It’s been a long week for the NHS in politics. The week opened with the announcement of further doctors strikes, three 48-hour emergency care only periods in two months, plus the launch of a legal enquiry into the imposition of the contract.
Jeremy Hunt’s and David Cameron’s argument goes like this;
“Studies show we have excess death on the weekend because we do not staff our hospitals properly. We need to create a ‘7-day’ NHS to fix that, and this junior doctor contract is needed to do so. We are putting £10 billion into the NHS to achieve this.’
The government has spun a tight narrative over the last six months- but this week it began to unravel.
Firstly the most quoted ‘study’ it emerged last week was shown to the DoH and Jeremy Hunt before it was verified and published; a serious misdemeanour for both ministers and ethical research. David Cameron missed the point at PMQs, mixing up two studies from different years as ‘estimates’, and continuing to misrepresent both. Interestingly he claimed that the Freemantle study arose ‘based on a question asked by the Health Secretary of Sir Bruce Keogh‘. Did the Prime Minister just intimate the government commissioned its own research?
Staffing hospitals is a major issue it would seem- but not at the weekend, throughout the week. During a DoH public accounts committee meeting it became apparent that due to overzealous ‘efficiency’ targets trusts were told to reduce staffing. When this became unsafe they hired agency staff to fill the rotas leading to the £2.8 billion deficit this year
NHS chief executives are also concerned that trusts prioritise ‘quality’ over ‘costs’. In healthcare I think most people would do the same.
On top of this the BBC reported a 60% rise in vacant posts for doctors and a 50% rise for nurses in two years. With so little staff do the department of health think it safe to stretch the NHS to a ‘7-day’ service?
Well it would seem they haven’t thought about it at all. In the same PAC meeting it emerged the Dept of Health have no formal strategy for ‘7-day’ services; they don’t know how much it costs, they don’t know how contract changes will achieve it and they don’t know the impact it will have. That sounds very dry so let me characterise that.
You go to see your doctor feeling tired. She says “you have cancer and we must start treatment straight away.” You are rightly upset.
“How do you know?” You ask.
“Well there are significant ‘data gaps‘ in the judgement, it’s not just scientific fact you know, and we need ‘certainty‘ going forward so, yeah. But we must start treatment straight away- I don’t know how much it costs, what the treatment is, and it’s probably very damaging. To be honest, I have no idea. I’m ‘flying blind’ on this one, but I’m going to impose this treatment anyway, because I’ll get sacked if I don’t’.
So where did this contract come from, if the DoH hasn’t actually done the work that demonstrates its necessity?
In a great article that looks into its origins Steve Topple reveals a group of hospitals proposed taking advantage of a (disappearing) excess of doctors in training to drive down pay and conditions. The originators of that work now hold high level positions in the NHS administration.
Lastly, the money. The NHS needs £30 billion to maintain current standards by 2020. The government chose to make £20 billion of cuts to services and put in the least funding rise in the history of the NHS- 0.9%/year. This is the £10 billion in every Tory quote- that was only ever going to (try to) keep the lights on. Cameron thinks it will pay for a 7-day NHS, despite no one knowing what that will cost, and Hunt is paying for a ‘paperless’ NHS, 7-day services and who knows what else. The £20 billion in ‘cuts’ is already creating huge deficits in care- the £2.8 billion ‘deficit’ this year in trusts is a direct consequence of this political decision. Despite the governments insistence- the NHS is dangerously underfunded.
In a speech to the King’s Fund, Professor Don Berwick, US healthcare expert and former government patient safety advisor, agreed; “I know no nation that is seeking to provide healthcare at the level that western democracies can at 8% of GDP, let alone 7 or 6.7. That may be impossible.”
Meanwhile the NHS crumbles- in a stage managed fashion as private companies come to collect. This is #cams7dayscam, and far from being an omnishambles it is a controlled demolition.
We need to make it clear to sitting MPs that this is a disaster that we will hold them personally accountable for, an issue that will make or break their political careers for years to come.
The NHS is nearly done- record waiting times, record deficits, record staffing gaps, record low morale. It needs more money and better leaders. We are desperate to get this message out: if you want the NHS to survive you must fight for it, because David Cameron and this government are going to destroy it if you don’t.
Join us on the picket lines March 9th and 10th.