Damage limitation

Which party would do least damage to the NHS? The Coalition has increased NHS funding by 0.9% a year in the last five years, when the previous average increase has been 4% a year. Unsurprisingly, given the cuts in social care, many services are now hideously overstretched. In England 3 million people are now waiting to see a specialist with 250,000 more patients needing treatment who are not on the official waiting list. But had Labour won in 2011, it seems unlikely they would have been able to fund the NHS any more generously given the economic circumstances.

The Coalition’s biggest error has been the Health and Social Care Act, not just because it destroyed trust in breaking a key pledge not to have a massive structural reorganisation of the NHS, but because it has lead to a rapid expansion of the role of commercial companies in the NHS. Outsourcing is rarely the answer to anything, and the record in the NHS thus far is woeful. Many of Labour’s early PFI schemes for hospital development have been eye-wateringly expensive, with some trusts lumbered with payback fees more than ten times the original build cost. The withdrawal of NHS services provided by Circle, Serco, UnitedHealth and other private companies when they have been unable to make a profit has not stopped vital clinical services being put out to tender. Excellent, well-established NHS sexual health services have lost out to private contractors and Virgin Care has just won a £280 million contract to provide care for the elderly and those with long term conditions in East Staffordshire (Eye last), with £1.2 billion of specialist cancer care also up for grabs.

The danger for patients of outsourcing the NHS is not just that services may disappear if they can’t be made to be profitable, but also that services may not be of a high standard if staff don’t want to work for private providers. Nottingham University Hospitals NHS Trust has had to stop its acute adult dermatology service after senior consultants left when the contract was awarded to the Circle Partnership. The consultants had made it very clear well in advance that they would not work for a private company and with so many consultant dermatology jobs in the NHS remaining unfilled, they will find it easy to secure work elsewhere.

This would be excellent ammunition for Labour, had they not started it all. And the reopening of GMC case into Dame Barbara Hakin is a timely reminder of the idiotic top-down ‘targets uber alles’ enforcement that existed under Labour (as well as the incompetent tardiness of the GMC). MD and Eye journalist Andrew Bousfield referred Dr Hakin to the GMC in in July 2012 to investigate if she put patients at risk in her role as CEO of the former East Midlands Strategic Health Authority by insisting non urgent targets be met when Gary Walker, the then chief executive of United Lincolnshire Healthcare Trust, told her that the hospital was so overcrowded that it would not be safe to adopt such an approach.

In October 2014 – 27 months after the original referral – the GMC decided not to take any action against Dr Hakin. MD and Mr Bousfield were so appalled at the failure of the GMC to grasp the basics of patient safety, particularly in the light of the disastrous effects that the mandatory target culture, over-crowding and under-staffing had on Mid Staffordshire hospital – that we mounted a detailed challenge of the GMC decision on January 6, 2014. On April 1 (sic) 2015 – nearly 3 years after the original referral – we were informed that the GMC will be undertaking a review of the ‘patient safety’ aspects of the original complaint because the original review “may have been materially flawed” and that a “review is necessary for the protection of the public or otherwise necessary in the public interest.” MD is almost certain that the GMC will take no action against Dr Hakin who says she was following the orders of her chief executive (Sir David Nicholson) and the Labour government. But whoever is in charge of the NHS on May 10 needs a far more intelligent, compassionate, honest and collaborative approach to patient safety – and a change in culture that is entirely alien to adversarial party politics. The omens are not good.

The most sensible, sustainable evidence-based NHS policy is from the National Health Action Party

MD’s best-selling book – ‘Staying Alive – How to Get the Best from the NHS’ is available here

Dementia Time Bomb

David Cameron’s reluctance to contest a third term or talk about the NHS is entirely understandable given the state it’s likely to be in whenever he leaves office. Last week, the Kings Fund reported that performance has regressed to 1990’s levels. NHS funding needs to increase year on year not just because people are living longer, but because they are living longer with multiple diseases, and particularly dementia. When the NHS was founded in 1948, half the population didn’t make it to 65. Now one in three people in the UK are likely to live to a hundred, and the person who lives to 150 may already have been born.

