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October 17, 2015

Private Eye Medicine Balls 1343
Filed under: Private Eye — Dr. Phil @ 10:28 am

Feeling the Squeeze

The Tory conference continued to peddle the delusion that routine NHS services can be safely extended to seven days a week whilst making eye watering efficiency savings. The government has a convenient blame figure lined up in Simon Stevens, the chief executive of NHS England, who calculated that the NHS shortfall by 2020 would be £30 billion, based on an ageing population that demanded more care. He also pronounced that £22 billion of this could be recouped by ‘working smarter’ and encouraging people to take more responsibility for staying healthy. This left the government with just 8 billion to provide at some unspecified time before the next election.

In the first year of Stevens’ ‘five-year forward view’, no efficiency savings have been made at all. Indeed, the NHS deficit will soar to over £2 billion, leaving the NHS to somehow make £24 billion worth of savings over four years. Even worse, the performance of the NHS has nosedived. Waiting times are up across the board, some Clinical Commissioning Groups are rationing NICE approved services illegally and every day 100,000 people aren’t able to see a GP when they want to.

It’s not just Stevens feeling the heat. Having dangled his balls over the balcony of the British Medical Association (Eye 1398), Health secretary Jeremy Hunt has been surprised at how vigorously junior doctors have squeezed them. Hunt initially threatened to impose a new contract on consultants but then decided to turn his fire on junior doctors. He described the BMA as “utterly irresponsible” for trying “to scare people into believing” he wants to cut pay. And yet the only way to extend services and make huge savings is to force doctors to work more hours for the same money. Many politicians have a deep animosity to the BMA, but many doctors find their union self-serving and ineffectual. However, in now threatening to impose a contract on junior doctors who have walked away from negotiations, Hunt has simply acted as a recruiting sergeant for the BMA.

The BMA is making bold claims of balloting for industrial action, but a compassionate and ethical workforce is very limited in the protests it can make. Hunt knows that if he toughs it out, he will win but at what cost? Every junior doctor who moves abroad, or even to Wales or Scotland, is a huge loss to NHS England. And anyone who leads an organisation but does not have the majority of the workforce on his or her side is doomed to fail. Hunt has already upset many NHS staff by suggesting they don’t already work at weekends, and by claiming that higher mortality rates at weekends would be reduced if more doctors were on duty. The evidence does not support this, and doctors are busy collecting evidence of ‘the Hunt effect’ – citing examples of patients who have come to harm by not seeking help at weekends because they were worried it was too dangerous to do so.

If Hunt is not careful, he will become the new Lansley, losing the confidence of the staff but still forcing through unproven policy based on ego and ideology. He has at least written a conciliatory letter to the BMA junior doctors’ committee, but whether he can recapture their trust remains to be seen. Hunt’s former health minister Dr Dan Poulter, who was involved in the junior doctor negotiations, has warned that some specialty doctors may indeed be facing large pay reductions.

The key point about junior doctors are that they are doctors in training. As well as providing a vital NHS service, they need to be properly trained and supervised. Great Ormond Street hospital (GOSH) has lost all of its haematology and oncology Registrars and SHOs because they were reduced to being ‘clerking monkeys’ and getting no training. Hunt wants to widen the normal hours of doctors in all hospitals, which means he will also widen the training mandate of each Trust, and this has to be properly costed.

GOSH is also closing its highly regarded paediatric chronic fatigue syndrome/ ME service, because it is no longer financially viable. In MD’s home city of Bristol, the NHS is giving up on providing community paediatric services for the same reason, leaving ‘private sector partners’ to bid for the contract. The suspicion that the NHS is being starved of funding to create opportunities for the private sector is hard to ignore, but it’s extremely unlikely that, say, Virgin, can do extremely delicate and vital child protection work any cheaper or more competently than the NHS.

For the NHS to balance the books under the current funding restrictions, the service must somehow make 3-4% efficiency savings a year, something it has never done, or simply provide less care. David Cameron’s announcement of a new contract for General Practice is a recognition that CCGs aren’t delivering savings, but select groups of GPs may yet be offered ‘a total budget’ to buy health and social care for large groups of patients. It’s a last roll of the dice for Cameron, Hunt and Stevens.

MD’s book, Staying Alive – How to Get the Best from the NHS – is available here