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Andy Burnham needs a mandate to secure the future of the NHS
The media are obsessed about making immigration a make-or-break issue for political parties. Column inches are devoted to UKIP totally disproportionately to the number of MPs they actually have.
While George Osborne will squeak his aspirations for hardworking people, ‘putting right what so badly wrong’, the country is less than impressed. He will ask for credit while doing his lap of honour, completely oblivious to the cost-of-living crisis forced upon the British public through unfettered privatisation of public services causing distorted competitive markets. However, Osborne doesn’t understand the distress of disabled human casualties at the hands of ATOS. He is instead obsessed by a race to the bottom which has made insignificant progress in tackling corporate tax avoidance. He has made little progress in the exploitation of workers in zero-hour contracts.
It is said that the civil service are already making plans for a Labour government on May 8th 2015. Anyone who has lived through Lord Kinnock asking ‘Are you all right?’ in the Sheffield Rally of 1992 will know not to count their chickens while they are still in the incubator.
Jeremy Hunt’s strategy of trying to frame Andy Burnham for all the woes of the NHS has spectacularly backfired. Hunt, trapped by the legacy of Lansley’s “Health and Social Care Act” which he dares not mention, gets nostalgic about Mid Staffs in the same way that motorway drivers slow down on the opposite carriageway at the sight of a car crash, but he has offered no constructive solutions about how efficiency savings don’t turn into dangerous staffing cuts. Hunt is also spectacularly lacking in insight as to why NHS whistleblowers don’t appear to be protected, despite all the promises. He talks and acts like somebody who has little experience of how the medical and nursing staff do their professional work and seems unconcerned about citizens losing their local hospitals.
The media have also been given a free run in running down the NHS. Memes such as ‘the NHS is unsustainable’ have gone unchallenged remorselessly, with think tanks known to be sympathetic to private health providers offering impassionate advice. The statement ‘the NHS is unsustainable’ has become dangerously confused with the statement ‘the NHS is underfunded’, with NHS Trusts running a deficit more of a sign of the notion we can’t afford the NHS rather than we’re giving it sufficient resources. Once you frame the narrative in these terms, it gets extremely dangerous for right-wing politicians. The debate no longer is about cutting your coat according to your cloth, a phenomenon clearly familiar to people with low incomes, but instead the debate turns into the people with the higher incomes in society not ‘pulling their weight’. The public seem keen to ‘out’ the nonsense of Osborne’s claim “we’re in it together”. And the right – even though there is no evidence that the left believe the opposite – certainly don’t want to go down the road to looking as if they’re unpatriotly running the country down “because we cannot afford it”.
And of course we are never going to be able to trust the Conservative administration when legislation appears from nowhere to implement a £2.4 bn reorganisation. We seem to be able to afford this, and yet we cannot afford a pay rise for the majority of nurses in the NHS. And if we can’t afford the NHS, how come many Trusts are running the bare minimum of frontdoor staff, while millions are returned unspent to the Treasury? Managers might be fulfilling their four hour target but medical teams in the rest of the hospital are left picking up the pieces over investigations not requested or results not followed up. For many, the economy and the cost of living crisis are huge issues. But the NHS also remains a totemic issue for Labour.
Andy Burnham needs to establish a few basic groundrules. He has pledged to repeal the loathesome Health and Social Care Act, and to remove clause 119 ‘the hospital closure clause’. He definitely needs to pledge to make sure that the NHS is not privatised further under his watch. He needs to be unashamed of securing an adequate level of funding, even despite the neoliberal fetishes of austerity currently.
This might stop ill-informed political commentators from spewing out their corporate memes for the duration of a Labour government. But time is running out – for those of us who wish to protect the NHS, we need to stop looking inwards, but need to start campaigning hard.
Can English health policy be advanced through signing petitions?
Today, the intensity of opinions of some parliamentarians in spitting bullets at 38 degrees was incredible.
In case you’ve missed what they were talking about, here it is.
Here was the first blast at ’38 degrees’.
Paul Burstow:I start by acknowledging the receipt of a petition handed to me yesterday, containing 159,000 signatures collected by members of 38 Degrees, expressing their concerns about the matter we are debating today. I know that a great many Members will have received e-mails about that and will have their own opinions, and I want to discuss the issues.David T. C. Davies:Will the right hon. Gentleman refresh my memory? Is that the same pressure group that a few years ago was saying that the NHS was going to be privatised, which is completely untrue, and which a couple of months ago was saying that it was about to be silenced by some Bill the Government were pushing through yet is now very noisily campaigning once again? Surely this cannot be the same completely unreliable group of left-wingers with links to the Labour party, can it?
And then there was more.
I listened with great interest to my hon. Friend the Member for Enfield North (Nick de Bois) but I will be supporting the Government 100% tonight because I have great confidence in what the Government have achieved with the NHS. I say that because I have seen the alternative; I have seen what has happened to the NHS when it is run by Labour, because that is the problem that I and many of my constituents face at the moment in Wales.
My right hon. Friend the Member for Sutton and Cheam (Paul Burstow) came forward earlier with a petition from the left-wing pressure group 38 Degrees. Health campaigners today have been talking today about the amount of salt that we take but one has to take dangerously large pinches of salt with anything that comes out of that organisation. These people purport to be a happy-go-lucky students. They are always on first name terms; Ben and Fred and Rebecca and Sarah and the rest of it. The reality is that it is a hard-nosed left-wing Labour-supporting organisation with links to some very wealthy upper middle-class socialists, despite the pretence that it likes to give out.
It is 38 Degrees who were coming out with all sorts of hysterical scare stories a few years ago about how the Government were going to privatise the NHS. It took out adverts in newspapers, scaring people witless that that was going to happen. Of course the organisation has forgotten all about it now because there was never any intention to do that. We will never privatise the NHS because we believe in public services in this party. A couple of months ago, 38 Degrees came out with more scare stories about how it was going to be gagged because of another piece of legislation that the Government were putting through to bring about fairness in elections. It said that we would never hear from it again, and yet here we are a few months later with yet another host of terrible stories, scaring members of the public quite unnecessarily. I do not think that we have to take any lessons from 38 Degrees, nor hear any more about their petition.
But are petitions are good thing?
Critics of petitions say that petitions are too easy to organise because of the automated nature of mailing lists these days. Because of the ease in producing a petition, it can be easy to inundate people with many petitions, thus making it difficult to work out which are the genuine causes.
Consequently, due to ease of producing petitions, some feel that the volumes of signatures need to be massive before any impact is made.
And even if petitions have a large number of signatories, it can be the case that their effects are short-lived. After amassing many signatures for months for the #WOWpetition, the parliamentary debate was barely covered in the media; and there appeared to be little consequence from it.
Likewise, there was little coverage of the clause 119 debate on the BBC News 24 ‘rolling news’ service. Nonetheless, it did manage to surface as a web news story on the BBC News website.
The frustration for members of the general public is that many parliamentarians don’t appear to be listening.
There’s an inevitability about votes in parliament, where the arithmetic means that votes can be won completely divorced from the quality of the debate.
And parts of the debate were bad. Dr Dan Poulter’s debating content was incoherent, badly structured and full of ectopic odd partisan point-scoring. The style was vulgar and offensive, like a junior doctor presenting a garbled and incoherent history within the constraints of a long medical ward round.
Many Labour MPs, not least the Shadow Secretary of State for Health Andy Burnham MP, were clearly more than mildly irritated at the grotesque depiction of the clause 119 policy as a natural extension of Labour’s policy.
Grahame Morris, MP for Easington, made as ever excellent comments. Along with Andrew George MP, he is on the influential Health Select Committee. And yet Morris was given rather odd replies by Simon Burns MP and Stephen Dorrell MP, head of the said committee, which did not take the debate much further.
Burstow, a Liberal Democrat who is likely to lose his seat in 2015, produced an amendment and withdrew it. But being bought off (not literally) to chair a committee is apparently not uncommonplace for shennanigans such as these.
Jeremy Hunt MP in summing up used the term ‘whole person care’ which could be an unconscious display of waving the white flag when he could have simply said ‘integrated care’.
Throwing forward, it could be that clause 119 in some form could be just what the Dr ordered to facilitate the future reconfigurations necessary for implementation of integrated care in some form.
Patently Dorrell wishes to avoid the term ‘integrated care’, in calling it ‘joined up care’, to avoid any breach of EU competition law.
It’s trite to mention it, but the only petition that really counts is the General Election.
I received a direct message from somebody today to say ‘I am fucking fuming’.
He then asked, “Should I vote Labour or NHA Party?”
As they say – “the choice is yours”.
‘Whole person care’ needs a bit of tinkering and strong leadership
In a now very famous article, “The genius of a tinkerer: the secret of innovation is combining odds and ends”, Steve Johnson describes how innovation must be allowed to succeed in face of regulatory barriers.
