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May 20, 2017

Private Eye Medicine Balls 1443 May 3, 2017
Filed under: Private Eye — Dr. Phil @ 12:04 pm

Labour’s Open Goal

Shadow health secretary Jon Ashworth could promise anything about the NHS without much fear of having to implement it, but the government’s screw up of the NHS and social care represents Labour’s best hope of staying alive. Andrew Lansley’s Health and Social Care Act has been a very predictable disaster, with billions wasted on commissioning, tendering, retendering and even suing the NHS because companies such as Virgin didn’t get the tender they wanted.

Aggressive austerity has probably been responsible for the spike of 30,000 extra deaths in 2015, albeit of people unlikely to vote Conservative. Admissions for malnutrition have trebled in the last 10 years. Mental health services are being savagely cut and there has been an increase in suicide rates in those struggling to cope, including female nurses. The sub-inflation pay rises and refusal to guarantee the rights of NHS and care workers from the EU has lead to record vacancies and ever more dangerous gaps in staffing levels. And the results are there for all to see. Nearly 4 million people waiting for an operation. Over 200,000 people waiting for four hours of more in A&E in February alone. The number of people waiting for 12 hours or more on trolleys doubled in a year. Some patients are waiting over 30 hours on a trolley, in scenes reminiscent of the nineties.

The government’s response has been to use NHS England CEO Simon Stevens as a human shield, announcing that the previously sacrosanct waiting time targets for non-urgent care were having to be abandoned to concentrate on the crisis in emergency care. The rota gaps in emergency specialties such as paediatrics are particularly alarming, not least because Jeremy Hunt’s clumsy attempts to crush the junior doctors has meant that 50% of them are refusing to go straight into higher specialist training. Not only is ‘death by corridor’ back, but patients are dying on waiting lists and the elderly are trapped in hospital for months – and even years – for the lack of social care. Hospital chief executives are being bullied into signing up to ‘cost control’ measures they know are sheer fantasy, to support the even bigger fantasy that the NHS can make a further £22 billion efficiency savings without causing widespread patient harm. In general practice, work related stress has reached record levels as staff struggle to cope with the ever rising demand. Labour could not have a bigger open goal to aim at.

Ashworth’s initial salvo was to guarantee the rights of EU workers. Good. Labour would ‘axe that Health and Social Care legislation that allows the NHS to be fragmented and sold off. Privatisation of the NHS will come to an end. We will reinstate the NHS – publicly funded, publicly administered and publicly provided.’ In reality, the NHS is likely to need the help of private providers in, say, psychiatry and surgery for the foreseeable future unless there is a massive investment. What needs to end is the enforced tendering of contracts to the private sector, apparently to comply with European competition law. One advantage of Brexit might be to remove this obligation.

Ashworth also announced Labour would scrap the 1% NHS pay cap, implement the recommendations of the independent pay review body, re-introduce bursaries and reinstate funding for health-related degrees. All of this is likely to improve recruitment and morale, if John McDonnell can get the maths right. Ashworth’s cleverest swipe at Jeremy Hunt was to commit to legally enforced safe staffing levels driven by evidence-based NICE guidance. Hunt made hay with the Mid Staffordshire disaster, blaming Labour for allowing such unsafe staffing levels to lead to such poor care. Hunt styled himself as a patient safety champion, committing to implement to recommendations of the Francis Inquiry before realising how much it would cost, forcing NICE to abandon its safe staffing work halfway through and allowing the dangerous rota gaps in hospital care that junior doctors felt strongly enough to strike about. The government still had the gall to pledge to make the NHS ‘the safest and most compassionate health service in the world’ in their 2015 manifesto, and has manifestly failed thus far. In taking over the ‘patient safety’ high-ground, Ashworth is committing Labour to putting a lot more money into the NHS, alongside all their other commitments. Again, it comes down to the maths.

As for Hunt, his best hope for this election is to go into hiding and let Simon Stevens take the flack. Stevens loves his strategy, and spinning dreams of new models of care, Vanguards, Five Year Forward Views, Sustainability and Transformation Plans and Accountable Care Organizations. Some of these may be good ideas, but all will flounder if they can’t be safely staffed. Ashworth has hit the nail on the head. He needs to keep hitting until his thumbs are purple.