Down the Rabbit Hole; Incompetence or Corruption?

If you read just this sentence, then read this; this Tory Government has ‘cooked the books’ on NHS finances, cut the budget far below what is safe or feasible, and let patient’s suffer to pursue a political ideology.

Want more information? juniordoctorblog goes down the rabbit hole. Watch your step – it’s a proper mess in here.

Let’s start at a beginning.

Here is a graph.

Here is the NHS budget (navy line). Here is the number of hospital ‘episodes’ (purple line). Here is the % of A&E attenders waiting over 4 hours (orange line), and here is the pan-NHS deficit (charted bars). A&E and hospital activity has risen predictably and steadily, while the NHS budget has fallen progressively behind, at a rate of ~0.9%/year, meanwhile hospitals started in 2010 with a £1.5 billion surplus, and will finish 2016 with a probable £2.3 billion deficit.

Bottom line: we are already doing more and more with less and less, and we are in trouble.

NHS 2010-16

Let’s walk on. Mind your step, Andrew Lansley has been in here.

How did we get to this point?

Well here is the Public Accounts Committee meeting into NHS workforce planning – the four heads of the NHS sat down in front of a parade of MPs and revealed they didn’t really have a clue what was happening, with ‘7-day NHS’ plans or with the ‘junior doctor contract’.

The bosses of the health service were told they were ‘flying blind’ on some of the biggest issues in the NHS at the moment.

During the proceedings the panel were rather anxious to find out how the NHS has fallen into such massive debt. It would seem that in trying to meet ‘efficiency’ targets, or ‘cuts’ as we would say, “they discovered that it was too ambitious and, as a consequence, they had to find temporary staff […] to help to meet safety parameters”. This was very expensive.

The problem with healthcare is when you try to ‘cut costs’ you often actually create larger costs. Look at social care – by cutting social care provisions e.g. carers and social workers, you save a little bit of money, but the patient waiting in hospital for a social placement is then stuck in a hospital bed with hospital care for longer – this costs a great deal of money.

The best way to explain it I have come across is this. Imagine you own a van, and every year you drive it a little bit further, and carry a little bit more. Now imagine you decide to make it more ‘efficient’ to save money. You make the van lighter by removing the car rack. A lighter van drives longer distances for the same money. To save a bit more money you stop taking the van to the garage. A year goes by, driving further, carrying more. Next the gearbox breaks, you could’ve prevented that if you’d gone to the garage every year. That costs more money, but rather than pay to replace it you decide to make more ‘efficiencies’. You sell off the wing mirrors and the bonnet one year, then sell the passenger seat, and the electrics the next. Before long you are driving further than ever before, on the same budget, but your van has no doors or windows. It’s not safe. You still won’t invest any more money, still want to drive it further. Next you sell the wheels and the engine. The budget is balanced, but the van is dead. A neighbour then says “Do you want to rent my van? It’s more expensive, and it’s not as good as your van was, but it’s all you’ve got.” Your neighbour is Richard Branson.

But I digress.

Let’s keep going. Here is a report to the public accounts committee on NHS finances, released this week.

Here’s a few highlights;

“The financial performance of NHS trusts and NHS foundation trusts has deteriorated sharply and this trend is not sustainable”

“There is not yet a convincing plan in place for closing the £22 billion efficiency gap and avoiding a ‘black hole’ in NHS finances.”

But we knew all that already. So who is to blame?

Let’s dig a little deeper. Watch your head.

Here’s some written evidence from an anonymous whistleblowing financial director of a NHS hospital – they were frightened to give their name publicly for fear they would lose their job.

They are concerned that “patient safety and quality of care may be compromised by trusts’ short term actions to reduce headcount” but even worse that financial directors are making ‘questionable adjustments’ to their accounts which are ‘merely window-dressing’ to their accounts to please ‘no 10 influence’. Through several dodgy practices, including a ‘Capital-To-Revenue’ Transfer scheme- which essentially means the Department of Health pays money to hospitals, which record revenue, and then pay it straight back to the Dept of Health, which record ‘capital’. When trusts find they cannot pay costs, like the wages of their staff, the government steps in, but only with large strings attached, that the hospital must make further cuts.

Bottom line: NHS trusts may have been ‘cooking the books’ in order to appear as if they are not making massive cuts and crumbling under the massive pressure of No.10 and treasury underfunding.