“The premise that innovation prospers when ideas can serendipitously connect and recombine with other ideas may seem logical enough, but the strange fact is that a great deal of the past two centuries of legal and folk wisdom about innovation has pursued the exact opposite argument, building walls between ideas”
“Ironically, those walls have been erected with the explicit aim of encouraging innovation. They go by many names: intellectual property, trade secrets, proprietary technology, top-secret R&D labs. But they share a founding assumption: that in the long run, innovation will increase if you put restrictions on the spread of new ideas, because those restrictions will allow the creators to collect large financial rewards from their inventions. And those rewards will then attract other innovators to follow in their path.”
Bundling of goods can offend competition law, so that’s why legislators in a number of jurisdictions are nervous about ‘integrated care’.
In the past, Microsoft has accused of abusing Windows’ dominant status in the desktop operating system market to give Internet Explorer a major advantage in the browser wars.
Microsoft argued bundling Internet Explorer with Windows was just innovation, and it was no longer meaningful to think of Internet Explorer and Windows as separate things, but European authorities disagreed.
There’s no doubt that ultimately ‘whole person care’ will be some form of “person centred care”, where the healthcare needs (as per medical and psychiatric domains currently) are met.
But it is this idea of treating every person as an individual, with a focus on his or her needs in relation to the rest of the community which is the most challenging aspect of whole person care.
Joining up medical and social care with an ‘unified care record’ has never been attempted nationally, but it makes intuitive sense that care information from one institution should be made available to another.
Far too many investigations are needlessly repeated on successive admissions of the same patient, which is exhausting for the person involved. It would make far more sense to have a bank of results of investigations for persons, say who are frail, who are at risk of repeated admissions to acute hospitals in this country.
And this can’t be brought in with the usual haphazard ‘there is no alternative’ and ‘a pause for consultation’ if things go wrong. The introduction of the Health and Social Care Act (2012) and the CareData makes one nervous that lightning will strike a third time.
Labour has had long enough to think about what could go wrong.
Care professions might feel themselves ill-prepared in person-centred care. A range of training needs, from seasoned physicians to seasoned occupational therapists, will have to get themselves oriented towards the notion of a ‘whole person’. This might involve getting to grips with what a person can do as well as what they can’t do.
The BMA will need to be on board, as well as the Royal Colleges. Doctors, nurses, and all allied health professionals will have to double declutch from the view of people as problem lists, and get themselves into a gear about their patients as individuals who happen to be well or ill at the time.
This needs strong leadership, not people proficient at counting beans such that the combined sum total of a PFI loan interest payments and budget for staff doesn’t send a Trust into deficit.
Nor does it mean hitting a 4 hour target, but missing the point as a Trust does many needless admissions as they haven’t in reality fulfilled their basic admissions assessment fully.
For too long, politicians have been stuck in the groove of ‘efficiency savings’, ‘PFI’, ‘four hour waits’, and become totally disinterested in presenting a person-oriented service which looks after people when they are well as well as when they’re ill.
Once ‘whole person care’ finds its feet, with strong leadership and evident peer-support, we can think about how health is dependent on other parts of society working properly, such as housing and transport.
Technology, if this means that a GP could immediately know what a hospital physician has prescribed in real time in an acute admission, could then be worth every penny.
For the last few years, the discussion has centred around alternative ways of paying for healthcare instead of thinking how best to offer professional care to patients and persons.
The fact that this discussion has been led by non-clinicians is patently obvious to any clinician.
Technology also has the ability to predict, say in thirty years, which of the population is most likely to develop Alzheimer’s disease. Do you really want one of your fellow countrymen to have health insurance premiums at sky high because of having been born with this genetic make-up?
A lot of our problems, like the need for compassion, have been as a result of the 6Cs battling head-on with a 7th C – “cuts”. It’s impossible for our workforce to perform well if they haven’t got the correct tools for the job.
Above all, whole person care needs strong leadership, not just management. And if we get it right the NHS will be less focused on what it’s exporting, but more focused on stuff of real importance.
TTIP presents as a crucial test for Labour’s future direction on the NHS
The EU-US (TTIP) trade deal could be worth £67 billion to the EU, and could bring 2 million new jobs to the EU. Here in the UK, it is expected to add between £4 billion and £10 billion a year to our economy. That could mean new jobs for British workers, and stronger, sustainable growth for the British economy. The car industry keeps on bringing up as the poster body for TTIP, but everyone knows there are clear differences.
In Peter Mandelson’s “The Third Man”, Mandelson talks about how his aim was to seek a post-Blair era in leaving a legacy of New Labour. However, he also describes the personal tensions between Blair and Brown. Mandelson felt that there was an inevitability about Labour losing the election in May 2010, but how the mantra “it’s the global economy stupid” might work for Gordon Brown. It didn’t.
The next General Election is due to occur on May 7th 2015. It will be first which Ed Miliband fights. It could also possibly be his last. Miliband is still not ubiquitously popular within his party. If he loses the election, he almost certainly will be ditched by the Party. It would be inconceivable for Ed Miliband to wish to bang on about ‘One Nation’ should the electorate deliver a defeat for his party.
If Ed Miliband loses, there will be a leadership election. Clearly activists, even those who are ambivalent about Ed’s leadership will not wish for anything other than a Labour victory. The chances of a leadership fight, given how time consuming the last one was for Labour, are virtually non-existent. It seems we are ‘nearly there’ with the Labour Policy Review and the Sir John Oldham Commission on ‘whole person care’. It’s unlikely to be as bad as 1983, but who knows. Under Michael Foot, in the 1983 general election Labour had their worst post-war election result.
It is intriguing how much both will have Andy Burnham’s personal stamp on it. Ed Miliband doesn’t wish to commit to the members of his Cabinet, if he were to be elected as Prime Minister. Likewise, there’s a growing feeling that some of the leading candidates, were he to fall on his sword, don’t particularly need his backing. Whether or not Labour can commit to Andy’s hopes would then become irrelevant, unless Andy Burnham becomes a central figure in health after the election. If somebody like Chuka Umunna takes over, what Burnham says now might not matter to an extent.
What Burnham says now can act as a ‘weather vane’ as to the opinions of grasssroots membership of Labour. There has been a growing feeling in this parliament that Labour has acted as a frontman for the corporate establishment. As criticism of monolithic unresponsive outsourcing private providers continues, Ed Miliband may wish to capture on certain elements of left populism, as indeed he did at the Hugo Young Lecture. Miliband has offered to repeal the Health and Social Care Act (2012), and has overall made pro-NHS noises.
There’s no doubt that the Tories are scared of Burnham as a potential returning Secretary of State for Health. When David Cameron first addressed Parliament on the Francis Report, he told MPs that he didn’t wish to seek scapegoats. Despite numerous parts of a ‘smear campaign’ from Jeremy Hunt, with one even culminating in a legal threat from Burnham, Burnham has appeared surprisingly resilient. The only explanation of this is that he still carries with him considerable clout within the Labour Party.
The most notable comments by Andy Burnham in George Eaton’s New Statesman interview were on the proposed EU-US free trade agreeement and its implications for the NHS. Many Labour activists and MPs are concerned at how the deal, officially known as the Transatlantic Trade and Investment Partnership (TTIP), could give permanent legal backing to the competition-based regime introduced by the coalition.
A key part of the TTIP is ‘harmonisation‘ between EU and US regulation, especially for regulation in the process of being formulated. In Britain, the coalition government’s Health and Social Care Act has been prepared in the same vein – to ‘harmonise’ the UK with the US health system. This would open the floodgates for private healthcare providers well known in the US already. Simon Stevens as the incoming head of the NHS will wish not to appear unduly sympathetic, despite his own background with a US healthcare corporation.
When Eaton spoke to Burnham, he revealed that he will soon travel to Brussels to lobby the EU Commission to exempt the NHS (and healthcare in general) from the agreeement. He said:
I’ve not said it before yet, but it means me arguing strongly in these discussions about the EU-US trade treaty. It means being absolutely explicit that we carry over the designation for health in the Treaty of Rome, we need to say that health can be pulled out.
In my view, the market is not the answer to 21st century healthcare. The demands of 21st century care require integration, markets deliver fragmentation. That’s one intellectual reason why markets are wrong. The second reason is, if you look around the world, market-based systems cost more not less than the NHS. It’s us and New Zealand who both have quite similar planned systems, which sounds a bit old fashioned, but it’s that ability of saying at national level, this goes there, that goes there, we can pay the staff this, we can set these treatment standards, NICE will pay for this but not for this; that brings an inherent efficiency to providing healthcare to an entire population, that N in NHS is its most precious thing. That’s the thing that enables you to control the costs at a national level. And that’s what must be protected at all costs. That’s why I’m really clear that markets are the wrong answer and we’ve got to pull the system out of, to use David Nicholson’s words, ‘morass of competition’.
I’m going to go to Brussels soon and I’m seeking meetings with the commission to say that we want, in the EU-US trade treaty, designation for healthcare so that we can exempt it from contract law, from competition law.
Burnham’s opposition to HS2 was also highly significant.
