Thursday, 30 April 2015

The BMJ: “secure the NHS’s future”

The BMJ, the prestigious British Medical Journal, today calls on the next Health Secretary to “secure the NHS’s future”.

England’s NHS is stretched close to breaking point, say the BMJ editors.

The BMJ today calls on the next Secretary of State for Health to “secure the NHS’s future as the best and fairest health service in the world.”

In an open letter, Editor in chief, Dr Fiona Godlee, and colleagues say England’s NHS is stretched close to breaking point - and they set down what they believe is needed to heal the NHS.

They point to current problems, such as virtually flat-line funding in real terms since 2010, the growing demands of an aging population, and extreme cuts to social care, that have “exacerbated the pressures, causing knock-on effects across the service.”

As a result, waiting times for treatment are the longest for many years, while staff morale in many parts of the service is at rock bottom because of real terms pay cuts and the relentless workload, they write.

Patient safety is now also at risk, they warn, with 13 NHS trusts currently in special measures because of concerns about the quality of care being delivered - and eighty per cent of acute trusts are now in deficit.

They explain that in his five year plan, NHS England’s chief executive, Simon Stevens, demands savings of £22bn over the next five years. But say this level of saving “will still require efficiency gains never before achieved by the NHS, and a further £8bn is needed from government by 2020 just to stand still.”

And they point out that additional election promises - seven day working, guaranteed shorter access times, and more GPs and nurses - have been described by Mark Porter, the BMA’s chairman,  as “outlandish and unachievable.”

Against this background, the editors ask the Secretary of State to give “an unshakable commitment” to providing a publicly funded national health service, free at the point of need, and to resist the temptation to undertake further major top-down reorganisation.

They call for a focus on collaboration not competition and marketisation, for public health budgets to be ring fenced to protect vital services, and for “good transparent governance and less political interference.”

Finally, they urge the government “to properly fund England’s health service.”

They point out that the UK spends the joint lowest of any G7 country on healthcare as a proportion of gross domestic product, and the NHS is widely acknowledged to provide the most cost effective care of any developed nation. The NHS is not unaffordable, they say, but if it is deprived of the funds it needs to meet demand effectively, it could become so.

“History will not forgive another health secretary whose actions contribute to its decline,” they warn. “Let this be the five years that secure the NHS’s future as the best and fairest health service in the world.”

Responding to the BMJ's call for the next health secretary to 'secure the NHS's future', Dr Mark Porter, the Chair of the doctors organisation, the British Medical Association (BMA), said:

“The BMJ’s call for urgent action to secure the future of the NHS echoes those made by the BMA for a number of years. While staff have done as much as they can to protect and improve patient care, they are battling rising demand and years of underfunding that have left the NHS close to breaking point. This has been compounded by the costly and unnecessary reorganisation that distracted attention from the real issues and wasted millions of public money.

"Doctors on the ground are seeing first-hand how the pressures on the system are affecting the delivery of care across the NHS and the impact this is having on patients. The BMA's latest research has highlighted how 29 per cent of doctors have experienced a 'black alert' in their hospital and 48 per cent experiencing breaches in A&E targets. While our largest ever survey of GPs has shown that a third are considering retiring from general practice in the next five years at a time when politicians of all parties are trying to outbid each other on the number of new GPs they can magically produce in the next parliament.

“If we are to secure the NHS in the next parliament urgent action is needed to address the years of underfunding, the damaging marketisation of the NHS, the increasing recruitment and retention crisis and the health inequalities and major public health issues in our society.

"As part of the BMA’s ongoing No More Games campaign we have been calling for an end to the political game playing and the unrealistic pledges that have been a feature of this year’s election. Whoever holds the keys to No 10 after polling day has a duty to commit to having an open and honest public debate on the future of the NHS and how they expect to pay for it.”



