MPs are waking up to the scale of the unnecessary destruction being wrought on the NHS. But with local NHS leaders now told to choose between sacrificing services or their careers, will it be too late?
This week Jeremy Hunt became the longest serving health secretary on record, overtaking Alan Milburn.
His achievement was praised by Labour's health spokesperson Justin Madders - as “the only target he’s managed to hit”.
Such knockabout stuff is grist to Jeremy’s mill.
But today, more seriously, the Kings Fund health think tank accuse him of misleading voters by claiming NHS funding has had its “sixth biggest increase in its history”. Try 28th biggest in the last 40 years, they say.
In fact this week, just about everyone has been queuing up to mark Jeremy Hunt’s long tenure by telling him how badly he’s doing it.
More or less the only experts not vocally criticising Hunt this week were the BMA, keen to show their reasonableness by agreeing a short pause in hostilities over the junior doctors’ dispute.
But the constant stream of critical reports is only likely to strengthen the resolve of junior doctors and indeed NHS staff more widely, who are next in Hunt’s firing line.
In the last week two separate teams of academics – one team from Manchester University and one from Oxford University – have revealed that the “weekend effect” that Hunt has used as his justification for trying to impose a new contract on junior doctors, simply “does not exist”. They found that variation in death rates is merely down to the fact that patients admitted at weekends are fewer in number but sicker to start with.
And the lead author of the Oxford University study told BBC's Today programme that in fact patients got better care at the weekends, because doctors were less distracted by endless administrative meetings. Hunt’s use of the data was “a shambles”, added Peter Rothwell (professor of neurology at Oxford University).
But you don’t need to be a neurosurgeon (or even a neurologist) to see that Hunt and his team are getting the NHS very, very wrong.
On Monday the Commons Health Select Committee grilled Hunt and forced him to admit that “we didn’t protect the entire health budget”.
On the upside, though, the problem of inadequately funded care was “one of the biggest commercial opportunities”, Hunt commented.
On Wednesday, the Public Accounts Committee said the Department of Health had set “unrealistic” efficiency targets and “provided ineffective leadership and support, giving trusts conflicting messages about how to balance safe staffing with the need to make efficiency savings”. The MPs pointed to a shortfall of around 50,000 clinical staff which was harming hospitals’ ability to provide services and could lead to longer waiting times and worsening patient care.
The cross-party MPs sounded almost baffled by the fact that there was “no coherent attempt” by Hunt’s department to assess the staffing implications of their "7-day NHS" plans.
It seems fair to assume that Hunt thinks the NHS staff gap can be met by more “health-related volunteering”, a greater reliance on lower skilled roles like physician and nurse associates, and using up more of the “renewable energy” of unpaid carers. Or perhaps by flogging off chunks of the NHS estate to “pump prime” the changes. All of these are recommendations set out in the NHS 5 Year Forward View produced by Hunt's NHS boss Simon Stevens, and which Hunt has endorsed.
Or perhaps he'll deal with the shortfall by reducing the A&Es that are the lifeblood of major hospitals, critical to patients, but expensive to run and not of interest to the private sector. He’s got Sir Bruce Keogh working on that one, when Sir Bruce is not otherwise distracted by aggravating junior doctors. Or perhaps, by turning hospitals into commercial 'chains' - he's had Sir David Dalton working on that one, when he's not busy criticising the junior doctors.
Of course no-one - not Hunt, Stevens, Keogh, nor Dalton - wants to take the blame for turning our cherished NHS into some kind of second-rate “knit your own” service, as “commercial opportunities” flourish for the private health and care industry.
So Hunt and Stevens have just carved the NHS up into 44 local areas – ‘footprints’ - and told THEM to come up with a plan to sort everything out – and to have everything patched up and restored to full financial health within a year.
The plans (cheerfully entitled "Sustainability and Transformation Plans") have to be submitted by the end of June. Local areas will have to show how they’ll collectively deliver the lion’s share of NHS cuts, whilst not damaging care.