Now it seems, from a totally unaccountable rumour, that Ed Miliband is to veto a policy by Burnham to hand over control of billions of pounds of NHS funding to local councils. Burnham, outlined proposals last year that would have committed a future Labour government to transfer around £60 billion of NHS money to local authorities to create an integrated health and social-care budget. It appears now that proposals have been rejected by both Miliband and Balls. Both men believe that the policy is misguided and would allow the Tories to accuse Labour of imposing another top-down reorganisation in England. Labour will still attempt to integrate health and social-care budgets to provide “whole person care”, but funding is likely to remain within the NHS.
But it is of course possible that Burnham wants increasingly to not pin his personal fortunes to Ed Miliband, but to what he believes in. And Ed Miliband may not necessarily taking Labour in the direction of a NHS relatively free from a ‘free’ quasi-market.
There are particular concerns about the potential implications of a mechanism called Investor-State Dispute Settlement (ISDS), if it is included in the trade agreement. ISDS allows investors to challenge governments in an international tribunal if the government’s actions threaten their investments. There is concern that this could bypass national courts and limit the ability of democratic governments to enact their own policies. This on top of the EU procurement law fixes the domestic government in a rather tight spot, threatening our national legal and political sovereignty potentially.
There are also particular concerns that the ISDS could apply to the NHS. The Health and Social Care Act (2012), widely held to be a ‘vanity project’ from Andrew Lansley but actually legislated by a neoliberal coalition including the Conservative Party and Liberal (Democrat) Party allows American health care companies to compete for and win NHS contracts. There is a risk that if ISDS was applied to the NHS, repealing the Health and Social Care Act could be deemed to be in breach of the free-trade agreement. This would be a catastrophic legacy for Labour to pick up in May 2015, regardless of whether Burnham is in situ. Of course, many hope dearly he will be Labour’s Secretary of State for Health.
Negotiations are still going on, and Labour will continue to pressure the Government to ensure that the agreement does not place undue limits on future administrations. While Labour are in favour of a transatlantic trade agreement, once a draft agreement is reached, a review will be needed as a matter of some urgency.
Andy Burnham MP’s speech in Birmingham on the state of the NHS
Thank you all for coming today.
It’s a sign of how much we value the NHS that you have taken time to come along this morning.
In February 2012, the battle over the Government’s proposed reorganisation was reaching its peak.
There were claims and counter-claims about what it would all mean.
Now, two years on, it’s time to assess what has happened in the two years since and the overall state of the NHS today as we head towards a General Election which will determine its future.
My conclusion is this: the NHS has never been in a more dangerous position than it is right now, and the evidence for that is the relentless pressure in A&E.
The last 12 months have been the worst year in at least a decade in A&E with almost a million people waiting more than four hours.
A&E is the barometer of the whole health and care system and it is telling us that this is a system in distress with severe storms ahead.
A reorganisation which knocked the NHS to the floor, depleted its reserves, has been followed by a brutal campaign of running it down.
It looks to many that the NHS is being softened up for privatisation which, all along, was the real purpose of the reorganisation.
Things can’t go on like this. It’s time to raise the alarm about what is happening to the NHS and build a campaign for change.
The tragedy is that the Government can’t say they weren’t warned.
Even at the eleventh hour, doctors, nurses, midwives and health workers from across the NHS were lining up in their thousands and pleading with the Prime Minister to call off his reorganisation.
Why?
Because they could see the danger of throwing everything up in the air in the midst of the biggest financial challenge in the history of the NHS.
But David Cameron would not listen. He ploughed on regardless.
It was a cavalier act of supreme arrogance.
As the dust settles on this biggest-ever reorganisation, the damage it has done is becoming clear.
The NHS in 2014 is demoralised, degraded and confused.
The last two years have been two lost years of drift.
Even now, people are unsure who is responsible for what.
Two years of drift when the NHS needed clarity.
And what was it all for?
The Government hasn’t even achieved its supposed main goal of putting doctors in charge.
CCGs are not the powerhouse we were promised.
Instead, the NHS is even more ‘top-down’ than it was before, with an all-powerful NHS England calling the shots.
Just look at Lewisham.
When local GPs opposed plans to downgrade their hospital, the Secretary of State fought them all the way to the High Court.
So much for letting GPs decide.
Now the Secretary of State wants sweeping powers to close any hospital in the land without local support. Labour will oppose him all the way.
And the specific warnings Labour made ahead of the reorganisation have come to pass.
First, we said it would lead to a loss of focus on finance and a waste of NHS resources.
An outrageous £3 billion and counting has been siphoned out of the front-line to pay for back-office restructuring – £1.4 billion of it on redundancies alone.
Just as we warned, thousands of people have been sacked and rehired – 3,200 to be precise.
One manager given a pay-off of £370,000 – and last week we learn he never actually left the health service.
It is a scandalous waste of money and simply not justifiable when almost one in three NHS trusts in England are predicting an end-of-year deficit.
Cameron promised he would not cut the NHS but that is precisely what is happening across the country as trusts now struggle to balance the books.
2,300 six-figure pay outs for managers; P45s for thousands of nurses – that’s the NHS under Cameron.
What clearer sign could there be of a Government with its NHS priorities all wrong?
Second, Labour warned that the reorganisation would result in a postcode lottery.
Last week, a poll of GPs found that seven out of 10 believe rationing of care has increased since the reorganisation.
NICE has warned that patients are no longer receiving the drugs they are entitled to and has even taken the unusual step of urging them to speak up.
New arbitrary, cost-based restrictions have been introduced on essential treatments such as knee, hip and cataract operations – leaving thousands of older people struggling to cope.
Some are having to pay for treatments that are free elsewhere to people with the same need.
Cameron’s reorganisation has corroded the N in NHS – again, just as we warned.
Third, we warned that rhetoric about putting GPs in charge was a smokescreen and the Act was a Trojan horse for competition and privatisation.
Can anyone now seriously dispute that?
Last year, for the first time ever, the Competition Commission intervened in the NHS to block collaboration between two hospitals looking to improve services.
How did it come to this, when competition lawyers, not GPs, are the real decision-makers?
The NHS Chief Executive has complained that the NHS is now “bogged down in a morass of competition law”.
Since April, CCGs have spent £5 million on external competition lawyers as services are forced out to tender.
And it will come as no surprise that, since April, seven out of 10 NHS contracts have gone to the private sector.
Who gave this Prime Minister permission to put our NHS up for sale, something which Margaret Thatcher never dared?
The truth is that this competition regime is a barrier to the service changes that the NHS needs to make to meet the financial challenge.
It is sheer madness to say to hospitals that they can’t collaborate or work with GPs and social care to improve care for older people because it’s “anti-competitive”.
If we are to relieve the intense pressure on A&E, and rise to the financial challenge, it is precisely this kind of collaboration that the NHS needs.
So the summary is this – the NHS has been laid low by the debilitating effects of reorganisation, has been distracted from front-line challenges and is now unable to make the changes it needs to make. It is a service on the wrong path, a fast-track to fragmentation and marketisation.
It lost focus at a crucial moment – and is now struggling to catch up.
The evidence of all this can been seen in the sustained pressure in A&E – the barometer of the NHS.
The price we are all paying for the Prime Minister’s folly is a seemingly permanent A&E crisis.
Hospital A&Es have now missed the Government’s own A&E target in 44 out of the last 52 weeks.
This is unprecedented in living NHS memory – a winter and spring A&E crisis was followed by a summer and autumn crisis. The pressure has never abated.
The reorganisation has contributed very directly to this A&E crisis.
Three years ago, the College of Emergency Medicine were warning about a growing recruitment crisis in A&E but felt like “John the Baptist crying in the wilderness” as Ministers were obsessing on their structural reform.
The very organisations that could have done something about it – strategic health authorities – were being disbanded. Just when forward planning was needed, we saw cuts to training posts.
All this leaves us with an A&E crisis which gets worse and worse.
Of the one million people who went to a hospital A&E this January, 75,000 waited longer than 4 hours to be seen.
Of the 300,000 people admitted to hospital after going to A&E, 17,500 had to wait between 4 and 12 hours on a trolley before they were admitted.
On one day in January, 20 patients were left on trolleys for over 12 hours.
In the last year, ambulances have been stuck in queues outside A&E 16,000 times – leading to longer ambulance response times.
On 92 occasions, A&E departments had to divert ambulances to neighbouring hospitals because they were so busy.
And now the pressure from the A&E crisis is rippling through the system.
In January, over 4,500 planned operations were cancelled – causing huge anxiety for the people affected.
The waiting list for operations was the highest for a November in six years.
The truth is that the Government have failed to get the A&E crisis under control and it is threatening to drag down the rest of the NHS.
They have desperately tried to blame the last Government’s GP contract – it’s never their fault, of course – but the facts shows an exponential increase in A&E attendance since 2010.
In the last three years of the Labour Government, attendances at A&E increased by 16,000.
In the first three years of this Government, attendances increased by 633,000. No wonder we have an A&E crisis.
The question we need to ask is: why, behind the destabilising effect of reorganisation, has there been such an increase?
I see three reasons – all policy decisions taken by David Cameron.
First, David Cameron has made it harder to see your GP.
He scrapped Labour’s guarantee of an appointment within 48 hours.
Now, the story I hear up and down the country is of people phoning the surgery at 9am only to be told there is nothing available for days.
