Hunt v Hawking
Why did health secretary Jeremy Hunt choose to have a public spat with Professor Stephen Hawking about statistical analysis and the future of the NHS? Accusing Hawking of spreading ‘pernicious falsehoods’ was a high-risk strategy, but Hunt has an ego, is proud of his record as health secretary and took the bait. Hawking suggested the NHS is heading towards a US-style insurance system, run by private companies, citing the increasing involvement of the private sector in the NHS as evidence for this. Hunt argued the government has no plans to introduce an insurance system and the private sector currently takes only 7.7% of the NHS budget. But as former Tory prime minister John Major during the Brexit debate; ‘Michael Gove wanted to privatise the NHS, Boris Johnson wished to charge people for health services and Ian Duncan Smith advocated moving to a social insurance system. The NHS is about as safe with them as a pet hamster would be with a hungry python.’
In 2005, Hunt co-authored a policy pamphlet with Gove, Douglas Carswell and others which proposed a universal insurance system for the NHS and stated; ‘Our ambition should be to break down the barriers between private and public provision, in effect denationalising the provision of health care in Britain.’ Hunt’s current position is that the NHS will remain ‘a single-payer system’, funded from general taxation, and by his definition would remain a public service even if all its services were privately provided. However, private provision transfers significant power and funds to profit-seeking shareholders and to many (including MD), that constitutes privatisation of the NHS.
Simon Stevens, the current NHS England chief is credited with accelerating competition and private outsourcing under Tony Blair, later boosted by Andrew Lansley’s health act, but the NHS is now having to live with the disastrous consequences. A report by the Centre for Health and Public Interest has found that in the last 6 years, companies that run PFI contracts for the NHS have made pretax profits of £831 million that could have been spent on patient care. In the next 5 years, £973 million of NHS funds will go to PFI companies. And up to £4.5 billion been squandered on setting up, administering and regulating a rolling program of competitive tendering in the NHS since 2012.
Hunt and Stevens stand no chance of making their planned £22 billion of austerity savings by 2021 by fragmented competition. Instead, the English NHS is trying to move to ‘place based planning’ where local services merge, rather than compete, in the form of 44 Sustainability and Transformation Partnerships (Eyes passim). Each STP is expected to make its share of eye-watering savings, and some will try to become Accountable Care Organizations. As Hawking pointed out in The Guardian: ‘An ACO is a variant of a type of US system called a health maintenance organisation in which all services are provided in a network of hospitals and clinics all run by the HMO company. It is reasonable to expect the powerful US HMO companies such as Kaiser Permanente and UnitedHealth will be bidding for the huge contracts to run these ACOs.’ Hunt trumpeted Kaiser as a model for future NHS care at the Commons health select committee in May 2016. The NHS could run its ACOs but Lansely’s Health Act may force it to put them out to international tender to Kaiser etc.
Other cunning plans to balance the NHS books include selling off its ‘redundant’ land and building assets to property developers on the cheap (see the Naylor Review), encouraging the NHS to take on more private work and further discouraging GPs from referring patients to hospital. Referral management centres started under Labour but are escalating such that all referrals will be triaged weekly by clinical peer review. A third of these centres are currently run by private companies, the rest by the NHS at a total cost of £57 million since April l 2013. Some patients may not need referral, but others who need hospital treatment may be refused or delayed.
Hawking also criticised Hunt’s cherry picking of weekend mortality statistics based on a single paper in the BMJ. Hunt’s defence was ‘that to decide that one piece of research is the most credible is not cherry picking, it is doing what you have to do when researchers disagree.’ Bollocks. What you do is a systematic review of all the existing studies, not choose the one you like the results of. Orthopaedic registrar Ben Dean discovered the updated study originated from a request by Simon Stevens in a ‘7 day services meeting’ involving senior NHS England members and Deloitte. So perhaps not quite as independent as Hunt claims. Before the paper had been properly peer reviewed and published, NHS England was using it to justify changes to junior doctors’ contracts, and this bad science subterfuge was one reason the conflict turned so sour. People may die at weekends because of chance, because they are sicker than those admitted during the week, or for lack of care. The deaths could be avoidable or non-avoidable. If research shows more services are needed, it will probably need extra staff, rather than shifting around the existing staff who can barely cover weekday shifts. The NHS could well be safer at the weekend but Hunt’s alienation of a generation of junior doctors is unlikely to help.
If the NHS can really make £22 billion more savings without harming staff and patients, Hunt and Stevens will deserve their place in history. MD’s money is on the NHS struggling along in heavy debt, cutting services, increasing waits and mopping up the crisis in social care that Theresa May is now too frightened to address. Merging health and social care into a single ‘care’ system makes sense but is fiendishly hard to do if one is tax-funded, the other is means-tested and the division is grossly unfair. For many, Nye Bevan’s promise of state funded ‘cradle to grave care’ has long since vanished.