Prof Sir Bruce Keogh argues that centralising some types of medical care benefits patients. Does anybody accept that, in this context? [Image: Christopher Furlong/Getty Images].
This is not an overhaul, because overhaul implies improvement. This is an act of vandalism on England’s life support machine.
You don’t close down a unit that could give valuable life-saving treatment to somebody – when it matters – and tell them to trek who-knows-how-many-miles down the road instead. They’ll be dead on arrival.
Sir Bruce Keogh can say whatever Jeremy Hunt tells him to, and I’ll call him a Tory stooge, because that’s what he is – and a dangerous liability to the health service, and the health of people across England.
How much more of this homicidal stupidity do we have to take?
When do the Tories cross the line?
Do we have to wait until people start to die – after these reckless and irresponsible plans are put into action and the health service cut beyond its ability to cope?
Or should the people who actually do the work in the health service just say enough is enough and refuse to go through with it?
I know it’s not a practical solution but neither is a plan for “sustainability and transformation” that transforms our internationally-revered health system into a death trap.
These so-called plans have gone too far already. They’re to be ripped up and a strong – and lasting – message sent to the swine who created them.
And the next person to see Jeremy Hunt should actually kick his ass. Hard.
Thousands of hospital beds are set to disappear, pregnant women will face long trips to give birth and a string of A&E units will be downgraded or even closed altogether as part of controversial NHS plans to reorganise healthcare in England.
A Guardian analysis of the 24 NHS regional plans that have now been published – more than half the total of 44 – has found that health service chiefs plan to push through an unprecedented centralisation of key hospital services across England.
Opposition to the plans is growing among campaign groups, councillors and a growing number of MPs, including Conservatives, in areas where major changes are planned amid fears that patients will be unable to access urgent care quickly enough.
The image above shows a letter from shadow health secretary Andy Burnham to our comedy Prime Minister David Cameron, demanding answers to the questions he dodged during PMQs on Wednesday. The date shows it was written immediately after the incident.
It would not have been necessary if Cameron had bothered to answer the question, rather than indulge in a pointless relativistic attack on the Labour-run NHS Wales instead.
We are sick of these distraction techniques. We understand them and they merely strengthen our long-held conclusion that Cameron is at worst a liar and at best a dissembler, who would not let the facts pass his lips under any circumstances.
And three years after he withdrew selling off the nation’s forests to private developers from the Public Bodies Bill, Cameron has gone back on his word and reintroduced a plan to give them to privateers in the new Infrastructure Bill.
Those are just a few examples from the last two weeks!
Mr Burnham’s questions are relevant; the public deserves answers on them.
Why have 16 leading health organisations representing doctors, nurses and patients warned that health and social care services in England are at “breaking point”?
Why can’t he confirm that:
National Health Service (England) currently has the highest waiting lists for six years;
It has the highest number of people waiting more than four hours in Accident & Emergency for 10 years;
It has missed its cancer treatment target for the first time ever; and
Millions of people there cannot get to see their GP?
Does he, or does he not, agree with his unnamed Cabinet colleague that his former boss Andrew Lansley’s hugely expensive – and unexpected – £3bn top-down reorganisation of the NHS was a huge mistake?
And why won’t he support a plan to fund one-week cancer testing by levying a tax on tobacco companies? Would the answer have anything to do with the other business interests of his campaign manager Lynton Crosby?
“The country and the NHS deserve better,” wrote Mr Burnham. “Rather than indulging in smears and diversionary tactics you would be better advised to spend your time addressing the fact that [the] NHS… is at breaking point under your government.
“Until you focus on saving rather than smearing the NHS, the public will be understandably confronted with the sad truth that all this government offers is five more years of crisis in the health service.”
Perhaps Mr Cameron needs to be reminded of the information in this BBC report from 2011 – before his government made such a mess of the service – showing that public approval of the National Health Service was at its highest point ever and questioning why he (Cameron) felt the need to change it.
“If it ain’t broke – don’t fix it,” as the saying goes.
Now the NHS is broke, thanks to the Tory (and Liberal Democrat, let’s not forget) scheme to siphon off our tax money into the hands of private health ‘providers’.
And the nation is still broke, despite years of unnecessary Tory and Liberal Democrat austerity that have brought hardship to millions and caused the deaths of tens of thousands, thanks to the Coalition scheme to put people to work for a pittance and let business bosses keep the profits.
With a general election just a few months away, more than 60 million of us are looking to David Cameron for an explanation, only to find…
Health Secretary Jeremy Misprint Hunt, whose 10 per cent pay rise on his ministerial salary of around £140,000 is safe, said the health service could not possibly afford to add one per cent to workers’ pay. The minimum starting salary for a registered nurse is £21,478; Hunt’s pay rise alone could cover a one-per-cent increase for no less than 65 such nurses, and they are by no means the lowest-paid NHS workers.