It’s hard to decide whether this is incompetence on the behalf of the department of health, or deliberate underfunding from David Cameron, to move to privatisation, which, without a democratic mandate, is corrupt.

In the meantime we cannot afford to staff our hospitals properly, we cannot afford to cope with the demand in A&E and into this crisis the government impose a completely unmodelled contract on junior doctors, and decide to pursue ‘7-day’ services and the ‘safest healthcare system in the world’. It’s as if the Titanic is sinking and the captain wants everyone to rearrange the deck chairs.

Where shall we go from here?

So, in 2009 David Cameron takes over the country. George Osbourne and Andrew Lansley take huge amounts of money out of the health service, while demand rises and rises. Later Jeremy Hunt, with aggressive No.10 and Treasury influence, continues to do the same, only now there is no slack to give, and the system starts to implode. This is a political ideology driving shambolic managers with few options to either ‘cook the books’ or get fired, and in the meantime the NHS is in the midst of the biggest crisis in it’s history. As it looks, it could be the last one- this time next year there won’t be an NHS if things carry on like this.

It doesn’t sound good for the Department of Health and Mr Hunt. Apparently some scallywags are taking them to court.

Anyway, I’m off. Make your own way out.





The government aren’t listening. Time to make them.

The junior doctor contract dispute has taken its toll; eight gruelling months, three major protests, four days of strike action, and 54,000 angry, articulate, dedicated individuals.

We have staged sit ins, delivered giant books, set up fake betting shops, supported two hugely successful choirs and one Christmas number one, created fashion lines, and even collaborated with a Time Lord or two. We have become our own investigative journalists: uncovering dubious research practice, revealing departmental incompetence and lies, and documenting tragic cases of the government’s spin causing real patient harm. We have become our own researchers: revealing flawed data, misrepresentation of statistics and huge holes in the government’s ‘evidence’ arguments. 
We are not giving up anytime soon.
Why are we doing this? David Cameron and company would have you believe we are grabbing for a payrise, grabbing for free weekends and better perks. Many of you know by now this is simply untrue.
What we are terrified of is an imposed contract, unmodelled, uncosted, and unbelievably unsafe. The NHS is on its knees- the knock-on effect to recruitment and retention alone, not just for junior doctors but all NHS staff, could collapse the entire service.
So what next? How can we make a government listen to our concerns.
This. We, a group of patients, doctors and NHS staff, are proud to announce the initiation of a second independent judicial review into the junior doctors contract.
We are not the BMA- they have challenged the government as an employment dispute, on equality grounds.
We are challenging them over patient safety- patients who are concerned an already underfunded NHS cannot cope with the government’s insistence on ‘7-day’ services without additional funds or additional doctors. We have huge gaps in cover already- 60% increase in rota gaps for doctors, 50% increase in agency nurses in a single year. 9/10 junior doctors have said they will resign if the new contract goes ahead. Even if 1/10 actually leave- for locum work, abroad, pharmaceuticals, or even simply stop being doctors- the system will crumble. Then the nurses, the pharmacists, the AHPs, the consultants, the GPs will undergo the same.

We have instructed renowned Human Rights and judicial review specialist law firm, Bindmans LLP, to investigate the legality of the decisions of the Secretary for Health. We will ask for a wide-ranging review into the impact on staffing, costing and the evidence for need and benefit of imposition. We will force the government to finally listen, and come up with the so-far missing evidence to back up months of wild claims and false promises.
At the very least we will see the necessity, and take the time to consider the biggest gamble in the history of the NHS. At best, we may finally prove that the DoH and government have been peddling smoke and mirrors, and find the real reasons for the underfunding, the enforced contracts, the increased privatisation. Most importantly, we may avert catastrophic patient harm.
What can you do to help?

We are not an organisation- we are simply individuals who care deeply about the future of the NHS. We are crowdfunding our case here, at CrowdJustice. Follow us on Twitter and Facebook as #JustHealth. We are off to a great start, but need at least £100,000 or more to fund such a complex and important legal action. We will possibly need more to keep going, and it will be only your support that will make this possible.
For years I have ranted on about trying to save our NHS. Many of you agree, but ask “what can I do about it?”
This. You can do this.
We can save our NHS. We must.

The battle for our NHS is nearly over. And we are losing.

