Hospitals to undergo Ofsted-style inspections
Health watchdog sets out proposals to restore public confidence in the NHS. Read more…
Children’s heart surgery review shatters confidence in NHS reconfiguration
Jeremy Hunt, the health secretary, hears of a failure to recommend a safe, sustainable and accessible way forward. Read more…
Jeremy Hunt suspends children’s heart surgery unit closures
Decision means reprieve for units at Leeds General Infirmary, Glenfield hospital in Leicester and Royal Brompton in London. Read more…
Andrew Sparrow‘s rolling coverage of all the day’s political developments as they happen, including Jeremy Hunt’s speech on GP reforms
By demanding Ofsted-style inspections for GPs, Hunt is passing the blame for disastrous coalition policies on to family doctors
I invite Jeremy Hunt, the health secretary, to visit my surgery. He might learn something. We like to think we offer a very personal, family-orientated service, where I rarely have a patient in front of me I haven’t met on many occasions. And yes, Mr Hunt, I do know their names and also those of their partners and children, and often grandchildren. Even where they last went on holiday, let alone personal medical problems and details. Anyone who wants an appointment that day gets one.
What is really annoying are the constant attacks on primary care by the very people who are responsible for the mess we are in, such as Hunt and his predecessors.
Apparently, family doctors are to face Ofsted-style inspections, overseen by a new chief inspector of general practice, to secure “safe and responsive care”.
In a speech he’s due to make to the King’s Fund health thinktank on Thursday, the content of which is reported in newspapers today, Hunt tries to blame the stripping away of the 24-hour responsibility from general practice in 2004. Six years later the NHS wasn’t even an election issue, and had the highest satisfaction ratings ever. I don’t remember calls for a reversal of policy then. Three years of this coalition government and the NHS is in the news every day. Hunt has to blame someone and deflect from what his policies are doing, so why not blame the workers?
Politicians have a cheek when they don’t even understand the very important concept of continuity of care. If they did, why have policies that have resulted in it becoming impossible? Groups such as the elderly and young need that continuity of seeing the same doctor. So why is it government policy to let private companies buy and run GP surgeries on the cheap, using locums who are rarely seen again? Why did they introduce the NHS 111 service before it was ready? It frequently gets the patient’s surgery, address and other details wrong, let alone their name. Why was NHS Direct, which had its faults but was certainly better than what we have now, abolished? Why is work formerly done by hospitals being dumped on GPs when they are already at breaking point? Even Hunt recognises this, otherwise why does he describe us as “mini A&Es” ?
My patients have almost given up seeking advice and getting care out-of-hours because of the mess the politicians have made of the service. They feel they have nowhere to go except A&E and apparently that’s the GPs’ fault.
I doubt Hunt won’t accept my invitation, as it won’t fit with his ideology. Privatisation is breaking the NHS into millions of little fragments, so chickens are coming home to roost.
The health secretary responds to a warning that NHS A&E services could collapse within six months unless planning improves
It’s absurd to assume that the NHS can fix everything. Two recent reports highlight the need to change our habits
The NHS was in the spotlight again last week after a report in the Lancet revealed that Britain has very high levels of premature deaths compared with other developed countries. Cue yet more chatter about where the health system is going wrong, our favourite national sport.
But what was most striking about the UK statistics was that three of the most important contributors to premature death – heart disease, lung cancer and stroke – are largely caused by preventable lifestyle factors. In short, too many of us smoke too much, drink too much and gorge on diets dominated by processed foods. This last was emphasised by another report last week which linked heavy consumption of processed meat with the risk of early death.
Most of us value our health but engage in behaviours that undermine it. It’s all too easy to understand, tempted as we are by that extra pint at the pub or the brightly coloured chocolate bar at the checkout. But, viewed from inside the NHS, I think that as a nation we’ve also lost perspective about what healthcare and modern medicine can achieve. Don’t worry if we let things slip, we think, we can always find a pill to fix things or secure a hospital makeover. (It’s a belief, often encouraged, I have to admit, by a medical profession too ready to administer drugs.)
During a recent clinic consultation, I saw a slightly overweight man who happened to be a smoker. He had developed chest pains and an angiogram had confirmed narrowed coronary arteries but not so severe that he needed an operation. “Isn’t there a special procedure to suck out and remove all the crud?” he asked.
I told him that, unfortunately, no such procedure existed and that the best thing he could do to improve his quality of life and longevity was to quit smoking – more effective in fact than all the medications we could chuck at him . But he seemed thrown, that the advice was so simple. He was expecting a magic bullet.
The truth is that while we doctors are well placed to educate and nudge our patients into adopting healthy behaviours, ultimately we have little direct control in shaping the environment that encourages bad habits. Neville Rigby of the International Association for the Study of Obesity told me that education will have limited impact when the food environment is working against you. “It’s like telling a child who grows up in a sweetshop to not eat sweets.” It doesn’t help that hospitals continue to legitimise junk food with corridors littered with dispensers for cheap , nutritionally poor foods. What’s more, 50% of the 1.4 million who work for the NHS are obese.
