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There’s no “magic money tree”, except when you’re signing off HS3 on a ‘nod and a wink’ for £7 billion, or interventions in Iraq and Afghanistan for £30 billion.
As a piece of marketing, for Simon Stevens to set out a stall for the rôle of the NHS in a global economy, “the five year plan” was nice and succinct. As a piece of strategy, it is dreadful. It’s dreadful – even if you decide to take the view that health policy is entirely market-driven or “value-based”, and not in any way written through a sophisticated clinical prism.
The irony of a “five year plan” for the National Health Service is pretty quick to see. “Five year plans” were, of course, used by Stalinist Russia. Nazi Germany preferred ‘four year plans’ as a strategy for war readiness, in comparison.
It is reported that the “Five Year Forward View”, published last week by NHS England, is a collaboration between six leading NHS groups including Monitor, Health Education England, the NHS Trust Development Authority, Public Health England, the Care Quality Commission and NHS England.
And yet ironically the future of two of the contributing organisations is under doubt. In a fringe meeting earlier this at the Labour Party Conference, it was again mooted what the precise function of Monitor might be. This is because it is definite that an incoming Labour Party government, in its first Queen Speech, will repeal the Health and Social Care Act (2012), a much loathed piece of legislation. This leaves the precise functions of Monitor uncertain.
One possibility which Burnham is seriously contemplating is whether Monitor, if it continues to exist, serves to regulate the integration of services as would be expected in ‘whole person care’. Burnham intends to introduce ‘NHS preferred provider’, which could insist on the NHS being the lead provider in contracts for as long as ten years in the ‘prime contractor model‘.
And the future of the Care Quality Commission was put on a cliff-edge with the report of the Sir John Oldham Commission, again to do with whole person care. It would make much more sense to reform the regulators to oversee health and care with a single regulator in future. This would again be in line with the regulation of health and care professionals, much needed, and proposed by the English Law Commission, but kicked into the long grass by the current Government as it ran out of time.
The “5 year Forward View” to all intents and purposes reads like a marketing document, a wish-list for further privatisation of the NHS. It may ‘pack a punch‘, from the BBC which has unreservedly succeeded in throttling any discussion of the NHS reforms. But talk of ‘accountable care organisations’, as developed in Spain and the United States, and the emphasis on preventive health packages so keenly sold by multinational corporates, are paradigmatic of a wish-list of a privateer.
The document is a naked shill, intended to carry on the ‘case for change’ which has been made exhaustively by think tanks such as the King’s Fund which, some might say, were instrumental in giving the catastrophic policy of market competition in the National Health Service some legs in the first place.
But the runes are clearly there.
Take, for example, the seemingly-modest proposal of “integrated care commissioning”. The policy of personal budgets in the full glare of sunlight looks incredibly anaemic. Unanswered questions exist how a universal health system is going to be successfully merged with a means-tested care system. NHS England tried, unsuccessfully, to head this issue off at the pass as far back as in 2012.
Personal health budgets, which Simon Stevens has continued to speak moistly of, are the perfect vehicle for introducing ‘top ups’ and ‘copayments’, threatening the fundamental principle of universal, free-at-the-point-of-need.
And moves, not contained in the ‘5 year plan’, spell out an ominous direction of travel. It has just been announced that the much maligned contract for processing ATOS, given under the last Government to ATOS, is to be given to a company called Maximus, which has a proven track record in handing long term care packages in other jurisdictions.
“Independent” think tanks have never shrugged off successfully the “power of the prepaid cards”, see for example the DEMOS initiative. It has always been vehemently denied that there will be no merging of universal credit and healthcare provision, although Liam Byrne’s account of Jennie Macklin in Australia painted a rather different story in an article in the Guardian provocatively entitled “Let’s help disabled people achieve their full potential“.
Like a multi-national corporate document, the “5 year plan” is high on marketing but poor on strategy. A good example of this is given on page 36 in relation to a ‘threat’ facing the National Health Service, that of recurrent pay freezes to the majority of nurses whilst the economy is reputed to be recovering.
The seemingly innocuous line, at the end of page 35, reads: “For example as the economy returns to growth, NHS pay will need to stay broadly in line with private sector wages in order to recruit and retain frontline staff.” But it is well known that any wish to pay nurses a wage that reflects the value that runs through their work like letters in a stick of rock will be strongly resisted by the Treasury, while the Conservative Party will prefer further to tattoo the words of low taxes onto his breast plate of ideology.
