Constitutional Crisis

Jeremy Hunt doesn’t want to be remembered as the health secretary who presided over the worst NHS performance figures on record. As doctors were gathering evidence of patients dying while waiting for emergency care, Hunt was refusing a reshuffle and grabbing extra responsibility for social care. Theresa May knows that NHS and social care services aren’t going to find the staff and beds they need to recover anytime soon. More than 33,000 nurses gave up working in the English NHS last year, a rise of 20% since 2012-13. Over 10% of the nursing workforce have left the NHS in each of the past three years. There are now more leavers than joiners. Hunt remains a convenient lightning rod for the anger that was supposed to be directed at NHS England CEO Simon Stevens.

In November, Stevens was warned by May that he would be held ‘personally responsible’ if the NHS went tits up over winter, but Stevens’ very public protestations that the NHS urgently needed an extra £4 billion this year gave him a convenient get out when the chancellor only gave £1.6 billion. Hunt has used the word ‘unacceptable’ for NHS failings under his 6-year

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Poor Care

January is always a good time to dust off the 2015 Tory manifesto promise; ‘We will offer you the safest and most compassionate care in the world.’ NHS England is pretending we are ‘coping well with planned-for winter pressures’ but patients stranded at the back of a corridor trolley queue or staff on their knees with exhaustion might beg to differ. The same excuse as last year – ‘a spike in respiratory infections’ – is being wheeled out but the NHS has not been able to cope safely with all the extra demands placed on it since annual funding increases were reduced to a trickle in 2010.

Such crises were common in the nineties until Labour decided to temporarily match the EU average for health funding, the one political intervention that dramatically reduced waiting times for emergencies and non-emergencies alike. Now we’re returning to the days when elective operations are routinely shut down over winter. 15,000 beds have been cut from the NHS in England since 2010, £6 billion has been cut from the social care budget and there are 100,000 NHS and social care staff vacancies. Between 2003 and 2015 the population of England increased by

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The End of the Nye

Professor Allyson Pollock, a senior consultant in public health medicine, gets far less public recognition than she deserves, because she has a track record of being right and spotting disasters long before anyone else has woken up. She was a fierce critic of the internal market introduced into the NHS by the Conservatives in 1991, arguing rightly that it would be wasteful and inequitable, and had no evidence base. In 1995, she pointed out the dangers of the NHS abandoning long term care of the elderly and farming it out to means-tested social care that transferred the costs of care, and the fear of paying for it, from society to the individual (precisely what Bevan was trying to reverse when he established the NHS 70 years ago) 

In 1997, Pollock was one of the first to highlight the lack of transparency, inadequate risk sharing and unaffordable long term costs of Private Finance Initiative projects, which are now crippling many hospitals. And she immediately saw through Andrew Lansley’s disastrous Health and Social Care Bill, campaigning vigorously for an NHS Reinstatement Bill that would restore the duty of the Health Secretary to provide universal care, rather than

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Something has to give (and it’s not the Treasury)

As MD predicted (Eye last), the NHS England board responded bullishly to being given 40% of what every expert authority (apart from the Treasury) deemed necessary to keep the NHS upright for another year. Whilst Philip Hammond and Jeremy Hunt insist the extra money be used to get waiting times back on target, NHS England declared bluntly that ‘NHS Constitution waiting time standards will not be fully funded and met next year’.  NHS England also said that new advisory National Institute for Health and Care Excellence guidelines would only be implemented ‘if in future they are accompanied by a clear and agreed affordability and workforce assessment at the time they are drawn up’. So even if NICE says a new treatment is effective and good value for the NHS, it may only be provided in your area if the funding and staff are available. Pretty much what happens now.

The NHS probably could do more to reduce waste and variations in the quality of care, but it was the Conservative’s lethal Health and Social Care Act 2012 that has squandered billions on unnecessary reform, compulsory tender and transaction costs, substandard outsourcing and

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Hammond’s Trap

Chancellor Philip Hammond had to give the NHS some extra funding to fulfil the government’s pledge of a year on year real terms increase in health funding per head of the population. Predictably, he promised just 40% of what just about every expert authority calculated was necessary for the service to remain upright. He then compounded the pressure by demanding that the extra £1.6 billion for next year must resurrect the long-lapsed targets for waiting for non-urgent operations (18 weeks) and in emergency departments (4 hours). He knows the NHS hasn’t got a hope in hell of doing this, so the strategy must simply be to set up NHS England CEO Simon Stevens as the fall guy for failure.

Stevens incurred the wrath of Hammond and Theresa May by firing a very public pre-budget broadside at a conference in November when he warned that the NHS waiting list was heading for 5 million by 2021, that the government may be forced to “publicly, legally abolish patients’ national waiting times guarantees” and that it would become “increasingly hard to expand mental health services or improve cancer care.” By ordering Stevens to get waiting times back on track

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