The strike has come as The Times newspaper claimed that “senior Tories have admitted that reorganising the NHS is the biggest mistake they have made in government,” with at least £5 billion a year wasted on inefficiencies.
The paper’s online version is hidden behind a paywall, but its front page states: “David Cameron did not understand the controversial reforms and George Osborne regrets not preventing what Downing Street officials call a ‘huge strategic error’, it can be revealed.
“The prime minister and the chancellor both failed to realise the explosive extent of plans drawn up by Andrew Lansley, when he was the health secretary, which one insider described as ‘unintelligible gobbledegook’.
“An ally of Mr Osborne said ‘George kicks himself for not having spotted it and stopped it. He had the opportunity then and he didn’t take it.’
“The admission came during an investigation by The Times that has found at least £5 billion is wasted every year on inefficiences, such as overpaying for supplies, out of date drugs, agency workers and empty buildings, a study carried out for ministers said.”
The report raises several questions. Firstly, if Lansley’s reforms were a mistake, that doesn’t mean Cameron and Osborne would have proposed anything better. Tories are almost universally dedicated to the end of the National Health Service and the worsening of working-class health.
Secondly, if David Cameron did not understand Lansley’s plans, why did he allow them to go through? As Prime Minister, he is responsible for the activities of his government and a lack of comprehension indicates that he is not fit for the role – and never was. Is it possible that Cameron was swayed by the fact that Lansley was his mentor at the Conservative Research Department and he thought he owed a favour?
Thirdly, if Gideon didn’t spot it, what does that say about his abilities as Guardian of the Public Purse? (Actually, here’s a link to an article about his abilities in this regard. Read it and weep, George!)
Finally, and perhaps most importantly: How did the government let the NHS fall into this terrible condition? For the answer, we have to go back, again, to the Coalition Agreement.
The Government believes that the NHS is an important expression of our national values [From this we may conclude that the Tories (and their little LD friends) decided to change the NHS and make it reflect their values]. We are committed to an NHS that is free at the point of use and available to everyone based on need, not the ability to pay [Fail]. We want to free NHS staff from political micromanagement [Fail], increase democratic participation in the NHS [Fail] and make the NHS more accountable to the patients that it serves [Fail]. That way we will drive up standards, support professional responsibility, deliver better value for money and create a healthier nation [Fail].
We will guarantee that health spending increases in real terms in each year of the Parliament, while recognising the impact this decision will have on other departments [Vox Political has just spent several weeks demonstrating to the BBC that this has not happened].
We will stop the top-down reorganisations of the NHS that have got in the way of patient care. We are committed to reducing duplication and the resources spent on administration, and diverting these resources back to front-line care [Andrew Lansley’s Health and Social Care Act 2012 was the largest top-down reorganisation ever imposed on the National Health Service. It was also gibberish (as top Tories now concede) and has cost the service more money than it could ever hope to save].
We will significantly cut the number of health quangos [Clinical Commissioning Groups are quangos – so in fact it seems likely the number has increased].
We will cut the cost of NHS administration by a third and transfer resources to support doctors and nurses on the front line.
We will stop the centrally dictated closure of A&E and maternity wards, so that people have better access to local services [The Coalition government has never – let’s have that again: NEVER – refused permission for a plan to close A&E wards].
We will strengthen the power of GPs as patients’ expert guides through the health system by enabling them to commission care on their behalf [This refers, again, to CCGs. In fact, overworked GPs do not have time to plan and commission services, and have handed responsibility over, in most cases, to private health companies. This has opened the way for a huge amount of corruption, as these companies may commission services from themselves. More than one-third of doctors who are board members of CCGs have financial interests in private healthcare (NHS SOS, p 5].
We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust (PCT). The remainder of the PCT’s board will be appointed by the relevant local authority or authorities, and the Chief Executive and principal officers will be appointed by the Secretary of State on the advice of the new independent NHS board. This will ensure the right balance between locally accountable individuals and technical expertise.
The local PCT will act as a champion for patients and commission those residual services that are best undertaken at a wider level, rather than directly by GPs [Fail. This hasn’t happened]. It will also take responsibility for improving public health for people in their area, working closely with the local authority and other local organisations [Fail].
If a local authority has concerns about a significant proposed closure of local services, for example an A&E department, it will have the right to challenge health organisations, and refer the case to the Independent Reconfiguration Panel. The Panel would then provide advice to the Secretary of State for Health [Fail. The right to challenge seems to have been introduced but has been ineffective].
We will give every patient the right to choose to register with the GP they want, without being restricted by where they live [Fail. In fact, the Coalition has given GPs – or rather, CCGs – the right to choose the patients they want, meaning they can exclude patients with expensive, long-term conditions. This has an effect on the promise to provide care to everyone that is free at the point of use, of course].