There are other clear examples of the document clearly lacking in clarity. For example, page 33 sees a promotion of ‘personalised medicine’, how the NHS and “our partners” (meaning in the third and private sector, actually) might deliver the genome based ‘revolution’. Again, the document’s thrust is one of marketing, not clear strategy. There is no mention of the changes in resource allocation which would be required to serve this revolution, essentially seeing hardworking taxpayers subsidise the shareholder dividends or surpluses of large corporate-like charities. There is absolutely no mention of the changes in the legislative framework that would be needed, as in the United States, to prevent genetic information non-discrimination. But here again the document serves its marketing function – as a prospective prospectus for would-be investors wishing to spot lucrative opportunities in the NHS as a data mine.
Like there is no mention of “NHS preferred provider”, unsurprisingly there is no mention of “whole person care”. And yet, even if Labour fail to win an outright majority, it will seek to implement this being the largest party in Government. And this policy is set to see a profound change in the landscape of health and care provision for England.
In any business strategy, one is obliged to think of the political, economic, social, technological, legal and environmental headwinds (affectionately known as “PESTLE” to business strategists). A good example of social changes in the five years might have been, for example, a change in direction of the NHS being seen as resentment as costing much money, despite its striking efficiency, but one which values its workforce (for example in the salary of most of its nurses).
Looking at the political headwinds, it is quite incredible for example there is no mention of trade agreements such as TTIP and the investor-to-state dispute settlement clauses. If this ‘5 year forward plan’ had been at all serious, it would have been included, not least as it is a headwind which could drastically throw off course further the direction of travel of the NHS as a state-run health service.
Simon Stevens’ vision is a ‘charismatic vision’ of sorts. But a vision does not have to be particularly credible for it to get populist appeal or succeed. It just needs to be communicated clearly, with supine and compliant supporters in the trade media.
If the document were a ‘heads up’ for how we could afford a NHS through general taxation which was genuinely universal and free at the point of need, this document would have served a function. As it is, the document is a lubricator for mechanisms which could optimise the part that the private sector has to play, with no mention of the dogs being unleashed in the global marketplace – in much the same way Cameron refused to signpost “the top down reorganisation”. It is impossible for a strategy document for the NHS simply to airbrush out the political and legal factors which will be at play in the lifetime of the next Government. As it is, the NHS ‘5-year forward view’ is a basic piece of marketing, which as a strategic plan scores 0/10.
There’s been a lot of diagnosis on improving the diagnosis rates for dementia in primary care as a result of the Prime Minister’s Dementia Challenge.
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Scrapping the Human Rights Act does not get rid of Strasbourg as a portal of action for health and care matters
Like most people who’ve had a legal training, I was baffled why David Cameron is so triumphant about scrapping the Human Rights Act (1998). The legal position is that “British citizens would still be able to take cases to the European court of human rights, and its case law and the principles of the convention would still be in force in UK courts.”
This is stated correctly here.
Leading commentators such as Joshua Rozenberg, Britain’s best known legal commentator, have previously advised that the debate must be conducted in a different light from the political grandstanding (article here).
When Dominic Grieve, the previous Attorney General, was asked at a fringe meeting for his reaction to May’s speech, he insisted he was “completely comfortable” with the idea of replacing the existing legislation with a British bill of rights.”
At the time, it was observed that Ken Clarke QC MP, like Dominic Grieve QC MP, was a keen supporter of human rights.
In 2011, when I was studying my Master of Law, I attended discussion at the Honourable Society of Inner Temple last night. The seminar is jointly hosted by the Constitutional and Administrative Bar Association (ALBA) and the new Bingham Centre for the Rule of Law. The speakers included Lord Justice Laws, Lord Pannick QC and Professor Philip Leach, London Metropolitan author, and author of numerous publications including the book “Taking a case to the European Court of Human Rights”. The session was totally packed out, and the speakers took many questions from leading practising international barristers and academics.
It is perhaps easy to overstate the opposition towards the Human Rights Act, but it was pointed out only two countries are openly questioning the legitimacy of the European Convention of Human Rights – Russia and the United Kingdom.
LJ Laws has long been in favour of developing domestic jurisprudence in the context of the Human Rights Act and common law.
