The NHS is a political minefield for all sides
David Cameron’s decision not to put the NHS in his top six election priorities, having placed it number one in the previous election, is either a political masterstroke or an act of gross ineptitude to rival the Health and Social Care Act itself. The masterstroke argument is that the NHS should be depoliticised. Andrew Lansley’s vision for his reforms was that he would become the serene Secretary of State for public health, with day-to-day running of the service devolved to NHS England, Clinical Commissioning Groups and Foundation Trusts. The Health Secretary would no longer be accountable or responsible for, the unfortunate shortcomings of the service even in the countdown to an election. Lansley’s replacement Jeremy Hunt has rather scuppered this plan by being one of the most interfering health secretaries in history. He knows where the buck stops.
The idea that you could put £110 billion worth of taxpayers money into a service not be held accountable for it was always laughable, but politicians on both sides have at least united around the ‘five-year forward view’ of NHS England’s chief executive Simon ‘the Messiah’ Stevens. After five years of flat-line funding in the NHS and large cuts in social care, the NHS has hit a wall but Stevens believes that the further £30 billion black hole in its finances can be plugged with another £22 billion worth of efficiency savings and an extra £8 billion stretched out over five years. £8 billion out of a five-year budget of £550 billion is a 1.5% increase, less than half of what Margaret Thatcher put into the NHS when she was accused of savage cuts. The current lack of hospital beds, social care, GP access and emergency department staff, combined with a frailer, ageing population and poor public health, makes the plan to keep the NHS afloat with a further £22 billion worth of savings sound like a sick joke. Far more sensible to scrap Trident and keep us alive now, rather than save up for Armageddon. No wonder Cameron wants the Green Party with him in the TV debates.
The Government’s immediate problem is that the NHS polls high on voters list of priorities and many of its current problems were made worse by its political interference. Labour too would have had to enforce flat-line funding bit without the pointless and destabilising structural upheaval of the Health and Social Care Act. Lansley argued he was merely building on Blair’s marketization agenda, but Labour’s PFI delivered shocking value and unsustainable debt for many hospital building projects, and franchising whole services and even hospitals out to the private sector is often doomed to failure because there is simply no profit to be made. As MD (and countless others) pointed out, Circle could never deliver its proposed savings at Hinchingbrooke Hospital or any profit without being able to cherry pick services (Eye 1374). 80% of NHS trusts are in debt and Circle is just a very loud canary in the mine.
The only surprise at Circle’s pull-out was quite how bad its Care Quality Commission’s report was1. To receive the CQC’s worst ever rating for ‘caring’ was truly shocking and a reminder of the dangers of pursuit of profit in healthcare when there was never any profit to be made in an area overpopulated with struggling DGHs. If the NHS was just a large collection of independent businesses, emergency departments would be welcoming customers with open arms rather than begging them to shop elsewhere. If money truly followed patients, the unprecedented demand that did for Circle would have saved it. Supermarkets would die for unprecedented demand.
The NHS uses the private sector a lot is some areas. The Priory Group of psychiatric hospitals and services does 80% of its work in the NHS, even operating in Scotland where private provision is even less welcome than England. NHS psychiatric services simply don’t have the funding and capacity to cope, but the Priory Group can only take on the extra work if there is money in it. Two patients with Alzheimer’s disease may have very similar needs but if one is classed as social needs, and one as medical needs, the former attracts a fraction of the funding and gets much less care, either from the state or the private sector in England.
In a hugely complex, inter-related debt-ridden system like the NHS, selling off services and outsourcing rarely works. It causes fragmentation when health and social care need to be joined up. The 111 out of hours service is another unnecessary political reform that has made the service more disjointed and less safe (Eyes 1340, 1346). The vast majority of the extra 400,000 casualty attendees this financial year have been sent their by 111. But where else can they go? Cameron’s desire to step back from the NHS debate is understandable but Labour has plenty of NHS skeletons in the cupboard too (PFI debt, marketization, targets uber alles, selling off out of hours care, Mid Staffs, the burying of bad news and brutal suppression of whistle-blowers). Shadow heath secretary Andy Burnham has his blind spots, and Ed Miliband’s plan to ‘weaponise’ the NHS may well backfire.