When the coalition government first introduced its landmark Health and Social Care Act in 2010, health secretary Andrew Lansley claimed the NHS would never again need to undergo such huge organisational change.
But even at the time, one widely respected commentator warned that – far from being the final fix that Lansley had advertised – the act “could become this government’s ‘poll tax’”.
In the event, it has been a slow-burn poll tax. Only now, ten years after it came into law, are we seeing its full effects, with publications from The Times to the Morning Star reporting that “A&E delays are ‘killing up to 500 people a week’”.
This figure – 5% above the normal number of people who die each week, though that baseline is also rising – can surely be traced back to the act, which ushered in a greater wave of privatisation than ever before. It compelled NHS management to behave as if they were in the private sector, competing to win business, and led to an increase in the proportion of contracts won and the use of contracts overall.
At the time, the damage caused was little noticed because government cuts in the first round of austerity targeted local authorities and adult social care. The first group of people to see their life expectancy fall were elderly women who most often lived on their own. It was in 2014 that this connection became apparent.
Back then, the government was still confident, with the Department for Health and Social Care rebutting any suggestion that austerity and privatisation might be linked to mortality. The privatisation figures were also opaque. In 2015, halfway through Jeremy Hunt’s tenure as health secretary, it was reported that ministers were misleading the public. By that point, private firms were winning 40% of new contracts – far higher than the 6% spend share claimed by the government and almost identical to the 41% won by NHS bodies.
The first great increase in mortality was recorded in that same year, a 5% rise that the government tried to attribute to influenza. The problem with that explanation was that the stalling and falls in life expectancy were not seen to the same extent anywhere else in Europe.
Last year it was claimed that austerity since 2010 had led to a third of a million excess deaths
By 2019, life expectancy for women had fallen in almost a fifth of all neighbourhoods and in over a tenth for men. Poorer people, both old and young, in poorer areas suffered most, with infant mortality among babies born to the poorest parents rising. Later there was a rise in deaths of women who were pregnant.
As NHS waiting lists spiralled, a tenth of all adults, most of those who could, were resorting to accessing private health care in 2021. But, in doing so, they lengthened the lists further by jumping the queues and thus diverting resources.
By April 2022, the number of vacant beds in hospitals was at an all-time low. Estimates of the damage done kept rising. Less than six months later, it was claimed that austerity since 2010 had led to a third of a million excess deaths, twice as many as from the pandemic.
Now, A&E departments are stretched to capacity, unable to clear patients to other beds in our hospitals as they could in the past. Those other beds cannot be cleared as they were before because adult social care has been repeatedly decimated, with what is left being tendered out to private companies.
All of this was foretold. In the four years after 2015, the value of one group of private sector contracts in the NHS rose by 89%. These figures were released just before the 2019 general election, partly in response to Matt Hancock, then the health secretary, claiming that “there is no privatisation of the NHS on my watch.”
Again, the damage was not so much through the extent of covert privatisation, but through the wider ethos that had been promoted. Take the USA: most of the enormous amount of money spent on healthcare there has little impact on improving health, because the ethos is wrong.
OPINION: Sunak wants yet another round of cuts to public spending. And just like in 2010, we didn’t vote for it
It is sometimes said – wrongly, that is – that the NHS has not been further privatised because the share of its spending that went to the private sector remained roughly the same between 2012 and 2020. By 2020 that share was about 7%, or just under £10bn a year. It rose to over £12bn during the pandemic when the government paid private hospitals to treat patients, but because overall health spending rose, the proportion remained roughly the same, still around 7%.
But the number of private companies involved did increase greatly, particularly in areas where there was already more private healthcare. By last year, private firms were delivering a quarter of all planned NHS hospital treatment in the least deprived areas of England, and 11% in the most deprived areas. Those shares – which have risen since 2020 – are higher than the overall 7% because it is in planned hospital treatment where the private sector has most infiltrated the NHS.
Last year, the Health and Care Act of 2022 put paid to Lansley’s claim that he had fixed the NHS ‘once and for all’. The act reduces the compulsion of the NHS from having to tender so many services to private sector bidding in future, but it was not designed to stop the rot. It will not solve the service’s problems, though there is hope that it could be the beginning of an actual change in ethos.