He opined at this event that “the cases were beginning to speak, but the Convention was an useful guidance”, and reaffirmed the influence of a graduated approach to proportionality, an argument which Laws noted had been accepted by Bingham (see for example Regina v. Secretary of State For The Home Department, Ex Parte Daly). Laws reminded the legal audience that we, as a country, have always been in a position to influence Strasbourg, as for example the Pretty v United Kingdom case.
Laws further mooted, however, why should the judges be deciding upon social policy. Considering particularly articles 8-12, Laws provided that often lawyers had to decide where to strike the balance in certain issues between competing interest, but fundamentally lawyers were there to establish the framework and issue – however Laws warned that the nature of this exercise in jurisprudence gives rise ultimately to issue of a philosophical nature. I found this academic exploration by Laws interesting in light of how human rights law might impact on aspects of health and care policy in England.
Lord Pannick charted the history of the reaction to our history right legislation, in relation to Strasbourg. Pannick reminded the audience that criticising the Human Rights Act, in relation to Europe, was not a recent phenomenon.
In relation to the Gilbraltar incident, Michael Heseltine – as far back as 1995 – said, “We shall do nothing. We will pursue our right to fight terrorism to protect innocent people where we have jurisdiction, and we will not be swayed or deterred in any way by the ludicrous decisions of the Court.”
According to Lord Pannick, prisoners’ voting rights and the use of hearsay have also produced conflicting opinions from the UK and Strasbourg, and indeed these legal conflicts appear to be ongoing (see for example the present case of Zainab al-Khawaja, where the original argument was heard by the Court in 2010).
Lord Pannick proposed that this conflict arose from various sources. Firstly, Lord Pannick felt there is a general resentment of European law amongst Conservative “elements”, and many of the population. Secondly, the objection to the European Convention of Human Rights could part of a wider objection to foreign law. Lord Pannick indeed reminded the audience that a Conservative MP, lawyer and judge, David Maxwell-Ffye, was instrumental in drafting the European Convention of Human Rights. Lord Pannick then identified a possible perception from the UK voting public, that judges should not be deciding on social policy: for example, the argument for prisoner voting is not a matter for judges, but should be a matter for parliament.
Lord Pannick did not feel fundamentally that the criticisms of the HRA amounted to much. For example, the HRA expressly recognises that the UK Parliament is not bound by the Convention. If Parliament wishes to exclude voting by prisoners, the Human Rights Act does not prevent this. The judges can decide whether the defendants comply, but, according to Lord Pannick, it is equally important that the last word lies with parliament. Lord Pannick instead felt that a much more difficult issue is the relationship between parliament and the Strasbourg Court.
A future ‘all Conservative’ government, even if it repealed the HRA would still leave the jurisdiction of the Strasbourg Court intact – our own judges have no effect on the jurisprudence.
If the 1998 Act were to be repealed, as parliament is overeign, the number of British cases to Strasbourg would increase according to Lord Pannick. Lord Pannick felt that an useful to look at the relationship between our Supreme Court and Strasbourg would be to look at the ‘control of its docket’ jurisprudence, in other jurisdictions of international law.
Lord Pannick ultimately felt that the power of our parliament to define power Strasbourg as a body is limited. It would be unprecedented for us to withdraw from the European Convention of Human Rights, incompatible with membership of the EU, or Council of Europe. According to Lord Pannick, the concept of European minimum standards is of vital importance to us. There may be be occasions when national or international considerations are that our judges do not originally recognise that human rights are being breached (e.g. gays in the military) It would be difficult for us to expect that other countries such as Russia should comply with the Convention, if we do not. Lord Pannick therefore felt that the situation now required an accommodation on both sides.
The Strasbourg is supposed to overrule a National court only in cases of fundamental significance, where the national supreme court has made an error of principle. If Strasbourg does not follow this principle, it may risk the growth of political opposition. However, likewise, Lord Pannick identified that the Supreme Court should not supinely follow Strasbourg, either. The Government for example accepted the DNA ruling in preference ot the House of Lords. If the Supreme Court were to be asked if the voting rule asked about the prisoners’ voting again, Lord Pannick felt that the Supreme Court would be unlikely to say it is compatible with the European Convention of Human Rights.”
The Human Rights Act (1998) is also relevant to aspects of policy relating to people’s health: there have been concerns whether the ‘welfare reforms’ have offended human rights legislation.
There have also been concerns whether the fitness to practise procedures of the GMC need to be explored with the human rights lens?
There are also further issues, unresolved as yet, about whether the Health and Social Care Act (2012) offends humans rights legislation.