Between 1948 and 2011, NHS annual funding growth averaged 4%. From 2011-2015 it was 0.9%, and the target growth 2015-2020 is 1.5%. If Cameron wins the election, and even if he loses, the NHS is likely to be stretched beyond repair in five years. NHS England gets very excited about the efficiency savings from new models of working (Vanguard locality commissioning has now replaced GP Pathfinder commissioning on the bullshit bingo cards), but the biggest challenges to the NHS remain inequality, poor self-care and frailty. The difference in disability-free life expectancy at birth between the richest and poorest parts of the UK is nearly 20 years. A quarter of the population (over 15 million people) have a long-term condition such as diabetes, depression or dementia– and they account for 50 percent of all GP appointments and 70 percent of days in a hospital bed.

The number of older people likely to require care is predicted to rise by over 60 percent by 2030. And yet local authority spending on social care for older people has fallen in real terms by 17 per cent during Cameron’s first term. In that time, the number of older people aged 85 and over rose by almost 9 per cent. The number of people able to get publicly funded social care has fallen by 25 per cent since 2009 (from 1.7 million to 1.3 million) and in 90 per cent of local authorities only those with ‘substantial’ or ‘critical’ needs get publicly funded services.

The buck at present stops with unpaid often elderly carers. 32 percent of carers aged 65 to 74 are providing 50 or more hours of unpaid care a week, and 55 percent of carers aged 85 and over – many of whom are in bad health themselves. The number of carers aged 65 and over has risen by 35 percent since 2001 to 1.2 million, and 90,000 are over 85. For dementia alone, there are currently 850,000 people in the UK who have been diagnosed, costing the UK £26 billion a year. Two-thirds (£17.4 billion) of the cost of dementia is paid by patients and their families, either in unpaid care (£11.6 billion) or in paying for private social care. This is in contrast to other conditions, such as heart disease and cancer, where the NHS provides care that is free at the point of use.

The King’s Fund predicts that the financial cost of dementia in England will rise from £14.8 billion in 2007 to £34.8 billion in 2026. Research suggests that this cost could be significantly reduced by improvements in diagnosis, treatment and support for people with dementia and their carers to help avoid future admissions and improve clinical management. However, that would require a substantial investment in services. Currently only 43% with the condition get a diagnosis, and so 57% are denied the treatment and support they need.

By the age of 80 about one in six of us will have dementia, and one in three people in the UK will have dementia by the time they die. It is a progressive condition that gets worse over time and sufferers increasingly rely on carers as it advances. There is currently no cure although there are treatments that can slow the progression of some types of the condition in some cases. Usually, only about one in three people show a positive response to such drugs. The longer we live, the more of us will get dementia and – for all the government’s focus on the illness – the NHS and social care system simply doesn’t have the funds to care for those most in need, and it’s going to get a lot worse. No wonder Cameron – who put the NHS centre stage 5 years ago – doesn’t want to hang around to see it.

MD’s book – ‘Staying Alive – How to Get the Best from the NHS’ is published by Quercus

The GMC wrote to me and others on 1 April 2015 stating it will be undertaking a review of the ‘patient safety’ aspects of the complaint against Dr Barbara Hakin in her role as chief executive of the former East Midlands Strategic Health Authority because the original review “may have been materially flawed” and that a “review is necessary for the protection of the public or otherwise necessary in the public interest.”

The complaint was made by Andrew Bousfield and myself on 19/7/2012. Here is the letter of response to the GMC from Gary Walker, the former NHS trust chief executive and NHS whistle-blower, whose career was destroyed in the process of raising legitimate patient safety concerns. He has not been able to secure another NHS post since. His letter outlines serious failings in the GMC investigation.

Letter to the GMC re Dr Hakin case