We will develop a 24/7 urgent care service in every area of England, including GP out-of-hours services, and ensure every patient can access a local GP [Fail, for reasons indicated above]. We will make care more accessible by introducing a single number for every kind of urgent care and by using technology to help people communicate with their doctors [The service was launched in 2013 and was a complete and utter failure – it could not cope with demand on any level].
We will renegotiate the GP contract and incentivise ways of improving access to primary care in disadvantaged areas.
We will make the NHS work better by extending best practice on improving discharge from hospital, maximising the number of day care operations, reducing delays prior to operations, and where possible enabling community access to care and treatments.
We will help elderly people live at home for longer through solutions such as home adaptations and community support programmes.
We will prioritise dementia research within the health research and development budget.
We will seek to stop foreign healthcare professionals working in the NHS unless they have passed robust language and competence tests.
Doctors and nurses need to be able to use their professional judgement about what is right for patients and we will support this by giving front-line staff more control of their working environment.
We will strengthen the role of the Care Quality Commission so it becomes an effective quality inspectorate [The CQC has been rocked by the revelations of one cover-up after another, involving physical and psychological abuse of clients]. We will develop Monitor into an economic regulator that will oversee aspects of access, competition and price-setting in the NHS [Monitor has been turned into the enforcer of the government’s privatisation initiative].
We will establish an independent NHS board to allocate resources and provide commissioning guidelines [This is NHS England, which now takes decisions that would once have been in the hands of doctors. It can intervene in the running of any CCG, forcing changes where they don’t fall into line. It rigidly enforces spending limits].
We will enable patients to rate hospitals and doctors according to the quality of care they received, and we will require hospitals to be open about mistakes and always tell patients if something has gone wrong.
We will measure our success on the health results that really matter – such as improving cancer and stroke survival rates or reducing hospital infections.
We will publish detailed data about the performance of healthcare providers online, so everyone will know who is providing a good service and who is falling behind.
We will put patients in charge of making decisions about their care, including control of their health records [Jeremy Hunt wanted to sell your health records to private companies. Although the scheme was put on hold in February 2014, it seems to be running now. Your health records may already be in the hands of private companies].
We will create a Cancer Drugs Fund to enable patients to access the cancer drugs their doctors think will help them, paid for using money saved by the NHS through our pledge to stop the rise in Employer National Insurance contributions from April 2011.
We will reform NICE and move to a system of value-based pricing, so that all patients can access the drugs and treatments their doctors think they need.
We will introduce a new dentistry contract that will focus on achieving good dental health and increasing access to NHS dentistry, with an additional focus on the oral health of schoolchildren.
We will provide £10 million a year beyond 2011 from within the budget of the Department of Health to support children’s hospices in their vital work. And so that proper support for the most sick children and adults can continue in the setting of their choice, we will introduce a new per-patient funding system for all hospices and providers of palliative care.
We will encourage NHS organisations to work better with their local police forces to clamp down on anyone who is aggressive and abusive to staff.
We are committed to the continuous improvement of the quality of services to patients, and to achieving this through much greater involvement of independent and voluntary providers [Fail. The introduction of independent (read: private companies) and voluntary providers has been a costly disaster].
We will give every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers [Not true. The patient never has a choice].
The comments (in bold, above) relate only to a few of the calamities that have been forced on the NHS by the Coalition government (you may be aware of others) – and it is important to add that these took place only in England, where the Coalition has control. Health in Scotland, Wales and Northern Ireland is a devolved responsibility but the Tories and Liberal Democrats have tried to influence the provision of services by restricting the amount of money available to the other countries of the UK.
In addition, fears are high that the proposed Transatlantic Trade and Investment Partnership between the European Union and the United States of America will “lock in” the privatisation of health services, as corporations will be allowed to sue national governments if they impose changes that would affect a company’s profits. These claims have been rubbished by the European Commission and Tory ministers – but they would, wouldn’t they?
In summary: The last four and a half years have witnessed a sustained attack on the National Health Service in the United Kingdom, by a government that won most of its votes on a claim that it would protect and strengthen that organisation. It was a lie that has caused misery for millions – and is likely to have cost many, many lives.
David Cameron should be very happy that UKIP is around to make him look acceptable.
We can’t ever say he’ll look good, but in contrast to the ‘Farage wave’, the spectacle of UKIP being thrown out of the venue where it was supposed to be launching its European election campaign, and the never-ending queue of candidates who are desperate to embarrass themselves publicly – what’s the latest one? “Women should be made to wear skirts because they’re a turn-on for men”? Ye gods… – it’s easy to think that the Conservatives are mild, or at least rational.