Most of this blogpost was first published on Dr Shibley Rahman’s legal blog here.
I believe that whole person care, to be introduced by the next Labour government, will be brilliant for bringing together health and care professionals with persons with dementia, and carers and support workers. But we should also be extremely vigilant of dodgy presentation of evidence being used ‘in the name of’ campaigning for my pet subject, dementia, I feel.
We keep on being told that the ageing population is one reason why we can no longer afford the NHS.
The clinical syndrome of dementia, for which advanced age is a risk factor, has therefore taken on a special significance in this context. Health policy gurus and politicians are seemingly having to find increasingly elaborate ways to force their agendas on an unsuspecting public. “The Shock Doctrine: The Rise of Disaster Capitalism” (2007), penned by the Canadian author Naomi Klein, argues that libertarian free market policies have risen to prominence in some developed countries because of a strategy by some political leaders. These leaders deliberately exploit crises to push through controversial exploitative policies while citizens are too emotionally and physically distracted by these crises to mount an effective resistance. Crises are, though, useful instruments for bringing about change.
Within the timescale of this parliamentary term, the Prime Minister’s Dementia Challenge (launched in 2012) has seen a torrent of newspaper headlines with sensational memes. They invariably depict some sort of crisis in projected numbers of people with dementia, and have helped Big Pharma with the task of campaigning for increased funds to find ‘a cure for dementia’. The memes have largely had twangs of crises. For example, ‘dementia is the “next time bomb”‘ was an early news story from 7 May 2012. This messaging has continued consistently since, with the latest popular meme being “soaring numbers diagnosed with dementia“. Indeed, only recently with the arrival of the “Dementia UK (second edition) report” presented in a conference in Central London, a press release was published stating “Alzheimer’s Society calls for action as scale and cost of dementia soars”. But this messaging has caused utter confusion and resentment amongst leading academics and practitioners in dementia. The cumulative effect, instead, of such headlines and articles in public health has been to produce a feeling of ‘moral panic‘. As rightly pointed out by Dr Martin Brunet in “Pulse Magazine”, a well respected commentator on dementia policy in English primary care, recent evidence suggests rather that that the prevalence of dementia in over 65s in 2011 is lower than would have been expected. This “CFAS-II study” from Cambridge, which was published last year in the Lancet, is widely quoted, comprehensively peer-reviewed, and is extremely well known amongst people working in this field.
This is all incredibly self-defeating, as the “Prime Minister Dementia Challenge” was intended to bring greater awareness of the dementias amongst the general public not least to tackle the stigma faced by people living with dementia in their everyday lives. But you have to wonder what the intention of this approach is in the long term? The final report from the Commission on the Future of Health and Social Care in England (“Barker Commission”) was published on 4 September 2014. It discusses “the need for a new settlement for health and social care to provide a simpler pathway through the current maze of entitlements”. Labour intends to introduce ‘whole person care’ in the next parliamentary term, and it could be that this “scorched earth” approach for dementia has served a useful function. “Whole person care” is their new “big idea“. The Barker Commission recommends moving to a single, ring-fenced budget for the NHS and social care, with a single commissioner for local services.
On page 9 of their final report, the ‘ultimate star prize’ is described, the personal budget:
“Personal budgets, and care in hospital and out of it, would be provided from a single, ring-fenced budget. There would be one budget and one commissioner for individuals and their families to deal with, in place of health, social care and, in the case of those aged over 65, the Department for Work and Pensions. Commissioners would be freed to acquire care designed around an individual’s need for support and health care, largely dissolving the current definitions of what is a health need and what is a care requirement.”
And this of course is nothing new: it has been in gestation for quite some time. I myself, in fact, wrote about personal budgets for ‘Our NHS’ in my piece ‘Shop til you drop?’ on 4 September 2013. It is said that Andy Burnham MP, Shadow State of Secretary of Health, “welcomes the Barker Commission“, but one wonders whether he wishes openly to support the more unsavoury parts. Labour is desperately keen to introduce its policy changes on integrated care, without them being seen as another “top down reorganisation”. Any public resistance to their flagship policy will be political dynamite. Labour is instead currently campaigning on an anti-marketisation and anti-privatisation slate, and has pledged to repeal the highly toxic Health and Social Care Act (2012) (“the Act”).