Friday, 3 April 2015

More Tory myths on welfare

An indicator of the squeeze on hospitals is the increased number of Trusts in financial difficulty.   Five years ago it was just over 20%.  Now it is over 50%.  More than half the NHS Trusts are running a deficit.  It amounts to £800 million in total. 

The origins of these deficits is not hard to find. Demand on the NHS has been growing yet funding has increased by just 0.9% per year.  With complex reorganisation, cuts in spending on social care of around 20%, the burden on the NHS has never been greater.  Little wonder then that there are stark warnings that the system is at breaking point.   

The projected figures are stark.  It is estimated that there will be a funding gap of £30 billion for the NHS by 2020.  None of the political parties have really demonstrated how they would fill this gap. But the Conservatives pretend there is no problem that can;t be solved according to Mr Cameron 'by efficiency savings'.    There has already been £20 billion taken out of the NHS over the last five years in 'efficiency savings'.  Mr Cameron it seems expects to find a further £30 billion!  It is 'bury your head in the sand' time.  

Whatever  100 business bosses may say, you cannot have a healthy economy with an unhealthy work force.  Their intervention is hopelessly shortsighted.  The poorest are being made to pay for the financial collapse and further cuts will be made in welfare  spending.  That is cuts in support for hard working families on low pay.   

The Tories like to spin the myth that cuts in welfare only affect 'scroungers' and the 'work shy'.  Yet this is not so.  Mr Cameron is happy for many to work with zero hours contracts.  He himself would not wish to work on such a basis.  Yet he will do nothing to stop the exploitation of others.  No wonder these business bosses support the Tories.  Miliband is right to push for regulation of zero-hour contracts.  The counter argument that some people benefit from them is disingenuous as the majority do not and have currently no choice.  Cameron talks of creating 'real' jobs. Real jobs have real wages and proper contracts. 

I don't normally give a party political opinion on this blog.  This is an exception. And it is and exception driven by the unbalanced intervention of these 'business bosses'.  I have advice for them.  It isn't business bosses that decide the outcome of the election. It is the voters, and voters should take a balanced look at the impact of 'austerity'.  They should consider the impact on the poorest and not simply the wealthiest.  It is no the business bosses who are 'wealth creators'; it is hard working people.  This does not dismiss the contribution entrepreneurs make, but they are only one factor in judging a successful economy.  A successful economy must be judged not solely on profits, not solely on number of jobs or on growth, but on how well all benefit from it.  

A 'successful economy' doesn't automatically trickle down to the poorest.  Indeed without regulation it almost certainly will not.  This is why it took years of struggle to improve pay and working conditions. That is why unions exist. That is the balance.  Free market capitalism isn't inherently beneficent. 

That is why the choice exists in politics. The choice isn't between profligate spending and cuts. It is about social responsibility and how best we meet it.  It is about how best we share.  How best we distribute the benefits of growth. It is about how best we can give all our children opportunities to gain the skills necessary for life and decent jobs. 

The Tories peddle a set of myths on welfare and not least of these is that somehow it can be cut without pain.  They peddle myths about 'efficiency' as if it can be easily identified and cut. It can't. When they boast of taking £20 billion out of the NHS in 'efficiency' savings they are talking about cuts.  Mr Cameron in the TV 'debate' said as much again in response to Miliband. The NHS didn't not fall apart for no reason.  It fell apart because  funding was reduced.  Mr Cameron says in reply that funding increased.  Yes it did by 0.9% per year on average.  That is the worst record of any government in decades.   It is the lowest average annual change of any parliament, contrasting with average annual increases of 5.7 per cent under the Labour administrations between 1997 and 2009. 

The problems of the NHS are not caused substantially by inefficiencies.  They are caused by increased burdens due to massive cuts in social welfare at a time when the government have introduced complex reorganisation and 'efficiency cuts'.   That is the bottom line.  

Who would I trust with the NHS?  I would trust a party with at least a record of improvement. I would not trust a party that has broken every pledge they made on protecting the NHS.  The party I trust on that basis is not the Conservative party and that is why I will not be voting for them.