But Cameron was keen to project an image of competence at the Conservatives’ campaign launch for the local council elections. This is strange because, with his record of achievement, the things he was saying seem more like stand-up comedy than serious statements of ability.
Try this, about the European Union: “I have a track record of delivery – and believe me, whatever it takes, I will deliver this in-out referendum.” A track record of delivery? Well, yes. He delivered a top-down reorganisation of the NHS that nobody wanted, leading to an inrush of private health companies into the NHS – that nobody wanted. He has delivered the lowest amount of house-building, per year, since records began. He has delivered a withered economic ‘recovery’ that arrived three years later than if he had continued with the plan of the previous, Labour, government. He has delivered all the benefits of that ‘recovery’ to the extremely rich, rather than sharing it equally with the people responsible for it. And he has delivered a new high in employment, with no economic benefit to the country, that has left workers on wages that are so low they are going into debt.
He delivered the bedroom tax.
He delivered a massive increase in the National Debt.
He delivered millions of people into poverty and food bank dependence.
Ha ha ha. Very funny, Mr Cameron.
He told us, “People said I would never veto a European treaty. In 2011 that’s exactly what I did.” Well, yes. But the rest of Europe just went right ahead and carried on without you. You marginalised Britain as a member of the EU and made us a laughing-stock in the eyes of the world.
Ha ha ha. Very funny, Mr Cameron.
“We came through the great recession together; we are building the great British revival together,” he said. But he can’t say that to the many thousands of people who used to be claiming sickness and disability benefits but aren’t anymore because they are all dead. They didn’t come through the great recession. Cameron cut off their means of survival, forcing them into situations in which their health was allowed to worsen until their conditions overwhelmed them, or their situation induced such huge bouts of depression that they took their own lives.
Ha h- no. That’s not funny, Mr Cameron.
“The job is not done. If you want to finish the job we have started, back the party with a plan,” he said. Well, no. The Conservative plan (such as it is) will destroy your employment rights, scrap the welfare state, maintain a huge underclass of unemployed people to use as fodder for work-for-your-benefit schemes (a contradiction in terms if ever there was one) to circumvent the minimum wage, and to claim credit for successes that aren’t theirs.
There is only one reason to support the Conservative Party in this – or any other election.
That is if there is only one other political party on the ballot paper – and that party is UKIP.
One down: Patrick Mercer resigned because the weight of corruption allegations against him was too great. But what are the other 649 MPs hiding?
We need to talk about the culture of deception that is festering at the heart of the British political classes.
Every party is guilty of this to some degree – all of them. They have all made promises to the electorate and then, once in positions of power, they have done exactly whatever else they wanted.
On Tuesday, Patrick Mercer resigned as an MP rather than face suspension from the House of Commons over allegations that, rather than carrying out the will of his constituents, he had corruptly set up an All-Party Parliamentary Group to life Fiji’s suspension from the Commonwealth, after having been offered money to do so by undercover reporters.
His resignation came 11 months after he resigned from the Parliamentary Conservative Party, and this decision was made in the knowledge that a TV documentary was about to present the allegations to the country. Would he have taken these actions otherwise? It’s highly doubtful. Nobody resigns when they think they got away with it.
Nobody seems to be mentioning the fact that this allegedly corrupt MP managed to keep his seat in the Commons for 11 months after the allegations came out – that’s nearly one-fifth of a Parliamentary term when he was still drawing his taxpayer-funded salary. Is that reasonable?
Mercer is, of course, just one individual case. In the lifetime of this Parliament we have seen entire Parliamentary political parties turn on their electors in betrayal. It is to be hoped that nobody has forgotten Labour’s betrayal of the unemployed when it failed to oppose the Jobseekers (Back to Work Schemes) Act that retrospectively imposed penalties on people who refuse to take part in state-sponsored ‘slave labour’ schemes.
Labour’s front bench claimed it had negotiated important concessions, including an inquiry into the effectiveness of mandatory work activity – and when is that due to report? Around 30 Labour MPs are still entitled to hold their heads high, because they rebelled and voted against the legislation in any case.
Far worse is the behaviour of the Conservative Party, who promised that the National Health Service would be safe under a Tory government and then set in motion the wholesale upheaval that we have witnessed over the past few years, with funding squandered on reorganisation and privatisation of services that is intended to lead to the abolition of the publicly-funded health service in a few years’ time.
Pensions are going the same way; the Workplace Pension discourages employers from participation, meaning they are trying to push their workforces into taking up private schemes instead. Meanwhile the state pension has been ‘simplified’ in a way that means people have to work longer before receiving it. The intention is, eventually, to privatise pension provision altogether and ensure only those on higher pay can afford them.