The Patients Association say that it will soon be the norm to wait a week or longer to see your GP.
What will they do? Go to where the lights are on – A&E.
We have called on the Government to reverse their scrapping of the 48-hr target this winter.
The problem is made worse by the scrapping of Labour’s extended opening hours scheme.
Now hundreds fewer GP surgeries stay open in the evening and at weekends – taking us backwards from the seven day NHS we need.
To make matters worse, a quarter of Walk-In Centres have closed and NHS Direct has been dismantled.
A terrible act of vandalism even by this Government’s standards – nurses replaced by call-handlers and computers that say ‘go to A&E’.
The second reason for the sudden increase in people attending A&E is cuts to social care and mental health.
Under this Government, almost £2 billion has been taken out of budgets for adult social care.
Compared to a decade ago, half a million fewer older people are getting support to help them cope.
We have an appalling race to the bottom on standards with 15-minute slots, minimum wage pay, zero hours contracts.
Over-stretched care workers, often not paid for the travel time between 15 minute visits, having to decide between feeding people or helping them wash.
Social care in England is on the verge of collapse – and yet last year Jeremy Hunt handed back a £2.2bn under-spend to the Treasury.
That’s unforgiveable when care is being taken away from vulnerable people.
If Labour were in Government now, we would be using the NHS underspend to tackle the care crisis this year.
Instead, older people are being allowed to drift towards A&E in record numbers – often the worst possible place for them.
A recent Care Quality Commission report found avoidable emergency admissions for pensioners topping half a million for the first time – and rising faster than the increase in the ageing population.
Terrible for older people, putting huge pressure on A&Es and costing around a billion pounds a year.
But other vulnerable people are suffering too.
The Government is cutting mental health more deeply than the rest of the NHS.
Some mental health trusts are now reporting bed occupancy levels of over 100%.
That means more than one patient being allocated to the same bed.
It’s no wonder we’ve heard growing evidence of highly vulnerable people being held in police cells or ending up in A&E because no crisis beds are available.
Under this Government, A&E has become the last resort for vulnerable people
And this brings me to the third reason for the pressure on A&E – the cost-of-living crisis.
As Michael Marmot set out in his seminal public health report, our health isn’t just about our health services, but the kind of society in which we choose to live.
No phenomenon more clearly symbolises the true impact of this Government than the rise of food banks, teachers having to feed hungry children at school or GPs having to ask their patients if they can afford to eat.
And all this while millionaires get a tax cut.
We have seen diseases of malnutrition like scurvy and rickets on the rise – diseases we once thought had gone for good.
Today we are exposing another scandal that goes right to the heart of whose side this Government is on.
People are struggling to keep warm in their homes.
The average energy bill has risen by more than £300 since 2010 – while the support for people in fuel poverty has been cut considerably.
The Government replaced 3 successful Labour schemes- warm front, community energy saving programme and carbon emissions reduction target with their ECO scheme.
And the consequence is that just a fraction of households have received help in the past year, just when the support is most needed.
I don’t see how it can be right that money from all of our energy bills should subsidise people who can afford to improve their properties, over those people in dire fuel poverty.
We’ve seen record levels of hypothermia reported this year.
Since the election there has been a dramatic increase in the number of older people admitted to hospital for cold-related illnesses.
There have been 145,000 more occasions when over-75s had to be treated in hospital for respiratory or circulatory diseases than in 09/10.
This is the human cost of this Government’s cost-of-living crisis and their failure to stand up to the energy companies.
And why Labour’s energy bill freeze cannot come a moment too soon.
In conclusion, this is the fragile state of the NHS and the country after almost four years of Tory-led Coalition.
The country can’t go on like this – the NHS needs a different Government.
Cameron’s Government has delivered it a brutal double whammy.
First they knocked it down the NHS down with a reorganisation no-one wanted. Then they have spent the last year running it down at every opportunity.
They are guilty of the gross mismanagement of the NHS.
But it is not just incompetence. They are running it down for a purpose.
Only yesterday, the head of the independent regulator attacked the NHS and called for more privatisation.
This was an astonishing intervention at a time when politicisation of regulators is so high in the news.
To have the independent regulator making such a political statement means there can no longer be any doubt – more privatisation is the explicit aim of this Government’s NHS policy.
Labour believes this will break up the NHS and bring fragmentation when what the NHS desperately needs is permission to integrate and collaborate.
That is why this Wednesday we will force a debate in the Commons on the A&E crisis and repealing the Government’s competition regime.
This is the choice the country faces – a public, integrated NHS under Labour or a health market under David Cameron.
That’s the ground on which we will fight in 2015 and, for our NHS, it’s crucial that we win.
Are Andy Burnham and Alan Milburn ‘in it together’?
When people come to vote for Labour on May 7th 2015, they’ll possibly be thinking of getting rid of this current government. There are various factors which might be important such as ‘the cost of living crisis’, but it’s quite possible there could be a strong anti-privatisation of the NHS contingent.
Tony Benn was last in office in the Department for Trade in 1979, and strictly speaking another Tony, Tony Blair, was the first elected Labour Prime Minister in the UK since October 1974. Benn does raise an interesting hypothesis of how people vote, in his latest (and last) set of diaries entitled, “An autumn blaze of sunshine”. He feels that people vote Labour when they get fed up of the Tories, to feel ‘less bad’ about voting for Tory policies; and after a while, they revert back to the Conservative Party. Benn’s thesis is that the two main parties are now essentially in the same. And to give him credit, Benn forecast the current Coalition long before it happened. Whilst generally quite critical of Gordon Brown and Tony Blair, there was a glimmer of optimism towards the end.
In a passage where Tony Benn is talking about the public opinion turning against railway privatisation (signposted by how Mandelson had to postponing the privatisation of the post office and pull out of a rail franchise):
“I can see a possibility Labour might win… Public opinion is very volatile… Cameron and Clegg are so ineffective… But when I look at people like John Reid and Patricia Hewitt and others, who held offices in government, and who are now working in companies engaged in government contracts and privatisation, it’s very revolting.”
(Tony Benn, “An autumn blaze of sunshine”)
It’s possible that the differences in approach of two former Secretaries of State for Health for Labour, Alan Milburn and Andy Burnham MP, have been exaggerated. However, it is still easy to underestimate how Burnham’s ‘NHS preferred provider’ places a wedge between him and Milburn, although the general assumption of the market may still be in place due to globalisation and the US-EU free trade treaty. It is likely that the two personalities largely agree on the ‘efficiency savings’, all but cuts in name. But certainly who wins out on the ‘NHS preferred provider’ could be symptomatic of what sort of Labour Party Ed Miliband wishes to lead. Tony Blair was generally considered to have brought Labour much more to the Thatcherite fold on the importance of the market compared to the State.
Ed Miliband, whose mother is well known to be good friends with Tony Benn, thus far has indicated that he wishes to challenge the Hayekian notion of the market being ‘liberalising’. Miliband in his first conference speech which was virtually ubiquitously panned also criticised ‘predators‘, presumably an attack on ‘quick buck’ hedge funds which are known to have lobbied aggressively for the Health and Social Care Act (2012). Miliband likewise in ‘One Nation’ has purported not to give any one ‘vested interest’ undue prominence, but this could mean restoring some value for workers including nurses which form the “backbone” of the NHS. Burnham, to give him credit, has argued that he wishes to move towards a society where carers are valued, rather than promoting the shareholder dividend of the directors of the large corporations than can provide them. You can probably run the NHS without hedge funds (though hedge funds will wish to argue that they play a critical rôle in the ‘sustainability’ of the NHS), but it would be impossible to run the NHS without nurses (whether unionised or not.)
In the 2010/11 Operating Framework, Andy Burnham said that the NHS would have to make the £15-20bn “efficiency savings” over four years. These efficiency savings had been previously identified by McKinsey. When Lansley took over the NHS the “efficiency savings” became £20bn over five years (or £4bn a year for each of the five years). We happen to know that attempts by government to make “efficiency savings” have always failed to hit their target.
Nick Timmins in October 2009 wrote an article in the BMJ which could turn out to be quite important in the months ahead for Labour. This was when Andy Burnham proposed that NHS organisations would now be the “preferred provider” of NHS care. Significantly the announcement was welcomed by the health service unions, including Unison, the BMA, and the Royal College of Nursing, in fact generally the same parties which were about to be disenfranchised in the discussions over the Health and Social Care Bill (2011), aka the Lansley Vanity Project (2011). However, it had produced a rather different reaction among private providers of NHS care, whose representatives included the “NHS Partners Network”, described it as “completely irresponsible.”
Burnham’s initial announcement about the “preferred provider” policy came in a speech in 2009 to the healthcare think tank the King’s Fund but fuller details were subsequently out in a letter to Brendan Barber, the then general secretary of the Trades Union Congress. According to the preferred provider guidance, NHS organisations must be given “at least two” formal chances to improve where they are underperforming. Even then, alternative providers should be considered only where the continuing underperformance is “significant.” Where incremental improvements in services are sought, existing staff should be given “at least two” chances to provide an acceptable service plan before any move to put the service out to alternative providers. Even then, clinical or safety issues may warrant an “NHS only” tender. It was hypothesised that staff and existing organisations should be engaged early and should help to design any new or important change of service. The BMA said the change was “a very positive sign” that the government was listening to its concerns about the increasing commercialisation of the NHS. Unison welcomed it as “a significant policy shift”.