One significant part of this repeal will be the abolition of “section 75″ and its associated regulations, which introduced competitive tendering in commissioning as the default option for NHS procurement. Nevertheless significant faultines in policy, described elegantly by Prof Calum Paton in his pamphlet “At what cost? Paying the price for the market in the English NHS” for the Centre for Health and Policy Interest (February 2013), still exist. They also are at danger of persisting, even if Labour triumphantly repeals the Act. There is a danger that unless these other pro-marketisation strands are addressed first, such as the purchaser-provider split, the “whole person care” policy will become engulfed in an intensely neoliberal direction. The counterfoil to this from Labour would presumably be that whole person care does not require a market in the first place. For this, clearly, Labour must not inflict personal budgets. A further big concern of mine is simple: not only will current scientific research into dementia have been completely misrepresented in the popular press, but also the field of dementia will be used to provide the raison d’être for yet another upheaval in service change.
And that upheaval could witness yet another change from the founding principles of the NHS. It could also be one too many.
This is the text of the speech given by Mr Jeremy Hunt, the Minister who oversees the running of the NHS and care despite having no legal statutory duty for it.
Today I am here to tell the British people that a future Conservative government will have no greater priority than to protect, support and invest in our NHS.
In 1948, the greatest of all Conservatives Winston Churchill supported the then Labour government in its plan to set up a National Health Service. He said ‘disease must be attacked whether it occurs in the poorest or richest man or woman simply on the grounds that it is the enemy.’
That safety net Churchill wanted is our NHS today, supported across the political spectrum.
Last week Labour tried to paint a different picture. They know this government increased the NHS budget despite the financial mess Labour left behind. They know the NHS has more doctors and more nurses than ever before. They know fewer people than ever are waiting long periods for their operations. They know the culture is becoming more caring. But they still seek to trick the public into thinking one party cares for the NHS and the other doesn’t.
Well I have a message for Mr Miliband. It’s not a Labour Health Service or a Conservative Health Service…it is a National Health Service. And when my father was cared for by a district nurse or my wife had our baby this summer or our son goes for his jabs, they aren’t Conservative patients, Labour patients or LibDem patients, they’re NHS patients. When people in this hall volunteer to support the local league of friends or join the board of a hospital we’re not Conservative supporters – we’re NHS supporters. We all support the NHS because the NHS is there for us all.
So don’t turn the National Health Service into a National Political Football and don’t use the NHS to divide us when it’s the fabric that unites our nation.
This morning the Prime Minister announced plans to make it easier for millions of people to get 8 till 8 and weekend appointments with their GPs.
And I want to start today by celebrating that and some of the other successes of our NHS, doing so well despite huge pressure.
Take cancer, our biggest killer. Every family in the country has lost a friend or loved-one to cancer – I lost my own father last year. It is a ruthlessly indiscriminate killer – whether it targets someone who has just retired after a life of hard work or a child with a life stretching out in front of them.
In 2010 this country had amongst the lowest cancer survival rates in Western Europe. So we set up the cancer drugs fund. We’ve transformed cancer diagnosis so the NHS now tests 1000 more people for cancer every single day. And so far this parliament we have treated nearly three quarters of a million more people for cancer than the last one – that’s thousands of lives saved, thousands of families kept together, thousands of tragedies averted. So let’s hear it for our brilliant cancer doctors and nurses.
Or look at dementia, one of the most terrifying conditions of all.
I’ll never forget the courage of man I met with dementia who single handedly stood up to the banks and demanded they gave him an alternative to having to remember a pin number. But it isn’t just your pin number that goes. It’s precious family memories, marriages of many years, relationships with children – all snatched away by cruel tricks of the mind. When we came to office fewer than half of those with dementia got a diagnosis, meaning many missed out on vital medicine or support for their family. We’ve now diagnosed an extra 80,000 people. The Prime Minister hosted a G8 summit to get the drug companies to do more to find a cure. And we’re working with the Alzheimers Society to enroll one million dementia friends to tackle stigma – with half a million signed up so far.
So let’s hear it for GPs, dementia nurses, dementia carers, dementia friends and people with dementia who are changing the way our society tackles this horrible condition.
Or A & E, the critical frontline for the NHS. A young A & E doctor told me how she had cried after seeing a 90 year old man say his goodbyes to a 90 year old woman he’d been married to for over 60 years. For her that was just part of the job. And with a million more people using A & E, the pressures on her and her colleagues are immense.
Sometimes, yes, it’s been tough meeting the target. But despite that we have halved the time people wait to be assessed and are treating nearly 2,000 more people every day within the four hour target compared to 2010. So let’s hear it for our brilliant A & E frontline staff now preparing for a challenging winter.