And the Tories are busy abolishing the rest of the welfare state as well. The harsh regime of sanctions and slave-labour schemes run by the Department for Work and Pensions is intended to soften up the workforce – and potential workforce – for the introduction of privately-run schemes, into which you will be expected to pay to insure against the possibility of becoming jobless – the policies would provide your income during any such period (as long as you didn’t stay out of work for very long) instead of the government.
The problem with such proposals is that, if they are run along the same lines as certain health insurance schemes, they would be scams – as the conditions would be rigged to ensure that the companies running them never had to pay out. This is what we have learned from the fact that the criminal Unum Corporation has been advising the DWP on its policies.
And then, worst of all, we have the so-called Liberal Democrats, who promised to eradicate student fees in the run-up to the 2010 election and betrayed that pledge two months before the poll took place, in a backroom power-sharing deal with the Conservative Party.
The same organisation has gone on to support the Conservatives every step of the way to dismantling the welfare state and reducing the vast majority of the UK’s workforce to conditions we have not seen since the early 20th century at the latest.
Many of us have been dismayed at this apparent betrayal by an organisation that we all hoped would have put a brake on the more excessive Tory policies, but VPFacebook commenter John Elwyn Kimber has cast illumination on the reasons we were mistaken.
“19th-century Whiggery, ‘Orange’ or ‘Manchester’ Liberalism, call it what you like, was about the unfettered power of new money – hence identical to modern ‘Toryism’,” he wrote.
“Just as Eisenhower was the last civilised Republican president, traditional patrician Downton-Abbey-style Conservatism of the more socially-responsible sort finally departed British politics after the MacMillan government. Even the sitting-on-the-fence Heathites, the ‘Tory Wets’, were gleefully kicked out of the cabinet by Margaret Thatcher after the ‘Falklands election’ in 1983, with the exception of Whitelaw who was retained [though sidelined] as a sort of sop to the traditionalists.
“Since when, the political consensus has been for whiggery-pokery all the way up till now. So while the understanding of ‘Liberal’ by Lib Dem grass roots voters is a mid-twentieth-century one, all about tolerance and socially-progressive policies, it seems obvious that Clegg’s cabinet are only too happy to be rabid whigs nuzzled up to another lot of rabid whigs – the only difference is in the mood-music provided for the grass roots in each case.”
The message is that we were all deceived – again.
The problem is that there is almost nothing we can do about it that doesn’t take a lot of time – a commodity that is in short supply.
Historically, the UK does not carry a box on the ballot paper marked “None of the above”. This means there is no direct democratic way of refusing all the candidates for election to a particular constituency and demand better. Nor is there ever likely to be, because our corrupt politicians know that would be equivalent to turkeys voting for Christmas.
Alternatively, we can form new political parties and try to beat the corrupt old parties at their own game. The problem with this is one of traction; it takes new parties many years to gain enough recognition to become a serious force. UKIP is only beginning to gain such recognition now, after more than 20 years – and this is as a protest party against membership of the European Union. If that party’s supporters took a look at its other policies, they’d desert en masse.
Another possibility is similarly time-consuming: You actually join one of the main political parties and try to effect change from within. The problem here is that you would be fighting established members every step of the way. It has been done effectively in the past, though – look at the way Labour was transformed into New Labour by the influence of a few neoliberal infiltrators, and consider the damage that has done to the party’s reputation and effectiveness.
The worst option is the most popular: You do nothing. This is, of course, the wide and easy path to disaster – but so many people are feeling disaffected because of the barriers that the corrupt political classes have put up against democracy, that they honestly can’t see the point of voting.
This of course means our government will be elected by an ever-diminishing group of electors, and makes it all the more possible for our ever-more-elite group of corrupt politicians to argue for those who don’t vote to lose the right to take part in elections. You will be disenfranchised.
Then you really will have no power to change anything at all.
Life imitating art: I made this poster months ago, and it is pleasant that its words were echoed by Andy Burnham in the NHS debate.
It was a debate the Labour Party could not win at the vote; the Coalition has the weight of numbers and is always going to vote down a motion that criticises its decisions and record – in this instance, it called for “much-needed honesty” in the public debate on the NHS, and “in particular, NHS spending”.
But it was also a debate that had to take place, and Andy Burnham, the Shadow Secretary of State for Health, was right to put the arguments before the public. Anyone listening to the arguments with an open, if inquiring, mind could see that Labour has won this argument.
The Opposition Day debate in the House of Commons yesterday was called by Mr Burnham after Andrew Dilnot, head of the UK Statistics Authority, wrote to caution the government that its claims of increased spending on the health service, year on year, during every year of the current Parliament, were inaccurate. He stated that the figures show a real-terms cut in expenditure between the 2009-10 tax year when Labour was in power, and 2011-12.