Alan Milburn, the former Labour health secretary who introduced independent sector treatment centres and patient choice in the NHS, said, “This is a retrograde step. If you are going to drive productivity and quality on the scale required [given the financial challenge the NHS is about to face], the last thing you do is renew a monopoly and say your existing provider is your preferred one.” He said that the NHS needed “not less competition but more” and that the move signalled that Labour was going soft on NHS reform. And we all know what happened next, with the Government throwing in section 75, the vehicle for outsourcing NHS services, into the mix like a policy hand grenade. He warned that failing to accelerate the pace of NHS reform will put frontline services at risk.
Milburn is of course one of the grand architects of the 2000 NHS Plan, under which private sector providers were welcomed, calling for state control over the NHS to be reined in. He said: “The NHS is in transition between a 20th century model of state control and monopoly provision and…a different model where the citizen has more control. The policy question is whether that journey is going to be finished or truncated. We have to take it to its final destination.” Wind the clock on a few years, Simon Stevens, a one-time Blairite health advisor and co-architect of this plan, was announced as the new chief executive of NHS England. He himself advised Milburn before leaving England to join US healthcare giant UnitedHealth.
Milburn in December 2011 said “it was depressing to hear Labour people defining themselves not against the government but the previous Labour government“. Speaking to the pro-market thinkthank Reform, Milburn called for “more competition and new entrants into the NHS” and said the two shadow health spokesman since the election defeat – John Healey and Burnham – were making a “fundamental political misjudgement” by attempting to roll back Labour’s previous policy on the NHS.
And it’s impossible to fail to be touched by the hand of the multinational corporations upon us (perhaps.) Earlier last century, amidst an equally disastrous global financial crash, Britain itself followed the depreciation of sterling with higher tariffs. In November 1931, it enacted an Abnormal Importation Duties Act which gave the authorities discretion to impose higher duties on selected goods. In February 1932, Parliament passed the Import Duties Act imposing a 10 percent across-the-board tariff on imports, with additional restrictions on certain imports and exemptions for imports from the empire.
Seventy years later, the collapse of world trade in 2009 was associated with significant part to a sharp fall in consumer confidence in most western economies. In previous economic downturns, most notably the 1930s Depression, a fall in the level of trade was also related to the use of import tariffs and quotas by many countries. In a situation where the economy remains depressed for a period of time, governments feel that they need to make sure that whatever consumer spending there is goes on domestically produced goods. Several recent reports have however pointed to rise in the use of measures such as import tariffs, exchange controls and import licenses by major trading blocs. Economic history overall perhaps suggests that wholesale recourse to tariffs and quotas is likely to prolong the world economic downturn, however, so while such measures might be politically popular at home, they are unlikely to make much of a positive contribution to economic growth. Labour currently seem to wish to change the narrative away from the macroeconomic issue of growth per se, but for many people the cost of living is the totemic issue of the cost of living, and indeed the economy. And it’s possible that other factors, such as the ‘right’ of the Tory Party and UKIP might be the anti-immigration force leading domestic politics (while Labour wishes to appear to strong on the abuse of multinational-corporations of workers below the national living wage to be enacted.)
Quite on the sly, with all the broohaha about privatisation of the NHS, the US-EU free trade negotiations appear to have gone relatively unnoticed. Not everyone is convinced of the benefits of free-trade, however. The centre-left think-tank, Compass, had argued that the fundamental cause of most of the economic ills in the UK, such as the much discussed squeezed-middle, is in fact globalisation. Although the argument that free-trade increases the overall value of economic output is convincing, economic evidence has revealed relatively little about how the gains from trade are distributed (to governments, corporations, and households, for example). Many economists have argued that globalisation has reduced the demand for labour and wages in in the UK and US, particularly for workers with less specialised skills. This might be directly through immigration or indirectly through trade and capital mobility.
A US/EU Free Trade Agreement, as publicly announced, will “dismantle hurdles to trade in goods, services and investment” and “make regulations and standards compatible on both sides”. The agreement is meant to give transnational corporations a level playing field, both in the trade of goods and in the provision of services. Rules must be the same for everyone, to avoid any extra cost or “import tax” for foreign providers. If a corporation thinks that a government or body is limiting their ability to profit, it can take legal action against them. The idea that the Health and Social Care Act (2012) was developed to allow foreign transnational corporations to profit from NHS privatisation is pretty unpalatable for some; but for others it reinforces the idea that ‘I don’t care who provides high quality care as long as it’s free at the point of need‘. Non-socialists argue that the State should not necessarily have a monopoly on NHS services; socialists will argue that leaving it to a market can only encourage cherrypicking and accelerated rationing, totally defeating the purpose of the NHS as comprehensive and universal.
Earlier this month, it was reported that New Labour “grandees” Alastair Campbell and Alan Milburn, as well as a batch of other advisers from the Blair and Brown eras, were to make a dramatic return to Ed Miliband’s general election team, according to a top-secret memo obtained by the Observer. The document – Proposed General Election 2015 Meeting Structure – drawn up in the office of Douglas Alexander, chair of campaign strategy, will infuriate many on the party’s left, who believed that Miliband had moved on from New Labour’s approaches to campaigning and policy.
It is of course perfectly possible that neither Alan Milburn nor Andy Burnham wish to have a big “bust up” over future Labour policy, arguing that there is much more in common between them. Andy Burnham clearly wants to get on with ‘whole person care’, bringing social care up to standard of what he considers to be reasonable for a social care service. Governments of whatever colour will have to implement coherent policies on patient safety, workforce performance management, financial budgeting and dynamic reconfiguration of primary and secondary care. It’s going to be a tough ask to require Alan Milburn and Andy Burnham to match the titanic reputations of Stafford Cripps, Aneurin Bevan, Clem Attlee and Tony Benn, but they’re going to have to have a go at the very least.
Jeremy Hunt fiddles while Rome or A&E burns, and a smear campaign continues
There is nothing as inevitable as death and taxes, apart from Channel 4 ‘scoops’ on the NHS and Conservative smear campaigns against Andy Burnham.
Ed Miliband’s narrative in the last few weeks or so has been about ‘facing up to bullies’. In this context, it is hard to imagine that he is going to reshuffle Andy Burnham MP out of Health. It is well known that Burnham knows this brief backwards, and is considering how to throw forward the issues about NHS financing with introducing innovative ‘whole person care’ to remould the design of primary and secondary care services.
You would have thought that Channel 4 and the Conservative Party would be more interested ‘in the national interest’ about the fact that cuts in the NHS are leading to over-pruned staff, and this can risk patient care. You would have thought that they would have been interested in a debate about a £3bn top-down reorganisation and £2bn ‘efficiency savings’ pumped back to the Treasury (not frontline care). This issue of pay unsurprisingly has demoralised NHS staff in comparison to NHS managers who have received a formidable pay increase.
This has struck a raw nerve with some people especially:
It is all part of a relentless campaign of attacks on the NHS, in the name of ‘investigative journalism’ where the evidence is either missing or distorted to suit the purposes of the broadcaster.
Dr Jacky Davis said of the previous Channel 4 programme, not the report last night, on the “Our NHS” blog:
On September 11th Channel 4 news broadcast a lengthy piece on the NHS, ominously entitled ‘Death on the Wards’. It presented new figures from Professor Sir Brian Jarman about alleged high mortality rates in UK hospitals. There was a clear intention to shock the viewers. The ‘s’ word was repeatedly used by the two presenters and after describing Jarman’s figures as ‘absolutely shocking’ Victoria Macdonald then attempted to put the words into the mouth of Sir Bruce Keogh (Medical Director of the English NHS) when she asked him ‘When you saw those data were you shocked?’ To his credit Sir Bruce sensibly claimed that he needed ‘to think about it’, a basic precaution that the broadcasters would have done well to emulate.
The piece was peppered with worrying claims including one that ‘the NHS is fundamentally failing’ along with claims about patients’ likelihood of dying in a UK hospital as opposed to one in the USA. Finally the presenter compared the average UK hospital with the Mayo Clinic in the US (one of the world’s most prestigious hospitals with an annual revenue of over $8 billion) without any suggestion that comparing a Mini to a Rolls Royce might be ingenuous at best and negligently misleading at worst. This was followed by a panel discussion involving Professor Jarman, Tory MP Charlotte Leslie and [Corrected: this should have read a 'a representative'] of Cure the NHS which was set up after the Mid Staffs disaster. Not a single person to speak up for the NHS or question the data.
Instead, all of this gives an appearance of a message which is being controlled very strongly from Conservative Central Office, though media outlets will of course strongly deny this. Many viewers are sick of reporting of this which is either inaccurate or misses out half of the relevant evidence, with the obligatory appearance from Brian Jarman whose research has been strongly criticised in the medical press. It is common knowledge that the BBC is accused to have devoted hardly any time to accurate, complete and balanced reporting of the acceleration in NHS privatisation, as shown in minimal coverage of a rally in Manchester recently which had attracted 60,000 people.