So, not only is it wise to keep yourself from needing a hospital in the first place; a campaign launched last week suggested the medical profession is guilty itself of perpetuating a quick-fix culture when we should be placing greater emphasis on prevention. The British Medical Journal‘s “Too Much Medicine” campaign is designed to combat over-diagnosis, and the harms and waste from unnecessary tests and treatments.
Richard Smith, director of UnitedHealth Group’s chronic disease initiative, recently blogged that only 11% of the 3,000 health interventions out there have good evidence to support them, with four-fifths of new drugs copies of old ones. A few weeks ago, I discontinued an anti-hypertensive medication on a patient, after reading a review by the Cochrane collaboration (an internationally recognised benchmark for providing the highest quality information on healthcare). Forget pills when it comes to mild hypertension was the review’s conclusion. Instead, exercise, don’t smoke and eat a Mediterranean diet. Just because you’ve heard this before doesn’t mean it’s still not the best way.
Sadly, this has not translated through to clinical practice. The government’s latest proposal for GPs is to call for an even lower threshold than the existing one for treating high blood pressure. A leading GP who doesn’t want to be named said that not only would this harm patients by increasing the risk of side effects, but that GPs would be financially penalised if they didn’t introduce medications. “The only beneficiaries will be the drug companies,” he said. “We should be taking a step back from polypharmacy. ”
If the health secretary, Jeremy Hunt, is serious about saving 30,000 early deaths from cancer, heart, stroke, respiratory and liver disease by 2020, he should implement cost-effective public health interventions. Curb the availability of junk food at schools and hospitals and severely restrict the advertising of products high in trans fats, sugar and salt to children.
Australia, which topped the health league, was the first country to impose plain packaging for cigarettes through legislation, a lead that the coalition has announced it will follow, with an announcement on legislation expected in May. Elsewhere, however, the government plans to increase private healthcare within the NHS. Private health companies profit through over-diagnosis, medicalising normal conditions and over-treatment. In the US, the most prescribed drugs are psychotropics. Mass advertising of anti-depressants to people with normal or healthy levels of stress has boosted demand.
Here in the UK, I am increasingly aware of health checks and total body scans being targeted at the ostensibly healthy by private providers. There is no evidence that this improves health outcomes, but it does increase the emotional and financial toll on an individual. It’s time, instead, to take a step back and pay more attention to the environment and our own behaviour.
We can all learn from John, a taxi driver in his late 40s, who suffered from breathing problems and chest pains. He was overweight and his blood tests revealed borderline diabetes, a condition that brings with it the potentially devastating complications of heart disease, stroke, kidney failure and even amputation. Fortunately for him, his coronary arteries were not at a stage of severe narrowing.
Although he wished he could turn back the clock, I emphasised that some simple measures could turn his life around. There was no need for a lifetime’s cocktail of medications. I advised him not to buy any food product advertised as “low fat”, “heart healthy” or “cholesterol-lowering”. They’re usually heavily processed and loaded with sugar. By replacing sugary drinks with water, opting to eat a piece of fruit instead of the Mars bar and taking a daily 20-minute walk with his wife after dinner, John now feels like a “new man”, he says. He’s lost two stone and his blood glucose is within the normal range.
Sure, we’re constantly having to grapple with environmental and commercial pressures that work against our ability to make healthy choices. But we still have the final say in what we choose to put into our bodies and in how we use them. Ultimately, it’s up to us.
Gloomy deficit and growth forecasts as health secretary Jeremy Hunt rebuked over spending claims
George Osborne is facing politically damaging charges that he is reducing NHS spending in England, and failing to cut the deficit this year, the opposite of the Conservatives’ central pledge of the 2010 election campaign.
Ahead of Wednesday’s autumn statement, in what is likely to be a day of bad news on growth, borrowing, debt, taxes and broken fiscal rules – and with the chancellor acknowledging there are “no miracle cures” to the country’s economic strife – the government faced the additional embarrassment of its official statistics watchdog telling the health secretary, Jeremy Hunt, he was wrong to claim that NHS spending was rising.
Ministers have repeatedly said the health budget was rising in real terms.
But the chair of the UK statistics authority Andrew Dilnot, following a complaint by the shadow health secretary, Andy Burnham, said he “concludes that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10″.
He has asked Hunt to “clarify” statements on the Conservative website claiming “we have increased the NHS budget in real terms in each of the last two years”. Hunt himself told MPs on 23 October that “real-terms spending on the NHS has increased across the country”.
The scale of the reduction in NHS spending is very small, but taken alongside the expected Office for Budget Responsibility report showing borrowing rising, it does mean Cameron is not meeting his promise at the start of 2010 to cut the deficit, and not the NHS.
The chancellor was expected to say on Wednesday: “In this autumn statement, we show that this coalition government is confronting the country’s problems, instead of ducking them. The public know that there are no miracle cures. Just the hard work of dealing with our deficit and ensuring Britain wins the global race.”
A Department of Health spokesman challenged Dilnot’s conclusion, saying: “The 2010-11 year should not be used as a baseline for NHS spending because the budget and spending plans were set in place by the previous government. For the first year of this government’s spending review, as Andrew Dilnot acknowledges, NHS spending increased in real terms compared to the previous year by 0.1%.”