In fairness, the next sentence of the letter went on to say that, “given the small size of the changes and the uncertainties associated with them, it might also be fair to say that real-terms expenditure has changed little over this period”. Even so, that is not an agreement that funding had increased; it is an assertion that the best the government could say is that funding has been at a standstill.
Mr Burnham pointed out two drains on NHS funding that have taken £3.5 billion out of the system – savings of £1.9 billion that went back to the Treasury instead of being ploughed back into NHS services as promised, and £1.6 billion spent on Andrew Lansley’s vanity-prompted, ideologically-based top-down reorganisation that brought private companies into the NHS with disastrous results.
(I think my own opinions may have intruded into the narrative of the last paragraph, but since these conclusion will be obvious to anyone who reads what follows, I feel justified in drawing attention to them here)
I hope we all know what the promises were. The 2010 Conservative Manifesto stated: “We will increase health spending in real terms every year”; the Coalition Agreement said “We will guarantee that health spending increases in real terms in each year of this Parliament”. And week after week, ministers from the Prime Minister downwards have claimed that is exactly what they have delivered. Until recently, the Conservative Party website prominently stated: “We have increased the NHS budget in real terms in each of the last two years”. And on October 23, from the Health Secretary, Jeremy Hunt, to the House of Commons: “Real-terms spending on the NHS has increased across the country.”
But there’s a mismatch here, said Mr Burnham. People have heard that spending is increasing, but what they have seen is an ever-increasing list of cuts to funding and services. Along with other Labour MPs, he delivered a devastating list of these cuts in support of his claims. These included:
750 jobs cut at Salford Royal Hospital, with a total of 3,100 job losses across hospitals in that area, and two walk-in centres closed.
Cuts to the mental health budget.
A broken pre-election promise not to close accident and emergency at Queen Mary’s, Sidcup; it closed after the general election.
A plan to close accident and emergency at Lewisham Hospital.
Cuts to cancer networks.
£1 billion spent on managerial redundancies when patients are seeing treatment restricted and nurses laid off in their thousands.
7,134 nursing posts have been lost since the Coalition came in, 943 in the last month alone.
Training places are being cut by 4.6 per cent this year, after a 9.4 per cent cut in 2011-12.
125 separate treatments have been restricted or stopped altogether since 2010.
More than 50,000 patients have been denied treatments, kept off waiting lists, and there have been big falls in operations for cataracts, varicose veins, and carpal tunnel syndrome. “We have heard claims about reducing waiting lists but that is because people can’t get on the waiting list in the first place,” said Mr Burnham.
West Midlands Ambulance Service advised on Tuesday that there are about half a dozen hospitals in the West Midlands whose A&E staffing situation is so critical that it is having a knock-on effect to turnaround time of ambulances.
In Bolton, South Tees, Maidstone and Tunbridge Wells, large numbers of staff have been given 90-day redundancy notices.
The consequences were clear, according to the shadow Health Secretary:
74 per cent of NHS leaders described the current financial position as the worst they had ever experienced or very serious, he said. “The reason the government’s cuts feel much deeper is because they are contending with the added effects of a reorganisation that nobody wanted and that they pleaded with the former Secretary of State to stop. Cuts and reorganisation – it’s a toxic mix. As trusts start to panic about the future, increasingly drastic cuts are being offered up that could have serious consequences for patient care.”
Leading on from this, he said the Care Quality Commission found that 16 per cent of hospitals in England did not have adequate staffing levels. “I am surprised a warning of this seriousness hasn’t received more attention,” Mr Burnham said.
“The Prime Minister has cut the NHS – fact,” said Mr Burnham. “But just as he airbrushed his poster, he has tried to airbrush the statistics and has been found out.
“What I find most troubling about all of this, and most revealing about the style of this government and the way it works, is that even when they are warned by an official watchdog, they just carry on as if nothing has happened. When they admitted cutting the NHS in 2011-12 by amending their website, what was the excuse that they offered to Sir Andrew? ‘Labour left plans for a cut.’ Simply untrue.
“According to Treasury statistics, Labour left plans for a 0.7 per cent real-terms increase in the NHS in 2011-12. From then on, we had a spending settlement giving real-terms protection to the NHS budget. It was this government that slowed spending in 2010-11, which allowed the resulting £1.9 billion underspend to be swiped back by the Treasury, contrary to the promise that all savings would be reinvested, and it was this government that still has published plans, issued by HM Treasury, for a further 0.3 per cent cut to the NHS in 2013 and 2014-15 – contrary to the new statement that they have just put up on their website.”
He said the Coalition parties’ arrogance “seems to give them a feeling that they can claim black is white and expect everyone to believe it“. (Would it be in poor taste to hope that, in this case, Douglas Adams is proven correct and they all have terminal experiences the next time they venture onto a zebra crossing?)
