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January 30, 2018

Private Eye Medicine Balls 1462 January 5, 2018
Filed under: Private Eye — Dr. Phil @ 6:09 pm

Poor Care

January is always a good time to dust off the 2015 Tory manifesto promise; ‘We will offer you the safest and most compassionate care in the world.’ NHS England is pretending we are ‘coping well with planned-for winter pressures’ but patients stranded at the back of a corridor trolley queue or staff on their knees with exhaustion might beg to differ. The same excuse as last year – ‘a spike in respiratory infections’ – is being wheeled out but the NHS has not been able to cope safely with all the extra demands placed on it since annual funding increases were reduced to a trickle in 2010.


Such crises were common in the nineties until Labour decided to temporarily match the EU average for health funding, the one political intervention that dramatically reduced waiting times for emergencies and non-emergencies alike. Now we’re returning to the days when elective operations are routinely shut down over winter. 15,000 beds have been cut from the NHS in England since 2010, £6 billion has been cut from the social care budget and there are 100,000 NHS and social care staff vacancies. Between 2003 and 2015 the population of England increased by 10 per cent, from 49.9 million to 54.8 million, and the number of people aged over 85 has increased by nearly 40 per cent. Care home debts has meant there are fewer experienced staff, scant falls prevention and a heavy reliance on the NHS for any medical problems. But the biggest rise in demand has come from people living with multiple long-term conditions, who are often poorer and socially isolated, and arrive in hospital cold, malnourished and dehydrated alongside their diabetes, dementia and heart failure.


The strong link between poverty and ill health was nailed by the Black Report in 1980, which found amongst other things that the death rate of the poorest men in the UK was twice that of the richest. Margaret Thatcher was so annoyed by the findings she released limited copies on a bank holiday Monday. Today, the rich live a decade longer than the poor, and the poor can expect 20 years more suffering from chronic diseases than the rich. An excellent analysis by the Nuffield Trust, hidden away on Christmas Eve, found that school-aged children from the poorest areas are two and a half times more likely to be admitted to hospital in an emergency for asthma than their counterparts in the richest areas, and this gap has grown substantially in a decade. Clearly, the crisis in the NHS will never be resolved without addressing the crisis of poverty.


Health secretary (at the time of writing) Jeremy Hunt has said his usual ‘sorry’ and bravely tweeted on December 15; ‘About to do my first Facebook live session: all are welcome, trolls and fans alike’. Alas, MD was working in the NHS, which does not allow access to Facebook (or porn), but on December 19 I politely tweeted ‘Dear @Jeremy_Hunt. The formation of Accountable Care Organisations in the NHS relies on the award of very large whole population budgets under long term contracts. Can you guarantee that these contracts will not be outsourced to the private sector? Please answer this, thank you.’ 15 days and many thousands of retweets later, no answer.


The private sector has been providing NHS care since 1991, and are now winning the majority of community care contracts, with scant evidence of improvement. ACO contracts would give companies a whole new level of long-term strategic control over NHS care, a bit like outsourcing entire health authorities. If we follow that route, we may as well outsource NHS England. Plenty of frontline NHS and local authority staff are currently working their butts off trying to develop voluntary public sector collaborations that should be the natural inheritors of ACO contracts when they have to be put to the market, as the Tory’s own health reforms demand, but there is a significant risk that unless they are given some form of legislative status, the private sector could swoop down and shovel up the contracts if they deem there to be some profit in them.


ACOs would in theory end the internal market, something the Tories introduced 27 years ago and has wasted a fortune on commissioning, tendering, retendering, management consultancy and legal fees. Life would now be a lot simpler for the English NHS if it had followed Scotland’s lead, ditched the internal market long ago and developed integrated Health Boards. However, structural reform doesn’t improve NHS performance unless you address the causes of the causes. Scotland too has huge levels of poverty related illness, unprecedented NHS demand and is missing many of its key targets (although not as badly as the English NHS). Happy New Year.