The OBR will on Wednesday reduce its 2012 forecast made in March from 0.8% growth to about zero and for 2013 from 2% to about 1%. The target to reduce public debt as a share of national income by 2015-16 will also be missed. Osborne may also be forced to concede the structural deficit will not be eradicated for another five years, pushing the austerity to near the end of the decade.
In an attempt to give the economy a short-term boost ahead of the 2015 election, Osborne announced on Tuesday he was releasing £5bn for capital projects, mainly funded by cutting Whitehall departmental spending by 1% in 2013-14 and 2% the following year.
Health, schools and overseas aid will be exempted from the cuts, as will local government in the first of the two years. The Ministry of Defence will be allowed to roll over an underspend this year to next year.
The capital spending will include £1bn for schools to find 50,000 extra school places, including new free schools, academies and places in existing well run schools. London councils say the money is insufficient to meet the shortfall in places in London alone.
The rest of the capital spending will go on transport, skills, including further education and science. Extra help will be provided to infrastructure projects.
The Treasury says the extra capital spending will mean that capital spending on average will be higher in this parliament than in the previous three parliaments from 1997 to 2010.
A similar £5bn switch was announced in last year’s autumn statement. But research by the Guardian shows that more than half of the new capital investment announced in that autumn statement has not yet been spent on buying goods and services or paying wages, while projects have taken months to be ready and to process the money, awaiting planning permission or other hold-ups.
Most economists believe the continuing deterioration in the public finances will force Osborne to abandon his hopes of meeting his self-imposed rule to get public debt falling as a share of national income by 2015-16.
The Treasury believes the markets are already braced for the announcement, and there will be no damage to Britain’s credit rating.
Osborne will aim his statement at Britain’s “strivers” with a freeze in fuel duty aimed at household budgets while welfare benefits will be squeezed, but not frozen. The chancellor has already said the rich will be asked to pay more, including an expected cut in tax relief on pension contributions for high earners.
The extra £5bn over the next two years on capital spending will have “a minor, almost negligible” impact on overall economic growth, the Ernst and Young Item Club said.
The club, which said earlier this week that an extra £14bn on capital spending over the same period would raise economic growth by 0.5% of GDP a year, said it would be difficult to estimate the impact of £5bn over the same period.
Nida Ali, economic adviser to the Item Club, said: “Although it is a step in the right direction it is likely to have a minor, almost negligible, impact on the growth rate. It is not likely to be very visible.”
Ali added that the impact of extra capital spending is “likely to be even more negligible” because the changes will be fiscally neutral after the chancellor announced that the money would come from underspends in current budgets.
“We think the £5bn on capital spending is a step in the right direction. But we feel this is still not enough to have a big impact on growth because he has tightened elsewhere to be able to find this £5bn.” Gemma Tetlow, of the Institute for Fiscal Studies, said the £5bn would stimulate economic growth, though this would be within the margin of error of GDP forecasts. Tetlow said the extra capital spending would stimulate growth by less than 0.2% of GDP a year using the OBR’s estimate that it provides a fiscal mutiplier of one. GDP stands at £1.5tn.
Osborne also faced the embarrassing news that his flagship plan for workers to be given company shares in return for abandoning their employment rights, to be confirmed on Wednesday, has already been rebuffed by business leaders. The business department confirmed that fewer than five organisations out of 209 respondents “had welcomed the scheme and said they would take it up”. Osborne had put the proposal at the heart of his speech to the Tory conference in October.
Hunt claims he won’t stand for poor-quality care for the elderly – but his beloved free market deals only in money, not dignity or respect
Health secretary Jeremy Hunt says there must be “no hiding place” for poor care of the elderly in a system where, as the Care Quality Commission reports, too many staff oversee “a care culture in which the unacceptable has become the norm”. How can this fanatical neo-liberal think he has the right to pontificate? Hunt is a great believer in the idea that free markets should be left to their own devices, so that they can decide. But markets don’t trade in “dignity” and “respect”, because they have no monetary value. Also, markets don’t develop dementia and need care.
If a market did develop dementia, a thorough-going free-marketer would not intervene, but simply leave the knackered, useless old market to starve to death. Hunt should be congratulating himself on the triumph of his ideology, not condemning a system that insists that money is the only thing that should talk, and that those without voices can only blame themselves.
A blogger has taken the political left to task for fiddling while Hunt performs dodgy backroom operations on the health service
Political website The Slog, run by a chap called John Ward, warns that while Britain passes around electronic scraps of paper listing unsubstantiated rumours, health secretary Jeremy Hunt really is up to no good.
Ward reports that “an informal but extremely powerful working group has been set up by the coalition – separate from both NHS management and the Department for Health – to assess the best way to facilitate the handover of NHS hospital trusts to the private sector”.
Ward points out that a total of 34 NHS organisations, almost one in 12 hospitals, is currently vulnerable because of money problems. He accuses the left of preferring “futile demonstrations, sound bites and slogan-yelling” to seeking “a more modern, better-funded and cost-free NHS”. I wish I could say I think he’s wrong.