“The lethal mix of cuts and reorganisation is destabilising our hospitals,” said Mr Burnham. “They are the first to feel the full effects of the free-market ideology that they have unleashed on the NHS. No longer a ‘One NHS’ approach, where spending is managed across the system, but now a broken-down, market-based NHS. The message to Britain’s hospitals, from this government, is this: ‘You’re on your own. No bailouts. Sink or swim. Oh, but if it helps, you can devote half your beds to treating private patients.’
“So we see increasing signs of panic as they struggle to survive in this harsh new world. And we see half-baked plans coming forward to reconfigure services, with an effort to short-circuit public consultation. Will the Secretary of State today remove the immediate threat to Lewisham A&E by stating clearly that it is a straightforward breach of the rules of the administration process to solve the problems in one trust by the backdoor reconfiguration of another? In Greater Manchester, will he ensure that the future of all A&E provision is considered in the round, in a citywide review, rather than allowing the A&E at Trafford to be picked off in advance? And in St Helens and Mosley, will he reverse the previous SoS’s comments when he told the CCGs they had no obligation to honour financial commitments to the hospital, entered into by the previous PCTs?
“It’s chaos out there, and [the Health Secretary] urgently needs – in fact, they all need to get a grip, not just the Secretary of State; all of them.
“Cuts and reorganisation are resulting in a crude drive to privatise services, prioritising cost over clinical quality. Across England, deals have been signed to open up 396 community services to open tender under ‘any qualified provider’. But these deals are not subject to proper public scrutiny as the deals are held back under commercial confidentiality. In Greater Manchester, plans are advanced to hand over patient transport services to Arriva, despite the fact that an in-house bid scored higher on quality, and despite the fact that the CQC recently found serious shortcomings with the same provider in Leicestershire. Nobody has asked the patients who rely on this service whether they want this change.
“‘Any qualified provider’ is turning into the NHS version of compulsory competitive tendering, a race to the bottom and a rush to go for the cheapest bid, regardless of the effect on patients and services. What clearer symbol could their be of a privatised, cut-price, Coalition NHS than the decision in Greater Manchester to award patient transport to a bus company.”
In the NHS constitution, patients and staff “have the right to be involved, directly or through representatives, in the planning of healthcare services, the development and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the operation of those services”. So Mr Burnham asked: “Why doesn’t he just press the pause button now, and ask people if they want their ambulance services run by a bus company? ‘The NHS belongs to the people,’ says the first line of the NHS constitution – not when this government has finished with it, it won’t!
“People will remember the personal promises this Prime Minister made on the NHS to win office. Promises it now seems had more to do with his desire to de-toxify the Tory brand than with any genuine regard for the NHS.
“No top-down reorganisation of the NHS – broken.
“A moratorium on hospital changes – broken.
“And real-terms increases in every year of this Parliament – broken.
“They can now see the chaos that the breaking of these promises is visiting on the NHS: Nurse numbers – cut.
“Health visitors – cut.
“Mental health – cut.
“Cancer networks – cut.
“Cataract operations – cut.
“The man who cut the NHS, not the deficit.”
How did the Coalition combat these assertions? First with an attempt to divert the debate onto the NHS in Wales, overseen by a Labour Assembly Government, where spending has been cut. This was a matter that has exercised David Cameron very much during recent Prime Minister’s Questions, and it was welcome to see Mr Burnham set the record straight as thoroughly as he did yesterday.
He said the Coalition has given to the Welsh Assembly Government a real-terms funding cut of £2.1 billion – and this is the truth of it. I remember discussing the matter with Assembly members last year and it seems that even funding, which had been set aside to cushion the expected blow of cuts from Westminster, had been clawed back by the UK Treasury, with no regard for the consequences to Welsh NHS patients.
“They have done their best to protect health spending in that context,” Mr Burnham said. “Since 2010 there has been no reduction in frontline staff, particularly nurses, unlike [the UK] government. The Welsh Assembly are doing the best they can with the awful hand of cards which [this] government dealt them.”
Next, Mr Burnham was asked if he regretted “removing and reducing health spending to old people and rural areas, which happened under his watch”. It appears that this was a fabrication, dreamed up by the questioner, as Mr Burnham said it bore no relation to reality: “There was no reduction in health spending on my watch. I left plans for an increase. He illustrates my point.”
We heard that the chief economist of the King’s Fund, John Appleby, said that before the general election, the former chancellor had left plans for 2011-12, 2012-13 that would see a cut in real terms.
“I did the deal,” said Mr Burnham, “just months before the general election, protecting the NHS in real terms.
“At the election I was arguing for real-terms protection. I said it would be irresponsible, yes, to give real-terms increases over and above real-terms protection because the only way [to] pay for that would be taking it off councils, hollowing out the social care budget.”