Conference our opponents say the NHS is in decline. But according to the independent Commonwealth Fund under this government the NHS became the top-rated healthcare system in the world. Better than America, better than France, better than Germany, better than Australia. And the way they rose to the challenge of Ebola says it all – with 164 NHS volunteers offering to go and help contain the outbreak in West Africa. So let’s hear it for all NHS doctors, nurses, porters, cleaners, caterers, carers and volunteers. You are the best of British and the pride of our nation.
But that doesn’t mean things are perfect. About the first thing I did as Health Secretary was to read the original Francis report about the terrible things that happened at Mid Staffs Hospital between 2005 and 2009. I was utterly horrified. As Francis made clear, system-wide failings meant these problems weren’t limited to one hospital.
One member of the public wrote to me about what happened somewhere else in a letter that was so shocking I asked to meet her.
She said she visited her late husband in hospital at 5 in the morning and found him naked on a deflated mattress, caked in urine and excrement, and curled in a foetal position with a cold air conditioner blowing directly onto his body. She still has nightmares about that visit. Now that story, thankfully, is far from typical of our NHS.
But I vowed that day that if I did nothing else, I would make sure I returned a culture of compassionate care to every corner of our NHS. Because caring is what the NHS stands for, what every doctor and nurse passionately wants, why the NHS was set up – and what a quagmire of targets, goals and plans too often allowed to be squashed.
Supported by a wonderfully committed ministerial team – Freddie Howe, Norman Lamb, Dan Poulter, Jane Ellison and George Freeman – we’re changing things.
We introduced a tough new inspection regime.
Since then our hospitals have hired over 5,000 more nurses to tackle the scandal of short-staffed wards; 5 hospitals – Basildon, North Lincs, George Eliot, Bucks and East Lancashire – have been put into special measures and been turned round; and patients are saying that they are treated with dignity and respect not just at Mid Staffs but across the NHS the highest numbers ever recorded.
Indeed on Friday of last week the CQC announced the first hospital in the country to get an ‘outstanding’ rating, Frimley Park in Camberley. Chief Executive Andrew Morris is so committed he has been there for 25 years and his son even works there as a porter. Well done to Frimley Park.
Now the problems of poor care highlighted by Robert Francis happened under Labour – so I thought Labour would rush to support me in sorting them out. In fact they did the opposite. They said talking about poor care was ‘running down the NHS.’ They even tried to vote down the law setting up a new Chief Inspector of Hospitals.
I’ll tell you what ‘running down the NHS’ is:
- It’s not learning the lessons when a mother is forced to give birth on a toilet seat, as happened in 2007. Ignored by Labour, being sorted out by us.
- It’s making hospitals Foundation Trusts even when their mortality rates are too high. Brushed aside by Labour, being sorted out by us.
- It’s stopping the CQC telling the truth about blood-stained floors in one hospital. Happened under Labour, stopped by us.
It happened in England before and it’s happening in Labour-run Wales today – so don’t you dare talk to us about running down the NHS.
Because for Labour good headlines about the NHS matter more than bad care for patients – and in our NHS nothing matters more than patients and whilst I am running it nothing ever will.
I simply say this to a Labour Party that still refuses to learn the lessons of Mid Staffs, until you do, you are not fit to run our NHS. And if you won’t put patients first we will – and it will be the Conservative Party that completes Nye Bevan’s vision for an NHS that treats every patient with dignity and respect. We will finish the job.
I could go on with my concerns about the culture Labour left behind in our NHS. But I want to look forward and deal with one of the biggest concerns people have about the NHS which is about funding.
Labour talked about putting in more money last week. But securing the NHS budget isn’t about an extra billion here or there. It’s about funding over £100bn, which is what we spend on the NHS every year. And that needs a strong economy. Because it’s very simple: you can’t fund the NHS if you bankrupt the economy. This parliament we’ve actually increased spending on the NHS by more – in real terms – than Labour promised last week. We’ve done it because of David Cameron’s personal commitment to the NHS and difficult decisions taken by George Osborne.
Other countries followed Labour’s advice. They ducked those decisions. They had no plan – and ended up cutting their health budgets. Italy by 3%, Greece by 14%, Portugal by 17%. I don’t want that to happen here.
