Hunt Rides Again (Again)

The parlous state of the NHS and social care came top, or nearly top, of many ‘voter issues’ polls but Theresa May has again decided on more of the same, reappointing Jeremy Hunt as health secretary to force through £22 billion efficiency savings while the Brexit chaos plays out. The NHS is currently 7 years into the most austere decade in its history. Demand rises at 4% per year and yet there is ‘negative real per capita growth’ (i.e. funding cuts) planned for 2018/19 and 2019/20. Cuts in adult social care have already left half a million fewer people with publicly funded social care now compared to five years ago, and many are having to use the NHS as a safety net. To balance the books, the NHS will simply have to provide less for less. Longer waiting times to see a GP and get hospital treatment, longer journey times as local services are closed and some treatments not available at all. And the levels of work-related stress amongst staff will simply keep rising.

The required £22 billion savings could come in part from selling off idle NHS buildings and land to property developers. Otherwise it’s down to Sustainability and Transformation Plans, many of which are looking about as sustainable as Theresa May. Ex Labour health secretary Patricia ‘Hire Me’ Hewitt – whose own austerity program helped sink Mid Staffs – is to chair Norfolk and Waveney sustainability and transformation partnership, ‘amid concerns about its progress and credibility.’ Meanwhile, the private outsourcing of community services continues apace in the hope that the likes of Virgin can run them more efficiently and safely (they can’t). The closing of local services means patients having to travel further, and the new Health Service Investigation Branch is looking at ‘systemic failings in NHS patient transfers’ following the death of a cardiac patient. The Royal College of Obstetrics and Gynaecology has an Each Baby Counts programme to reduce the 500-800 deaths each year caused by ‘something going wrong in labour.’ In 2015, 550 babies might have lived with better care, but only 34% of reviews into the deaths invited parents and families to be involved.

This pervading culture of secrecy and cover up is strongly illustrated by the long standing and deeply unethical behaviour of Birmingham breast surgeon Ian Paterson who – in full sight of colleagues, private and NHS employers, commissioners and regulators – went completely rogue with his cancer surgery, causing widespread harm and contributing to death where tumours were inadequately removed. Despite the horrors of Bristol, Shipman and Mid Staffs, Paterson proves once again how little the NHS has learned. Some staff did blow the whistle, many should have done more, but no one stepped in quickly to stop a narcissistic liar and bully who was clearly diverting wildly from the accepted guidelines for managing breast cancer. And this may not be an isolated example. A urologist who worked at the same trust (Heart of England Foundation Trust) is under investigation for off-piste prostate cancer treatment for hundreds of patients. Hunt has ordered an inquiry into Paterson which would normally be overseen by NHS England Medical Director Sir Bruce Keogh. However, Keogh’s wife Ann has been Director of Medical Safety at HEFT for a decade, and if will be interesting to hear if she tried to raise concerns with her husband, as well as her colleagues.

Given the scale of the avoidable harm and failure to act on it, the inquiry should be public, particularly given Jeremy Hunt’s promise of ‘no more NHS cover ups’ and to make the NHS ‘the safest and most compassionate health service in the world’. The roots of the scandal will be horribly familiar. Inadequate management trying to stay afloat in the face of prolonged underfunding, focusing on reducing the debt and pleasing the regulators and Treasury rather than investigating serious and obvious malpractice. There will be bullying of those who spoke up or refused to ‘fall into line’. Safety systems will have failed again. The regulators were complicit in failing to act. They had regular meetings with HEFT during Paterson’s worst excesses, but doubtless the focus was on finance with scant regard to quality of care. The GMC will pretend annual appraisal would have stopped him.

The NHS often delivers extraordinarily heroic and dedicated care, as the response to recent terror and fire atrocities illustrates. Trauma staff regularly work way beyond their paid hours. The NHS is woefully understaffed in many places and the government ducked out of mandatory safe staffing levels. The NHS in England is short of 30,000 nurses (10% of the total) and the 2016 staff survey found 47% of staff view current staffing levels as insufficient to allow them to do their job properly. Brexit has meant a 96% fall in EU nurse applications, and 150,000 EU NHS and social care staff still don’t know if they can stay. Vacancy rates for social care staff in the public sector are now 11%. Pay has been frozen at 1% for nine years. 50% of junior doctors are taking a break from specialist training after their foundation years. But Jeremy Hunt is still there with his smiley face and his shiny NHS badge promising us a kinder, safer fantasy for less money.