The pandemic made the effects of privatisation clear: Britons now have the worst access to healthcare in Europe and some of the worst post-pandemic outcomes. But the successive health secretaries who inflicted this tragedy are unrepentant.
The pandemic made the effects of privatisation clear: Britons now have the worst access to healthcare in Europe and some of the worst post-pandemic outcomes. But the successive health secretaries who inflicted this tragedy are unrepentant.
In 2018, Lansley criticised Hunt’s cuts in screening services, blaming them for delaying the detection of his bowel cancer. Hunt, meanwhile, went on to become foreign secretary and then chancellor of the exchequer. His legacy, as openDemocracy’s Caroline Molloy wrote last year, is “one of missed targets, lengthening waits, crumbling hospitals, missed opportunities, false solutions, funding boosts that vanished under scrutiny, and blaming everyone but himself.” Hancock is now most remembered for eating a camel penis and cow anus on live TV for money.
Belligerence, bravado and buffoonery. We got here because too many of us believed the words of fools.
The Labour leader, Keir Starmer, is under pressure from campaigners, unions and his own MPs to set out plans for “wealth taxes” on the richest in society in order to support public services and help the poorest through the cost of living crisis.
As the government prepares to cut spending to fill an estimated £35bn black hole in the nation’s finances, calls are growing for higher taxes on the super-rich, many of whom have seen their fortunes soar during the pandemic.
Richard Burgon, the Labour MP for Leeds East, said: “While living standards are plummeting for most people, it’s been boom time for the super-rich, whose wealth has soared to record highs in recent years.”
Starmer, who is trying to position his party in the centre ground, has avoided committing to higher taxes on private incomes as Labour seeks to woo the City and businesspeople angry at the damage caused by the Conservatives’ mini-budget. But that approach is causing concern on his backbenches and more widely, with the Greens calling Labour “timid” on wealth.
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Molly Scott Cato, the Green party’s spokesperson on finance, said: “The Tories have created a big hole the public finances but there is an obvious place to look to fill it: taxing the super-rich. Not only do they have the broadest shoulders but they also increased their wealth during the pandemic because of enforced savings.
“What is more surprising is to find Labour being so timid on wealth taxes. Their proposal to abolish non-dom status will only bring in a few billion while a proper wealth tax could yield tens of billions. We’ve now got two weeks for Labour to remember their egalitarian roots and support loud and growing calls for a wealth tax. Otherwise they will be colluding in the devastating cuts to public services that are being cooked up by the millionaires in Nos 10 and 11 Downing Street.”
Raiding the NHS budget or scrapping plans to rebuild crumbling hospitals would plunge the health service into its deepest crisis in decades. This was the stark warning this weekend from Matthew Taylor, chief executive of the NHS Confederation, who said the government is “living in a fantasy land” if it believes it can cut funds to the NHS without endangering patients.
Jeremy Hunt promised spending cuts of “eye-watering difficulty” last week after becoming chancellor of the exchequer. Yet he also did not reverse his predecessor Kwasi Kwarteng’s decision to scrap the £7bn health and social levy that had been earmarked for the NHS.
Taylor, whose organisation represents hospitals, ambulance trusts, mental health care, community care and GP services, said his members were issuing the “starkest warning” about “the huge and growing gulf between what the NHS is being asked to deliver and the funding and capacity it has available”.
Nine out of 10 schools in England will have run out of money by the next school year as the enormous burden of increased energy and salary bills takes its toll, the Observer can reveal.
Early data from the National Association of Head Teachers – results of a survey of its members are due later this month – shows that 50% of heads say their school will be in deficit this year, with almost all expecting to be in the red by next September,when their reserve run out. This comes as Jeremy Hunt has made clear that all departments, including education, will be expected to make cuts as part of the government’s debt reduction plan, to be announced on 31 October.
Headteachers and academy leaders are warning that further spending cuts will push many schools and academy trusts over the cliff, and result in most schools having to lose essential teaching and support staff. “There are no easy fixes left,” said Paul Whiteman, general secretary of the NAHT. “Schools are cut to the bone. This will mean cutting teaching hours, teaching assistants and teachers.”