And yet the true facts are disgusting as to what has actually happened to acute care under this Government’s watch. The number of A&E units missing targets has trebled in a year, as the Government was accused of presiding over an unprecedented “summer A&E crisis”. Between July and September, 39 departments failed to meet the Government’s key target of seeing 95 per cent of patients within four hours, new quarterly figures from NHS England show. Last year only 14 units missed the target for the same period.
It is reported that the Shadow (and former) Health Secretary “Andy Burnham is facing calls to quit after claims he tried to “block” the publication of a devastating report into hospital neglect before the last election”, but in fact these “calls” have come from Tory MPs and a very unpleasant media campaign from certain recurrent protagonists in the media. Nothing would give these people greater delight than ‘gaining a scalp’ when they should be sorting out the mess of service provision of acute medical care in England.
It is also reported that, “Britain’s most powerful civil servant Cabinet Secretary Sir Jeremy Heywood was last night examining whether he needs to set up a Whitehall investigation into whether civil servants breached their code of conduct.”
However this is only because he has been written to. If Heywood has read the letter, he will indeed be considering this issue. He has not decided to investigate this issue yet.
A set of emails were released after Conservative MP Stephen Barclay made a Freedom of Information request to the Care Quality Commission, relating to the Basildon and Thurrock University Hospitals NHS Foundation Trust. Barclay has campaigned on this issue vocally in the past (see for example his article in the Telegraph “The only way to cure the NHS is to change the way we police failures”). The terminology of “cure the NHS” is also striking given the name of the campaigning group “Cure the NHS“, the leader of which was indeed cited by Jeremy Hunt in parliament in one of his numerous speeches demoralising current staff in the NHS. This patient campaigning group – like Channel 4 and the BBC – has also been keen in the past to quote Brian Jarman’s statistics which have received widespread criticism in the academic press. Mid Staffs Foundation Trust is now set to ‘dissolve’. All the sensationalist bravura has actually achieved absolutely nothing in itself.
The awful spectacle of this whole political debacle is that in English health policy this is all incredibly important. Phil Hammond (GP not Secretary of State for Defence) and Heather Wood have both been instrumental in bringing to the fore what had tragically happened to this Trust, and what does need to be remedied in parts of the NHS, for example.
Isabel Hardman, in a narrative which now sounds like intensely boring stuck record, reports that:
The knives are clearly out for the Shadow Health Secretary – and if MPs are calling for him to resign just before a reshuffle, it suggests they want to leave him wounded in the run-up to the 2015 election, rather than leave his post.”
But reporting malicious gossip rather than English health policy is clearly not going to benefit the patients of NHS England.
The problem, is that the central claim – that Burnham himself personally engaged in a ‘cover up’ – might well be potentially legally defamatory on the balance of probabilities under English law.
On the information publicly provided by Andy Burnham in a ‘Labour List’ post, provided as he was totally fed up with the gun-ho nature of the smears, it appears that there is prima facie no evidence of a cover-up. There is only evidence that there was anger at CQC/DH protocols not being observed. (THIS IS NOT AN OFFICIAL LEGAL OPINION).
Indeed, there are wider issues about the legitimacy of the need to publish potentially defamatory information in such a hurry, ahead of a reshuffle, under the “Reynolds Criteria”.
But there is currently a long-running dispute in the law whether such comments should be covered by defences such as legal parliamentary privilege. Hence Burnham’s litigation experts are asking Jeremy Hunt to ‘put it to proof‘.
A Conservative health spokeswoman, and countless people in the past ad nauseam, is reported to have said there was “overwhelming evidence that Labour ministers leant on the quality watchdog to tone down and cover up NHS failure for political purposes”.
In the absence of knowing what the civil service were ‘up to’ at the time (and many of these staff might have moved on) at the Department of Health, it is actually impossible to make this claim.
The irony is that, when the PM addressed Parliament originally over the Francis Report into Mid Staffs, he said categorically that he ‘did not want scapegoats’, despite patient campaigners having a hit list or ‘wall of shame’ of those people which they wished retributive justice to be administered on.
In his centrepiece Conservative party conference speech this week, Hunt lambasted Burnham for “covering up” poor care during his time as health secretary yet again despite the fact these smear tactics have failed to impact any polling on the NHS for Labour and the Conservatives. And in the meantime performance of A&E actually has been reported to deteriorate.
Hunt repeated the narrative of Channel 4, in regurgitating Jarman’s statistics which many have panned in the academic press, and ratcheting up the pace on Twitter. It has long been appreciated he does his own tweets, in the same way that Andy Burnham does.
Burnham insisted that those “damaging emails” showed only that he was concerned that rules about disclosure had been broken.
In a furious open letter, Burnham wrote:
It is impossible to see how you can claim this mounted to a cover-up. I therefore ask you, by the end of today, to provide me with evidence to substantiate your assertion.If you fail to provide such evidence, I will require a full retraction and public apology. If that is not forthcoming I will consider further action.
However, Baroness Young, who is now chief executive of Diabetes UK, last week was at the Conservative Party conference in Manchester, and responded to Mr Hunt’s claim at a debate held by the think tank “Reform”:
BY:
“I just want to put the record straight because within your speech today, Jeremy, particularly the press release that accompanied it, you continued to misrepresent my evidence to the Francis inquiry and to misrepresent that the situation the letter from Andy Burnham to me and I really am very angry about it.
“I have already written to you and the prime minister previously to point out the fact that the way that you are abusing my evidence to the Francis inquiry in a partial manner misrepresents entirely the situation that existed at that time.
“I think it’s unfortunate that you’ve used a partial quote from me to imply that the CQC was pressurised into concealing this because it simply was not the case. If I was pressurised at all either politicians or by civil servants it was about the process by which CQC went about its regulatory work. At no point was I ever asked to or indeed did tone down the evidence. I really do find it very unsatisfactory on a number of counts that this continues to be pedalled in public and in newspapers. I’m not sure what it is that you don’t understand about me saying I was never put under pressure to subdue the findings of the CQC as a regulator.
“The most distressing part of this is that we are constantly harking back to what the political classes were doing rather than looking forward and giving CQC and others involved in healthcare as much support as possible in improving and building on the problems of health systems rather than constantly undermining the work that was done in the past.”
JH: “I really do need to respond to that. Do you have the words that you said under oath to the Francis inquiry?”
BY: “I have a full copy of the Francis inquiry.”
JH: “Will you read out the words you said to Francis inquiry.”
…
BY: “I was paraphrasing the best bit about the pressure coming from civil servants rather than ministers and I’m now quoting ‘it was primarily because what we wanted to do (ie our regulatory processes) not so much what we wanted to say because I don’t think we were really under a lot of pressure not to say things’. That cannot be clearer, that was from my Francis evidence a long, long time before this hoo-ha arose.”
JH: “First of all I think it was deeply wrong that you should have been under pressure from civil servants, who are under the orders of ministers, in terms of what you do in connection to the whistleblowing issue.
None of this is helping with the morale at the current situation in Staffordshire, especially with regards to recruiting excellent staff to work in their units. Mid Staffs and surrounding areas have also in the meantime embarked on successful programmes of cultural change, and therefore this slamming of Mid Staffs in the media can only be seen for petty nasty electoral reasons. And, most significantly, many people in Staffs themselves are now very upset. It is said that Sir Hugo Mascie Taylor, involved in the current Staffs reconfiguration, has repeatedly made the point that the key reason for the propsals to change services here are because of the reputational damage inflicted on Mid Staffs, and the way this has made recruitment more difficult.
It also very much emerges that, if there is anything to investigate, it is the civil service culture of the Department of Health. And meanwhile none of this helps the current crisis in A&E. Despite the government’s pledge to protect frontline services with real-terms increases in funding, Monitor, the NHS watchdog, has proposed that in 2014-15 hospitals should be paid 4% less for operations than they were the previous year. While hospitals were braced for a cut of about £1bn in funding, the Foundation Trust Network, which represents all 160 hospital trusts in England, calculates that Monitor is now asking for another £500m in savings – roughly £3m from each trust.
Chris Hopson, chief executive of the Foundation Trust Network, said cuts to frontline services would be deeper than expected and questioned whether the NHS could invest in much needed changes to the way hospital services work, as had been recommended by the Francis report into failings at Mid Staffordshire NHS Trust. The need to correct funding shortfalls was also identified in the Keogh report on mortality, recently, in 14 NHS Trusts. Indeed, countless studies have shown a link between unsafe levels of staffing and poor patient safety, and this is the real debate. He is quoted as follows:
The level of efficiency savings the NHS has delivered over the last three years is unprecedented, but this level of performance cannot be sustained year on year till 2021. We need a reality check here – in the end you get what you pay for, and trusts can’t perform miracles out of thin air.
And actual staff are totally sick of it all now.