(Local cuts that - as we discovered this week - are expected to rise to £15 billion a year, including nearly £9 billion a year of cuts to hospitals and other providers.)
And if local health bosses DON’T manage to deliver on these hastily cobbled together 'Plans'?
So as far as NHS cuts go – you ain’t seen nothing yet.
This week the Health Foundation think tank revealed the NHS is “substantially off target” with its efficiency – or cuts – plans, having made only £1bn of the imposed £22bn cuts in year one of its ‘five year plan’. That’s an awful lot of catching up to do, and some drastic plans are beginning to emerge through the footprint process and elsewhere.
This week North West London’s ‘footprint’ cuts plan emerged, showing it plans to cut a further 500 beds on top of those already cut – this in a country that already has fewer hospital beds than just about any other developed nation.
It’s a similar story elsewhere. Already many other hospitals and A&Es are threatened, from Devon to Huddersfield. Liverpool Women’s Hospital – surely a prime example of ‘personalised care’, if that really meant anything – is under threat. So is hospital care all round the country - under the rubric of ‘care in the community’ and 'specialisation'.
And primary care is suffering as much as hospitals, with GPs fobbed off with strings-attached, re-announced money, as they struggle with the twin burdens of admin and picking up the patients hospitals haven’t got beds for.
Health bosses in areas like West Berkshire are now planning that receptionists should do triaging of sick patients, and that "virtual [ie, telephone/internet based] outpatient clinics...should become the norm".
And all the local health bosses (CCGs) have been told they have to “moderate the level of activity growth” by using ‘RightCare’ – an insurance-inspired system to reduce ‘demand’ and ‘variation’ in what operations patients get referred for. Which – in the context of cuts – seems to be code for “if some areas are getting away with refusing people some operations, that’s what you should all be doing”.
So this is the cost of ‘localising’ the impossible. Ultimately it will be patients who pay, as our local NHS leaders sacrifice services we need to save their organisations' existence. Or if they refuse – as they are taken over by organisations over whom we’ll have no control.
And – just like the 24/7 row – none of these varied plans have a proper evidence base. They draw on the un-evidenced claims in the Five Year Plan that ‘care planning’ and ‘integrated care’ based more in the community, will reduce “avoidable hospital admissions” and therefore save money. In fact meta-reviews by the University of Manchester, the BMJ and even the Department of Health itself, show that if anything, such policies generate more hospital admissions, as patients’ very real needs are picked up. Which is great, but it’s not a route to saving money.
Meanwhile, no-one wants to talk about the one pot of money that could begin to fund savings without impacting on frontline care – the billions that are wasted annually on administration of the NHS as a ludicrously complicated ‘marketplace’ set up to allow private firms to get their hands on some of the NHS cash.
Hunt’s talent was to sell himself, post-Lansley, as the ‘patient champion’, and – for a while – he got away with it. He got away with portraying NHS workers as both lazy and callous. He got away with distracting us with soundbites about a ‘7 day NHS’. He got away with underfunding and spending money on the wrong things, with ignoring the evidence, with scrapping targets for the things that do matter, like safe numbers of nurses.
He got away with it partly because he hides behind Stevens – who, before becoming Hunt’s NHS boss, and before spending 10 years at US health conglomerate UnitedHealth, was a labour councillor, health advisor to Tony Blair and key architect of earlier marketising policies. Stevens is therefore something of an embarassment to Labour – or at least, to that section of the party that isn’t nurturing a "dream fantasy" scenario of Stevens returning to the fold and taking over the party leadership from Corbyn, as apparantly some are! Such strange wranglings are for the Labour party to resolve.
But let’s hope the rest of us – campaigners, patients, and medics – aren’t going to let Hunt or indeed, his successor continue to get away with claiming to be 'on the patients side' against doctors - when the reality is Hunt is laying out very dangerous, quite possibly lethal, times ahead for the NHS.