budgets stack? It’s a nightmare. Idle theatres. Idle surgeons. Idle clinicians. Idle anaesthetists. I mean it just isn’t right”, added Carter.

He is also a non-executive director of NHS Improvement, the financial regulator that issued the edict he criticised so heavily, which told hospitals to cancel planned surgery from 16 December to 19 January.

Carter, a Labour peer, has undertaken a series of reviews of challenging and costly issues since 2002 for Tony Blair, Gordon Brown and David Cameron’s governments. They have included criminal records, legal aid, Wembley Stadium and NHS pathology services. Hunt is trying to achieve £5bn a year of NHS efficiency savings identified by Carter in 2015.

Theresa May's decision to squeeze health funding this winter has caused chaos and misery for patients Jonathan Ashworth, shadow health secretary

Carter also warned that the NHS “is going to face a very, very difficult three years” between now and 2020. It is unlikely, on current prospects, to get any extra money, despite growing concern that it risks falling over unless it receives an emergency cash injection, he said.

“Last year we spent £120bn on the NHS. That’s the equivalent of the whole of VAT collected in England. Now the Treasury takes a view that if they gave us another million or two we’d just swallow it up, as we have in the past, and we would not actually materially make a difference and we would stand there saying ‘more money, more money, more money’.”

Labour seized on Carter’s comments. “Even the government’s own health advisers are now saying that austerity for the NHS has gone on too long and is creating war-like conditions for patients,” said Jonathan Ashworth, the shadow health secretary.

“Yet again we are warned of the NHS crisis this winter in the most astounding of terms. What’s more, for it to come from a government adviser is quite simply staggering. It’s now blindingly obvious to everyone – other than ministers – that Theresa May’s decision to squeeze health funding this winter has caused chaos and misery for patients, who are having to wait longer than ever for basic services,” he added.

His comments come as the latest official figures showed that NHS performance was the worst ever against most of its waiting-time targets in December, just as the service’s winter crisis was beginning.

For example, a total of 25,157 people during 2016 had to wait more than the supposed maximum of two months after referral by their GP to start urgent cancer treatment – the highest number on record, and more than the 23,760 seen in 2015 and 13,191 seen in 2010.

Similarly, just 86.2% of A&E patients were treated and admitted, transferred or discharged within four hours – the lowest proportion since records began in 2004.

Ambulances breached waiting-time targets to respond to the most seriously life-threatening of 999 calls by the widest margin ever. Crews responded to just 66.4% of Red 1 calls within eight minutes, when someone is not breathing or has had a cardiac arrest, when it should be at least 75%. And they reached only 58.8% of Red 2 calls within the required eight minutes, for which the target is also 75%. These involve fits, strokes and other life-threatening incidents.

The percentage of patients given hospital treatment within 18 weeks has also fallen below 90% for the first time since March 2011. And the number of hospital bed days taken up by patients who are fit to leave – “delayed transfers of care” – hit 195,286 in December, another record.

Carter lavished praise on the NHS and urged people to “talk the service up rather than down”. He also cast doubt on whether the sustainability and transformation plans (STPs) of NHS England boss Simon Stevens would transform care as much as promised, and said rationalisation of specialist hospital units, as many of the 44 STP plans envisage, was necessary but “politically extremely difficult”.



The Department of Health declined to comment directly on Carter’s views, despite a request to do so. A spokeswoman said only that: “Despite the pressures of winter, more than 54,000 people were seen within four hours in A&E every day during December. Rescheduling operations to free up space for other patients was a clinical decision made by medical experts.”

Jim Mackey, NHS Improvement’s chief executive, said: “Our hospitals have never seen this level of demand and it is causing real problems for them. Despite this, the NHS continues to outperform health systems in other major nations.

“Such intense pressure on emergency services has had a real impact on elective services and patients are having to wait longer for non-emergency treatment, and this is also adding to the financial pressures being felt by NHS providers.”