The head of health at the union Unite, Rachel Maskell, is reported to have said:
Jeremy Hunt is responsible for either undermining the Treasury position or trying to act in an even more draconian way than the Treasury with regards to staff who work across the NHS. He blames the staff on a regular basis; now he wants to further cut their terms and conditions.
Mark Porter, chairman of the BMA Council, is also reported to have said:
Doctors fully recognise the economic constraints the NHS is facing, but for the government to imply that unless NHS staff endure what is effectively another year of pay cuts they will put patient safety at risk is insulting at best, given doctors are working harder than ever before and have borne the brunt of the government’s efficiency drive.
Correction: Perhaps some other things are inevitable after all. The NHS ‘efficiency drive’ will continue, the smear campaign against Andy Burnham will continue, the malaise over what is happening to the NHS will continue for a bit, Brian Jarman’s methodologically problematic weak statistics will continue to get quoted on the BBC and Channel 4.
But – in a latest twist to the story, Andy Burnham’s (Labour) lawyers are completing the pre-action protocol for civil litigation against Jeremy Hunt on the law of the tort of defamation under English law.
If this all proceeds to formal legal proceedings, I will not be able to make any comment on it.
And Andy Burnham will still be in a job.
How a fairly standard hate campaign against Labour and Andy Burnham on the NHS went so badly wrong
Andy Burnham in Willow Park Housing Trust
I am not even a hard-core ‘activist’ of Labour, whatever that is. I do nonetheless find it highly amusing how a pretty bog standard hate campaign against Labour and Andy Burnham MP, former Secretary of State for Health and current Shadow Secretary of State for Health, went so badly wrong. Isabel Hardman from the Spectator recently remarked that Andy Burnham MP is driving the Conservatives potty. Nothing would give the Conservatives greater satisfaction than to achieve the Burnham scalp, but the fundamental problem is that the facts keep on getting in the way of this hate campaign. Burnham, unfortunately for them, has considerably more experience than his counterpart, who is currently Jeremy Hunt. Burnham does not fit the mould either of someone who looks as if he wishes to work for a private equity fund when he’s more ‘grown up’. Burnham firmly believes in the founding principles of the NHS, and ideologically he is desperate to unwind the marketisation of the NHS. He wishes to make a break from the past, and “good for him”, many will say. He is in fact one of Labour’s biggest assets in the party as a whole, and has even put his neck on the block to say constructively why Labour might need to up their game to be guaranteed of a good working majority. Labour can win a massive majority on the back of their policy in the NHS, as indeed the 1997 Blair victory, helps to demonstrate. As in all of medicine, it has to make an accurate diagnosis of the problem before putting in a coherent management plan. The argument against the markets, which can drive up shareholder dividend at the expense of patient care and which introduces a level of inefficiency and waste such that an estimated 31% of the budget will now be going on admin. and wastage (as beautifully articulated by the Himmelstein and Woolhandler papers), has been won. The need to encourage collaboration and the dignity of clinical staff cannot be underestimated. The Conservative Party have failed miserably on the NHS, and it is for this fundamental reason why they will ultimately become unstuck on May 8th 2015.
The problem with the Conservative HQ copy, regurgitated in the medical and health policy press uncritically, is that it simply does not make sense. Even worse, it is not borne out by the facts. Take the meme that “money does not grow on trees“. Even the most ardent patient safety campaigners need to acknowledge the need for safe staffing levels, which might include a basic level of nursing staffing numbers. If money does not grow on trees, how is it possible that £860 billion was found miraculously by a Labour government to fix market failure of the first global financial crash. If money does not grow on trees, how come is it that estimates of HS2 are pitched around £40-60 billion realistically? Even the £2.4 billion McKinsey ‘efficiency savings’ were returned to the Treasury, and not ploughed back into frontline care. It all fundamentally hinges on a steady stream of lies about the NHS from the Conservative Party.
Money tree
Andrew Dilnot, chair of the UK Statistics Authority, recently concluded in December 2012 that changes in NHS spending over the two years had been small and health spending was actually lower in 2011-12 than in 2009-10. He nonethlesss said the watchdog’s calculations were based on what he considered “the most authoritative source” of national statistics on the subject from the Treasury. In a letter to Health Secretary Jeremy Hunt, Mr Dilnot said: “On the basis of these figures, we would conclude that expenditure on the NHS in real-terms was lower in 2011-12 than it was in 2009-10.”
Another trick is the misuse of the term ‘sustainability’ is used by people who really have no idea what this means – sustainability clearly not be a lame excuse of stripping frontline staff of the resources they need to do their job. This all pricks the nation’s conscience which is increasingly skeptical of the ‘austerity’ blank cheque excuse to decimate public services in the name of ‘public sector reform’. It simply is a pack of lies, as Labour knows the public fundamentally has no problem with a well-funded by taxpayers state-run service, free-at-the-point of use, offering a comprehensive universal healthcare? The current Coalition vastly underestimate the public’s fundamental mistrust of money being paid on excessive CEO salaries in the NHS, especially on senior members of NHS England who repeatedly offend on the point of lack of accountability of their decisions. They do not accept the business plan that it is necessary to spend thousands or millions on redundancy payments, or compromise settlements to avoid unfair dismissal claims.
Even the question of the nation’s “priorities” generally runs into the buffers immediately. The public resent the idea of carers in a ‘caring profession’ by definition being put on ‘zero hour contracts’, even if the party-line from profit generating multinational corporates is that these allows staff ‘flexibility’. The arguments criticising the NHS have swung from one hyperbole to another, with the NHS having been called a 65 year mistake. And yet, this argument is unable to touch the scandal at Winterbourne in the private sector. On the issue of the nation’s priorities, can one reasonably suggest that one of the very worst things for this current Government to do was to embark on a £3bn reorganisation of the NHS with the sole primary purpose of outsourcing and privatising the NHS? As the lawyers say, “res ipsa loquitur” or the facts peak for themselves. In a 493 page Act, there is not a single clause on patient safety, which seems rather odd given everyone’s correct focus following the disasters at Mid Staffs and Morecambe Bay which Labour has every intention of remedying. The Act clearly thrusts private competitive tendering as the prime method of commissioning, which is being played out as a disaster in the legal/justice system. The Act has clearly massively increased the amount of income that a NHS Trust can make from private sources. It is an Act which fundamentally the public did not vote for, and it is little wonder that Andy Burnham MP and his team have repeatedly promised to repeal the Act. Like High Speed 2, which many do not similarly remember ‘voting for’, the costs are threatening to spiral out of control, which makes it all the more ludicrous that it is the Labour Party should be blamed for misuse of the handling of the public finances. Like High Speed 2, this policy is an outcome of intensive behind-closed-doors lobbying, and the genesis of the Act sits uncomfortably with the widely reported general issue of the Conservative Party and hedge funds.
Burnham has not sat on the fence over issues of health policy either. Despite the ‘smoke and mirrors’ of untrue fatuous claims of David Cameron, Burnham resolutely has promoted plain packaging of cigarettes, consistent with current global evidence and much to the chagrin of Philip Morris International. Burnham has also supported the evidence-led view of the Faculty of Public Health of the UK Royal Colleges of Physicians over ‘minimum pricing’ of alcohol. Burnham has said ad infinitum and absurdum that, despite the purported advantages, the ‘private finance initiatives’ need to be drafted such that the public do not lose out. Three things to say here, that the policy has been extended by the current Government under George Osborne. Secondly, it is a policy which was born under John Major’s government in the mid 1990s Thirdly, the first ‘sighting’ of this policy, which represents fundamentally a synthesis of a Conservative ‘Butskellite‘ policy, was in a 1993 policy document published by the Social Market Foundation with David Willetts MP, current Conservative minister for Universities, entitled “The Opportunities for Private Funding in the NHS”. Burnham, furthermore, has not his hid under a bushell regarding NHS 111. He has in fact accused the Government of destroying NHS Direct, “a trusted, national service” in an “act of vandalism”. According to him, “It has been broken up into 46 cut-price contracts. Computers have replaced nurses and too often the computer says ‘go to A&E’.”
Writing about the situation in Lewisham, Burnham unsurprisingly has been spitting bullets, remarking that:
“The High Court yesterday delivered a damning verdict on an NHS now being run by accountants rather than in the interests of local communities. This ruling is a humiliating blow to Jeremy Hunt. It is outrageous that he thought he could rob a community of its A&E and maternity services to solve financial problems at a neighbouring trust.Labour warned him that he was acting above the law but he refused to listen, and that arrogance has cost taxpayers dear in legal fees but has also caused people of Lewisham unnecessary worry.”
The general public resent this general sense of arrogance with which Jeremy Hunt and colleagues behave in their management of the NHS. The ‘democratic deficit’, where the public are simply not included in decisions about the NHS, makes a mockery of the ‘no decision about me without me’ mantra so beloved of NHS commissioners currently. Arguably, this is not seen any more clearly than in the sharing of confidential data without the valid consent ethically or legally of NHS patients. This was even reported in right-wing newspapers who have on occasion been strongly in favour of patient rights as follows:
“Mr Burnham said it is “absolutely essential” that patient data is safeguarded, after The Sunday Telegraph revealed David Cameron will use a keynote speech to outline far closer “collaboration” between the health service and life science companies. The Prime Minister will say that the controversial industry has the potential to be a powerhouse of Britain’s 21st century economy, but that it is stifled by excessive regulation at present. Speaking to Sky News, Mr Burnham said that while he did not object in principle to close ties between the NHS and private sector life science companies, he was concerned that “one of the patients’ groups that was on the working group looking at this issue has walked away”.”