So never forget we’ve just had the greatest squeeze on finances in NHS history because a Labour government lost control of our national finances. So to anyone worried about investment in the NHS I say this: a Labour government with reckless economic policies is the biggest single danger to funding our NHS. Do not take that risk. Nor should we forget that every penny of NHS funding comes not from the government but out of the pockets of hard working taxpayers. So if we increase spending on the NHS we must also look every one of them in the eye and promise that every penny is being spent wisely. Which means we mustn’t stop new ideas that come from outside the NHS – whether from charities or, yes, the independent sector.
Labour call this privatisation. But using a charity like WhizzKids to supply wheelchairs to disabled children or using Specsavers to speed up the supply of glasses is not privatisation. When the last Labour government used the independent sector to bring down waiting times that wasn’t privatisation either. So stop scaremongering about privatisation that isn’t happening. It nearly cost us Scotland – and we won’t let it poison the debate in England as well. Secure NHS funding backed by a strong economy is the foundation.
But the building blocks to a modern health service are two things that need real cultural change.
Personal care – a real challenge as patients navigate one of the biggest organisations in the world. And personal control – in a world which has too often said the doctor, not the patient, knows best.
I remember when I did a shift in an A & E last year. A 90 year old lady with dementia was brought in by ambulance after a fall in her care home. She was completely motionless. She couldn’t talk. She couldn’t feed herself or even drink a glass of water. What made it worse was that in that A & E we knew next to nothing about her. We didn’t have her medical record. We didn’t know her allergies. We didn’t know if she was normally able to talk or whether it was just because of the fall. To us at that hospital she was not just unknown. She was anonymous. How could we possibly give her the personal care she desperately needed?
The same could happen to any one of half a million over 90s in our society. And it could happen to anyone with long term or mental health conditions, anyone of whom can find themselves anonymously pushed from pillar to post in a system that doesn’t know who they are. But for me the point of the NHS is to make sure all everyone gets truly personal care from people who know about them, know about their condition, know about their care plan – so that what happened in that A & E never happens again.
As a first step that needs the integration of the health and social care systems. And for the first time ever this year it is happening. 150 local authority areas working together with their local NHS on their Better Care plans to pool commissioning, reduce emergency admissions and share medical records all starting from next April – with many of you in this hall involved.
But truly personal care means more than joining up health and social care. It means personal, responsive care from your GP too.
Last year I manned the phones in a busy London GP practice. The doctors there worked very hard. But what was frustrating was having to tell nearly every caller there were no appointments available for two to three weeks.
We urgently need to make it easier for busy, working people to get an appointment. That means more GPs, so I can today confirm plans to train and retain an extra 5,000 GPs.
But it also means new ways of working. Last year we announced plans for 7.5 million patients to get weekend and 8 till 8 appointments. Today we have also announced we are rolling that out to millions more – meaning this service will be available for a quarter of the whole population. And going even further, I commit that at the end of the next parliament a Conservative government will make sure every NHS patient across the whole country will be able to get weekend and 8 till 8 GP appointments.
But personal care isn’t just about a convenient appointment. It means talking to a doctor who knows about you and your condition.
Astonishingly in 2004 Labour abolished the requirement for every patient to have their own, named, personal GP. At a stroke, many patients were told they no longer had their own GP, but were merely attached to a surgery. And GPs were told they were no longer personally responsible for patients. If you have a chronic condition or complex needs, continuity of care is absolutely vital. You don’t want to have to explain everything about yourself over and over again – and you want a doctor who takes ongoing responsibility for sorting things out – not just that day but every day.
So last year I changed that back for over 75s by insisting they get a GP named on their medical record and responsible for their care. Today I can go further and announce that in the new GP contract for 2015 every single person in England will go back to having a family doctor named on their record and responsible for their care.
Personal care for every NHS patient – delivered by this government. People want personal care. But in the 21st century they want something else. Not just personal care but personal control. People with diabetes, or a heart condition, or recovering from a stroke say the best person to take control of your care is not actually your doctor – it’s you. And right now we make that far too hard. We don’t give people enough information.
So this summer we became the first country in the world to publish detailed information about safety, waiting times, patient experience and food for every major hospital. And on the new MyNHS website we’ll go further.
But it isn’t just information about your local hospital you want, it’s information about you. So today I can confirm that by April next year, every patient in England will be able to access their own medical record online – the first country in the world to take this huge step. It means you will no longer have to pay to access your medical record. You’ll be able to see it and show it to anyone you choose. You’ll find it easier to do detailed research about your condition and easier to challenge decisions. Because the boss is not the doctor – it’s you. Nothing about me without me. Personal control of your health delivered by this government.