Be kind, for everyone you meet is fighting a battle you know nothing about.
Wendy MassThe Candymakers

There are secret battles going on all over the country right now: battles to keep teachers, fire fighters, police officers in work, to protect the rights of disabled people, and save children from poverty. The NHS is quietly becoming a war zone all by itself; there are battles to stop stripping student nurses of their bursaries, to stop A&E and maternity closures, to keep community pharmacies open, to challenge consultant contracts, to keep GP practices open, and the most publicly of all; to halt the imposition of the junior doctors contract.
These battles are secret not by our choosing- I have colleagues who have done nothing but work themselves to the bone for the last eight months to try to get the word to you- I hope you were listening. Many mainstream media outlets were not. The uphill struggle to even dent the public perception from the governments spin machine has been titanic. I still think we haven’t got even halfway there.
This isn’t about weekend pay or hours, it’s a little about unsafe staffing and a lot about dangerous underfunding of the national health service. What it’s mostly about is challenging a government set on dismantling the free at the point of use service of the NHS.
Since 2010, on every recordable measure the NHS is failing: waiting times, staff retention and recruitment, funding ‘deficits’. If you want to get really simple: death rates are up. Let me reiterate that- since 2010/12, after fifty years of steady decline, death rates in the UK have started to rise. More people are dying. THIS is the result of a financial crash and a Tory government ‘not letting a good crisis go to waste‘- pushing an ideology of public sector sell off and shrinking of government that is the core of conservatism.
You might think they’ve gone too far- I do. So does Prof Don Berwick, the Nuffield Trust, the Financial Times and the Kings Fund to  name a few. The deficit is £97 billion, the national debt is £1.6 trillion– there is no ‘balancing of the books’. Austerity was a great lie. This is a government of PR, not policy.
Now circle around to the junior doctors contract dispute. The contract is a means to provide lucrative cheap elective weekend work at the cost of safety to patients during the week. There are no more doctors to provide these services. The National Audit Office and Cass Business school said these changes ‘posed a genuine risk’ and may ‘breach employer duty of care’.
Why would David Cameron do this then? Because for twenty or thirty years successive governments have tried to privatise health in the UK: the head of the NHS is an ex-US health care executive, Virgin own many NHS community services ALREADY in the UK, the former Health secretary now works for a private health consultancy, £1.5 billion pounds of private contracts linked to companies of sitting MPs. Still don’t believe me? Here is the plan- from 1988  Britains Biggest Enterprise by Oliver Letwin, current Tory advisor and strategist. Here is the plan revisited in 2005- Direct Democracy, co-written by current health secretary Jeremy Hunt.
The plan is to drive down terms and condition, create an unworkable and unsafe NHS, and then in a crisis- roll in private companies. As they say- ‘never let a good crisis go to waste’. While people, other normal human beings will suffer; your families, grandparents, uncles and aunts.
That is what this fight is about. The battle for the NHS has raged for thirty years, and you mostly had no idea about it.
I have colleagues who spend all their own time organising, campaigning, giving interviews, challenging the government to show us we are wrong; and thus far all we are met with is lies and spin. Colleagues who have taught themselves law, economics, public relations, journalism, song-writing. These men and women are all working doctors, nurses, physios and AHPs- saving your life as a day job, trying to save your health service from home.
We are doctors who want to do our jobs; to protect the health of our patients. We are fighting because banging our heads against the wall just isn’t enough anymore.
We will fight them in the courts.  The BMA is launching a legal challenge to the contract. It will force the government to legally show us that they will not harm patients, that they will not create further crisis in the NHS, that they are doing as they say, and acting in the best interests of patients. We know they are not.
We will fight them on the streets. Join us on the picket line on March 9th and 10th March. Show them you value the service and staff of the NHS. Come and talk to us at Meet The Doctors events. Find out more here.
We will fight them in Parliament. The NHS reinstatement bill has its second reading on the 11th March- it challenges the legality of privatising the NHS and the market that encourages private takeover, at huge public cost. Write to your MP and tell them you support this bill.
The fiercest battle is sometimes one you never heard of. Don’t let this one be – join us in our fight to save our NHS. To paraphrase a superb junior doctor on social media; “in two decades time you can tell your kids the reason there’s still an NHS is because twenty years ago you stood up for it”.
Stand up.