I first spoke with Andy Burnham after one of the leadership hustings in 2010 at the Methodist Central Hall. I liked him as a person, and I was really struck by the sheer passion he genuinely had for an integration of health and social care pathways, even long before the political shennanigans of the Dilnot Review which were delayed because of the Health and Social Care Act. This was further embellished in a seminal speech to the King’s Fund in January 2013:
“For 65 years, England has tried to meet one person’s needs not through two but three services: physical, through the mainstream NHS; mental, through a detached system on the fringes of the NHS; and social, through a means-tested and charged-for council service, that varies greatly from one area to the next. One person. Three care services. For most of the 20th century, we just about managed to make it work for most people. When people had chronic or terminal illness at a younger age, they could still cope with daily living even towards the end of life. Families lived closer to each other and, with a bit of council support, could cope. Now, in the century of the ageing society, the gaps between our three services are getting dangerous. The 21st century is asking questions of our 20th century health and care system that, in its current position, will never be able to answer to the public’s satisfaction. As we live longer, people’s needs become a complex blur of the physical, mental and social. It is just not possible to disaggregate them and meet them through our three separate services. But that’s what we’re still trying to do. So, wherever people are in this disjointed system, some or all of one person’s needs will be left unmet.”
I feel that nobody could have worked harder than Andy Burnham for the NHS on a range of issues, such as nursing staffing levels, the lie about the NHS budget being protected, the sharing of confidential patient data, the Lewisham decision under appeal, minimum pricing of alcohol, standard packaging of cigarettes, the repeal of the Health and Social Care Act (2012), and PFI. He has also worked extremely hard in exploiting his ‘first mover advantage’ over health-and-social integrated care and ‘whole person’ care. Labour is consistently trusted by the voters on the NHS ahead of the other parties, and this is not particularly any surprise when you consider that many employees of the NHS receive more balanced information about the actual situation of the NHS from their Unions of which they are a part. There is no doubt that the toxic memes of “competition” and “choice” are here to stay, totally bastardised by health policy wonks who have never set foot on a busy NHS ward in their life. Andy Burnham MP can do no worse than to maintain the reputation of and trust in the medical and nursing professions and the NHS. After years of the Coalition rubbishing the NHS, it is definitely time for a change, and we can’t go on like this.
The big NHS underspend: Andy Burnham writes to Jeremy Hunt
This is the rather dramatic start of the HSJ article yesterday:
At a time of a huge financial squeeze being put on hospitals and when treatments of all sorts are being cut or delayed (or “rationed”), it turns out that the Department of Health – the unit in charge of the NHS – has a huge surplus that it is returning to the Treasury.
Andy Burnham MP has written to Jeremy Hunt MP as follows.
Dear Jeremy
NHS Budget underspend
Figures published today by the NHS Information Centre show that in December 2012 there were 4,887 fewer nurses working in the NHS than in May 2010. This followed the Care Quality Commission Care Update, published earlier this month, which warned that 11% of hospital services inspected were failing to meet the standard on adequate staffing levels.
You can therefore imagine my surprise when reading figures published in the detail of the Budget document yesterday that show the Department of Health is expected to underspend against its 2012-13 expenditure limit by £2.2bn.
Furthermore, the table on page 70 of the Budget document appears to show that none of this has been carried forward to be used in subsequent financial years as part of the Budget Exchange programme.
At a time when the NHS is facing its biggest financial challenge, when almost 5,000 nursing posts have been lost since the general election, and when one in ten hospitals are understaffed, I find it staggering that £2.2bn of the NHS budget is to be returned to the Treasury.
It would be helpful if you could therefore answer a number of important questions.
1. Were you aware of the £2.2bn underspend before yesterday and did you authorise the decision not make any use of the Budget Exchange programme? Or were you overruled by the Treasury?
2. If so, when did you make your decision?
3. Can you confirm that this means the Department’s underspend for 2012-13 would be 2%, higher than the 1.5% figure that your Department says is consistent with “prudent financial management”?
4. Do you accept the recent findings of the Care Quality Commission that one in ten hospitals are failing to meet the CQC standard on adequate staffing levels? Did you consider this when making your decision?
5. Why did you not make use of this underspend to prevent job losses and ensure all hospitals have adequate staffing levels?
6. Yesterday, a Department of Health spokeswoman told the Health Service Journal that the NHS underspend would “still be available for NHS organisations to ensure high quality, sustainable health services are delivered to patients now and in the future”. Can you confirm that this will not be the case, as none of the £2.2bn underspend has been carried forward for future use?
I look forward to your response.
Best wishes
Rt Hon Andy Burnham
The plot thickens…
Eastleigh: Collaboration, not competition, is what we need from Labour and the NHA Party
This is a totally independent post.
Clive Peedell doesn’t want the creeping marketisation of the NHS to go any further. Andy Burnham MP was the person who ventured out into ‘NHS global’, so that Foundation Trusts could sell their products abroad under the NHS logo, and who continued the march of the NHS Foundation Trust machine.
However, Andy feels now ‘enough-is-enough’. Despite being from the Labour (and some would say “New Labour”) stable, Andy has signalled that he wishes to repeal the Health and Social Care Act (2012). Of course, reversing the changes in it presents a more formidable challenge, but Andy says that he wishes to reverse Part 3 of the Act. This is code for getting rid of the fact that private companies, to which the NHS has been increasingly outsourced, will not be ‘competing’ to do what the NHS is supposed to do, using the NHS logo to maximise their own shareholder dividend. The unfortunate effect of engaging domestic and international competition law has become the ludicrous situation where the NHS cannot be given any preferential treatment for fear of offending European law, ‘distorting’ the market and so on.
There are strong economic arguments for not running the NHS in a fragmented piecemeal outsourced fashion; not least the NHS can benefit economically from ‘economies-of-scale’ and there is hope that with the proper leadership it can further national policy. Unfortunately, Sir David Nicholson and his army have stayed in situ when cultural change, when – in fact – a new charismatic change leader, is need to drive a move away from his failed ‘efficiency savings’. Efficiency was managerial speak for a Frederick Taylor-approach to management, looking at productivity and activity, meaning that one Foundation Doctor would be running around all the geriatric wards for the whole-of-the-night while his or her colleague was doing all the geriatric admissions in Casualty, to save money. The fact that you cannot have ‘something for nothing’, a popular philosophy of Thatcher, is borne out by the 400-1200 deaths in Stafford, where the inaction by the health regulatory bodies has been striking, and the political reaction somewhat confused.
In innovation, it’s possible for a new entrant to dislodge an incumbent by a slight subtlety. That is the basis of the splendid body of work by Prof Clay Christensen at Harvard Business School. However, nobody is expecting the NHA Party, co-founded by Dr Clive Peedell, a NHS oncologist, to dislodge Labour. However, Labour have openly admitted that Eastleigh is 285th on their “hit list”, so many question indeed Ed Miliband’s wisdom in spectacularly losing a safe Hampshire seat.
We have seen coalitions can work for one of the parties within it. We have also seen single-issue parties getting MPs somehow, such as Caroline Lucas in Brighton. If you park aside the perceived differences of NHA Party and Labour, given that Labour is “the party of the NHS” with its own brand loyalty, it might be conceded that Labour not winning does not further the NHS debate. It is possible that, as a protest vote against the Conservatives and Liberal Democrats, the NHA Party do indeed have a fighting chance of getting one MP.
And what is the point of one MP? Well what is the point of a handful of Liberal Democrats? In practice management techniques, such as PRINCE2, it is customary for there to be a ‘senior user’ as well as a ‘senior customer’ on your project board. While many will balk at the idea of ‘customers’ of NHS, unlike Prof Karol Sikora at the weekend on BBC’s “Sunday Politics”, there is a lot to be said, arguably, for input from frontline doctors and other healthcare staff in the NHS debate.
To delve into business management speak, which has possibly crippled the NHS thus far, the NHA Party and Labour have important synergies in values and competences in their outlook on the NHS. Ironically, there is an active debate about how collaboration, as well as (or rather than) competition, should be encouraged. It might be time to ‘think the unthinkable’, and consider the vague possibility that Labour, while desperately trying to fight for an electoral majority in 2015 despite the statistical odds, might benefit from a strategic alliance, or partnership, with the NHA Party. This does not need to be a formal joint venture, but, to expand the business analogy, could be a clever way for Labour to reaffirm its commitment to the NHS and for the NHA Party to gain ‘market entry’. Given that the traditional media appear not to allow the NHA Party to discuss the agenda fully, this may not be a bad thing, I feel.
Please feel free to contact me on @legalaware if you wish to have a constructive debate about any of the issues therein. Many thanks.