One Tory who seemed particularly keen to assert his superiority said she was “very disappointed” to hear Mr Burnham “talking down the NHS”. She claimed that, before the election, the NHS knew it was facing an “unprecedented efficiency challenge”. And she said that, under Labour, productivity in the NHS fell continuously. Would the shadow health secretary acknowledge the achievements of the NHS in achieving a productivity gain?
This member got what she deserved – a three-word dismissal: “Productivity hadn’t fallen.” It’s a classic Tory ploy, criticising the opposition’s previous record to take the heat off their own current policies. But it doesn’t work when it’s based on a falsehood.
All of these were interjections from backbenchers. We could expect more high-quality responses from the Health Secretary himself, couldn’t we?
Judge for yourself.
“This government is spending more on the NHS than Labour would have, and because that money has moved from the back office to the front line, the NHS is performing better now than it ever did under Labour,” said Jeremy Hunt, the well-known misprint, providing no proof to support his claims.
“In 2011-12, spending went up by £2.5 billion in cash terms, 0.1 per cent in real terms, on 2010-11. And this year, 2012-13, it will go up again, as it will in every year of the Parliament.” But this did not address Andrew Dilnot’s assertion – that spending had dropped from 2009-10 levels. He was being selective with his statistics, and one can only conclude that he was trying to avoid dealing with an inconvenient fact. This was the point at which I knew Labour had won the argument.
“He [Andy Burnham] can hardly come to us, criticising our plans for NHS spending, if his own plans would have led to not higher, but lower NHS spending.” Note that it had already been stated that this was not what Mr Burnham had been doing. He made it clear that he would have protected levels of spending.
Mr Hunt joined the attack on the Welsh Government by stating that Labour has announced plans to cut the NHS budget by eight per cent in real terms, “despite an overall settlement protected by Barnett” (the Barnett settlement is a funding plan for devolved governments. Note that Mr Hunt did not say what the settlement was, and we are therefore deprived of the ability to determine whether this settlement is fair). Mr Hunt went on to ask of his Labour counterpart, “Will he condemn the choice that Labour made in Wales? If he doesn’t want to condemn that, let me tell him what the BMA says is happening in Wales. They talk of a ‘slash and burn’ situation. They talk about ‘panic on the wards’. Would he want that to be repeated in England?” He seemed not to have noticed Mr Burnham stating this is exactly what is already happening.
On a personal note, I use hospitals in Wales – a lot. My girlfriend is disabled and I myself have had occasion to seek hospital treatment. It has always been timely, professional, conducted in a calm, warm, welcoming atmosphere. I have seen no signs of panic on the wards, and if any aspect of the service is being slashed and burned, I haven’t experienced it myself. I have absolutely no complaints about the health service in Wales; if I were to level criticism anywhere, it would be across the border in England.
The final shot in the Wales mini-debate came from a Labour member, who wondered if the cut in Welsh health funding “has got anything to do with the cuts in capital spending from the Westminster government?”
This member added: “And has he any comment to make on National Audit Office figures that show spending on health in Wales is higher than that in England? Or does that not fit with his fictitious version of events?”
Fictitious. That’s exactly right. Now contrast Mr Hunt’s approach to questions from the opposition with the style already displayed by Mr Burnham – who, as evidenced above, tackled his critics head-on, answering them directly with the required facts.
The question was: Will he confirm just how many nurses have been cut under this government’s watch? The answer? “The nurse to bed ratio has gone up. The average bed is getting an extra two hours of nursing care, per week, than under Labour.”
That’s not an answer, and the Labour backbenchers knew it. Smelling blood in the water, another asked: “Why won’t he answer the question put to him – how many nurses have lost their job on his watch? Don’t tell me about nurse-to-bed ratio – answer the question.”
Fat chance! The response, again avoiding a direct answer, was: “The number of clinical staff in the NHS has gone up and not down. I don’t want to micro-manage every hospital in the country and tell them how many doctors and how many nurses.”
Mr Hunt returned to the Coalition line on NHS spending: “”We are increasing spending by £12.5 billion; he [Andy Burnham] thinks that is irresponsible.”
He was, of course, shot down – by two separate comments. One female Labour member stated: “My understanding of that english is that things had not changed much, in any circumstances, but the Secretary of State has said, consistently, he and the government were pledged to an increase. There is nothing in that letter [by Andrew Dilnot] to suggest that any increase has occurred.
And I believe it was Dame Joan Ruddock who said: “I find it impossible to find a record of this extra spending. It seems the reality is cuts and reductions to services.”
No point in listening beyond that. Coalition demolished.
Note: I apologise for the lack of information on who said what, other than the Health Secretary and his Shadow. I’m afraid I was too busy taking down what people were saying to catch their names, as they flashed up on my computer screen. It is not my intention to cause offence.
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