Conference my vision is simple. We in this party have always believed passionately we should honour our debt to previous generations. So I want Britain to be the best country in the world to grow old in. I want us to enjoy the fruits of prosperity, yes, but never forget the people before us who’ve worked hard to make that possible. Never forget that all our success, all our strength, all our wealth as a country is but a hollow dream if at the end of it we are not able to give all our citizens the healthcare and support they need in old age. Never forget that it’s not a choice between a strong economy or a strong NHS. You need both and only one party – this party – can deliver both. A strong NHS. A strong economy. From a Conservative party proudly rebuilding a strong country. Personal care. Personal control. For patients treated with dignity, compassion and respect. Delivered by our party. For our NHS. For our country.
The “disastrous” performance of this Tory-led government was not accidental. It was entirely deliberate.
One conversation I once had with Jos Bell (twitter here), an incredibly productive campaigner and chair for the independent Socialist Health Association London division, had much more of a profound impact than I thought at the time.
I simply remarked that the Conservative-led government had been ‘disastrous’.
Jos disagreed. She pointed out that the term of office had gone extremely successfully for the few who’ve made shedloads of money through private equity and hedge funds.
A massive assumption we’re all prone to make, some more than others, is that the political class largely represent us and our interests.
The number of ‘lost votes’ is the reminder to all of us of how disconnected parliamentary politics have become with our needs and concerns.
There are, of course, some truly outstanding MPs, however.
Another realisation for many, almost a right of passage, is the “lightbulb moment” that some leading ‘independent’ health and care think tanks have not been offering useful reliable impartial advice after all.
The performance of some on the issue of competition, a shoo-horn for neoliberal markets, against the wishes of many professionals, is a testament to them.
Dodgy advice was used to prop up the business case for the Health and Social Care Act (2012), and it is going to take a long time to unwind from this.
I know of the misery that the ‘welfare reforms’ have had on the morbidity and mortality of disabled citizens. This does not prevent ATOS from fulfilling a lucrative contract, which was made under the last Government (Labour).
There are accusations and counter-accusations of the effects of injection of private capital, the private finance initiative, which many hope will be addressed properly by the incoming government next year. City financiers and law firms continue to benefit from this sustained policy which has reaped havoc on various ‘local economies’ of the NHS.
The sale of Royal Mail, and various other projects, into the private sector at an undervalue (it is alleged) clearly has not been to the best benefit of the taxpayer. But again many in the City, some alleged to be close to the current Government, have benefited personally (it is alleged).
Through the prism of me and my friends, this Conservative-led Government has been ‘disastrous’. But they’ve actually achieved a lot for themselves in the last few years in the tenuous argument of ‘austerity’.
The buzzword for George Osborne was ‘choice’, and you could hear a pin drop literally at George Osborne’s reassurance in his speech yesterday, “We’re all in it together”.
I simply can’t agree with political commentators who wish to pollute the discussion with their meme that ‘Labour do not wish like a party who wish to govern.”
Many grassroots activists in Labour are desperate to sort out the mess the country finds itself in.
They certainly detest the idea of a Tory-UKIP coalition.
The repeal of the Health and Social Care Act (2012) will be in the first Queen’s Speech of an incoming Labour government.
This Act of parliament turbo-boosted the aggressive pimping of NHS contracts into private sector providers. Correct – another set of beneficiaries from this government, led by the Conservatives but the lifeblood of which is currently provided by the Liberal Democrats.
In many ways, the next period of office is a ‘poisoned chalice’ once again, with debt in the last four years 4 x as much as the debt amassed by Labour in 13 years.
But, to repeat David Cameron, “we can’t go on like this”.
And the goalposts keep on moving.
An identifiable threat still remains having a means-tested social care service bolted onto the ‘universal’ health system, like a badly soldered “lemon car”.
A threat, less visible on the event horizon, is the corporatisation of general practice in the English jurisdiction.
I suspect that, despite the noise produced by UKIP and LibDems, the NHA Party will fail to make inroads in seats in the actual election. This will be of great sadness to me, despite the fact I wish all Labour candidates very well, as they are clearly campaigning on many relevant issues.
I feel that Labour will win the next general election. But I am terrified that, like the aftermath of 1997, it will be another missed opportunity for us.