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From my vantage point as a junior doctor, I can tell you the NHS is not in a good place
When Jos Bell, experienced campaigner for the NHS, says she wept at the end of yesterday’s march, you know two things. First of all, it was an amazing event. Secondly, there is something very wrong with the NHS.
In my brief time on the wards, I witnessed how the Hammersmith A&E department ‘functioned’. And how Addenbrookes managed its acute take. And also the daily chaos in Northwick Park. It was pretty unpleasant training, covering the acute medical unit and all the medical wards at night simultaneously, with the cardiac arrest bleep. I note with some mirth the eventual fate of those hospitals. I am glad I am not the only one who had his doubts.
A decade ago, I am still technically a junior doctor, as is anyone technically below Consultant level in hospital medicine. What I do know from my vantage point on the GMC Medical Register is how to produce and share research and learning about living better with dementia and to enjoy it. I get considerable pride in what I do, which is ultimately to improve the quality of life of people with dementia and carers. This was acknowledged in my BMA Best Book of the Year Award 2015, though I think the NHS is saturated with competitions and award ceremonies.
The NHS is really not in a good place – and nor is social care. I don’t think I’ve ever known a peaceful time in the politics of the NHS, but the current Secretary of State, Jeremy Hunt MP, is uniquely bad. I share his anger with how bad things got at Mid Staffs, but it is also the case that the place has been a reputational nightmare to recruit at ever since.
The safety at weekends does not require a highly paid NHS manager to work out. You have a skeleton staff trying to do their best in what is already a seven day service. With so many Trusts in deficit, I look forward to the day when the staff to bed ratio is the same at the weekends as it is during the week, and Hunt has to concede that he cannot achieve this with the same number of staff just doing ‘different things’. It is utterly unacceptable that he has whipped the general public into a frenzy such that members of the public are now frightened to seek medical help at the weekend: if a doctor on the GMC register did that, he’d be heavily disciplined. For politicians, a seat at the House of Lords beckons instead.
But it is not Hunt’s operational ineptitude which gives me most distress. It’s just that he seems to have complete and utter contempt for the staff in the NHS. He reckons that professional people who’ve done at least five or six years unpaid before qualified are being ‘misled’ by the BMA, implying that they are too stupid to make up their own mind about the new terms of their contract.
This lack of investment in people, while simultaneously siphoning off money in payment of PFI loan repayments, is evident too in the lack of pay rise for many nurses. The wider picture is certainly concerning. George Osborne MP is clearly involved in the fire sale of State assets, and this has included NHS tangible property, so it will be natural for him to think what else he can transfer to the private sector to make his books balance.
Being fixated on the deficit, which he has not fixed by 2015 as promised, means that he has not be able to address the mess in social care funding. Social care is on its knees, and it is not acceptable that there are people languishing in hospital who literally can’t escape even once discharged.
The NHS is not going to be ‘saved’ by gimmicks with hashtags into quality mightier than the sword on Twitter. It, like social care, is going to be saved with proper funding and investment for the future – not with a view to selling it off at some later date.
So, in full solidarity, this mess has been a long time coming, and I fully support the junior doctors (of which I am one, technically). It will not be understood by well paid journalists in their ivory towers necessarily, and certain high profile people need to concede some lack of progress in ‘curing’ the NHS.
Legal proposals on the repeal of the Health and Social Services Act [2012]
Andy Burnham MP, currently Shadow Secretary of State for Health, will repeal the Act, but is due to establish Labour’s official position at Conference later this week. Burnham answered my straightforward question about the Health and Social Care Act (2012) with a simple answer, at the Fabian Society Question Time this evening, hosted by Alison McGovern MP, and a panel also including Owen Jones, Dan Hodges, and Polly Toynbee. I had a very nice chat with Andy at the end, and Andy seemed to be quite impressed that I had read the entire Act carefully ‘from cover to cover’.
Andy reinforced his belief that the Act would be repealed, but he wanted the NHS to further a spirit of collaboration. There’s been a question about, even if the Act is repealed, there are genuine questions about which policy planks might go into reverse. I feel it is unlikely that NHS Foundation Trusts will be revised, and I don’t think commissioning will be done away with, though I am uncertain about the future of ‘clinical commissioning groups’ (“CCGs”). Andy’s indication that existing structures might be asked to do different things gives Andy a bit of lee-way as to the working relationship between NHS Foundation Trusts, or CCGs (or whatever they turn out to be).
Part 3 will be first in the firing line, the Act will be repealed, and the NHS will go back to a system based on collaboration consistent with its founding principles. Critically, this Part of the Act establishes the legislative framework for the sector-regulatory body and its functions, “Monitor”, competition and licensing. My guess is that Andy Burnham MP will find a way for the NHS not to be a free-for-all in an unfettered market. My impression is a lot depends on escaping the EU definition of “undertaking” in EU competition law.
Dr Kailash Chand OBE (@KailashChandOBE), who is the Deputy Chair of the BMA, has this morning voiced in an article in the Guardian grave concerns about CCGs:
“Unfortunately, this proposed new dawn has already been tarnished by the protracted passage of the health bill and the ongoing financial squeeze that could mean there are fewer services available for CCGs to commission. Many GPs are concerned that they could become the administrators of NHS cuts as they are handed responsibility for decimated budgets. The NHS Act 2012 gives CCGs the authority to decide to whom they will provide a service, and what service they will provide. They will be under no obligation to ensure that a whole range of services are available to their catchment population. (There is already rationing of services such as hernia, cataracts and hip or knee replacements). The NHS Act also enables CCGs to enter into joint ventures with private companies to outsource most work to private companies with vested interests, beyond the scope of full public scrutiny.”
The NHS prior to this Act had been immune from a discussion of competition in that the NHS had from this previously is that a regulatory authority for competition, the Office for Fair Trading (“OFT”) did not consider that any public bodies involved in the purchasing or supply of goods or services within the NHS were “undertakings”, and therefore were not subject to action under the Competition Act. In other words, any involvement of these bodies was for “non-economic purposes”. This was reinforced by the EU in relation to a Spanish healthcare case FENIN v Commission in 2006, on the basis that the system concerned operated on the principle of ‘solidarity’. They have therefore exposed some services (which previously would have been provided in-house) to a scenario where they will be considered for competitive tendering. The extension of Any Qualified Provider (albeit with a more limited, phased implementation from 2012) to a wider range of services, and the distancing of the state from acute sector provision in the form of foundation trusts could conceivably weaken the argument against healthcare provision being for “non-economic purposes”, particularly when individual service lines are considered.
This is a highly significant development, I feel, that Andy Burnham could be steering the NHS away from being run for ‘economic purposes’, and this could be the passport for Andy for not becoming enmeshed in lots of complicated domestic and EU law. As it happens, I have a real feeling that European lawyers would prefer not to enmeshed in a complicated discussion about private provision in healthcare, as they feel that competition law is best applied to pure private or commercial entities not involved in social/healthcare policy.
As it stands, the Health and Social Care Act (2012) is a complex interplay of domestic and EU law in the disciplines of company law (including mergers, financial assistance), commercial law, procurement law (including public contracts), regulatory law, insolvency law (particularly administration). However, the law, albeit at nearly 500 pages, does have some notable omissions, such as what happens if a CCG ‘trades’ while going insolvent. Law would have to clarify consider, in its capacity as a ‘body corporate’, whether the CCG were still capable of wrongful or even fraudulent trading.
@JonSnowC4 discusses the summit for the Health and Social Care Bill
Dr Carter and Dr Poulter discuss with Jon Snow this evening today’s summit concerning the implementation of the Health and Social Care Bill.