In my 39 years in parliament, I cannot remember a fiscal plan so reckless, arrogant and out-of-touch. More than one in five people – and one in three children – are in poverty in the UK. A quarter of a million people in England are homeless. This October, millions of people will struggle to heat their homes or feed their children. But will nobody think of the bankers?
It doesn’t matter which remnants of neoliberal economics this government tries to rescue from the rubble. Nor does it matter how many chancellors they use to try to resuscitate them. The Tories will never be able to fix the economy until they reckon with the fact that they’ve spent the past 12 years destroying it.
By preparing for another wave of austerity, the new chancellor is not just in denial about the scale and severity of the cost-of-living crisis. He is in denial about the very economic policy that engendered it. The last round of cuts to public services – which has been linked to 330,000 excess deaths by a recent report – did not just plunge millions into poverty. It stole resources from the poorest people in society and transferred them to the richest: as child poverty was heading towards its highest levels since 2007, Britain’s billionaires more than doubled their wealth. Far from rectifying this act of social robbery, the government is intent on helping the 1% steal even more.
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As the Tories plunge themselves into electoral oblivion, those in opposition have a precious opportunity: to redistribute wealth, ownership and economic power. To end insecurity, exploitation, poverty and homelessness. To build a society grounded in compassion, creativity and care.
Jeremy Hunt pitches himself as the safe choice after Johnson | Belinda Jiao/Thomas Krych/Alamy Stock Photo. Composite by James Battershill
If Jeremy Hunt succeeds in replacing Boris Johnson as British prime minister, it will be another instance of the ‘nice Tory’ coming after the panto villain.
Hunt’s pitch to the Tory faithful is that he’s the ‘serious’ one: the earnest ex-head boy with a grasp of detail and the ability to get things done. And that impression appears to hold water, with even the liberal media repeating these ideas.
Earlier this week, The Guardian’s Ben Quinn waxed lyrical about Hunt trying to play the role of “elder statesman from the backbenches, offering gentle and usually friendly criticism over the government’s Covid mistakes”. Of his latest leadership hopes, Quinn was positive: “Firmly on the centrist side of the party, he could be viewed as a calming presence after the tumult of the Johnson years, if the membership are desperate for some stability.”
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The fact that Hunt was health secretary – the longest-serving in history – barely makes it into the narrative at all. If it does, it’s restricted to his battles with junior doctors and funding – both of which Hunt likes to portray as victories.
Maybe it’s not surprising that so much of the media takes at face value Hunt’s self-presentation as a nice guy with a “consensual approach” (slogan: “Unite to win”). For most of his tenure as health secretary – except, perhaps, during the junior doctor dispute – they fairly uncritically adopted Hunt’s persona of the ‘champion of patient safety’.
I spent much of Hunt’s period as health secretary running openDemocracy’s OurNHS section, investigating what he was really up to. I soon discovered that when you looked past his press releases, you found a very different story – one of missed targets, lengthening waits, crumbling hospitals, missed opportunities, false solutions, funding boosts that vanished under scrutiny, and blaming everyone but himself. This is that story, which was first published on openDemocracy on 13 July 2019.
Hunt’s hospital legacy
Hunt took over responsibility for the NHS in 2012. By the time he left the post six years later, patient experience and staff morale had both taken a dramatic turn for the worse across many key indicators. Winter crises deepened, with official figures showing 2017, 2018 and 2019 were successively “worst on record”. The British Medical Association (BMA) reported that by 2018, “the “winter crisis” has truly been replaced by a year-round crisis”.
Hunt’s answer (aside from making it harder to access the figures, as we’ll see below) was to float the idea that patients could perhaps be banned from just walking up to A&E – an idea that he was forced to disavow, but that has resurfaced recently.
A&E is a bellwether for the NHS. The number of hospital beds (already low compared with those in most developed countries), also dropped significantly – from 135,559 beds in the quarter that Hunt took over, to 127,305 when he left, a loss of over 8,000 beds. Bed occupancy rates over 85% are considered overcrowding, and increase infection risks, cancelled operations and pressure on nurses. They peaked at record levels of over 90% in Hunt’s last winter – and this was an average, with some hospitals repeatedly hitting 100%.
Nationally and locally, a range of treatments were restricted. Hernia, hip and knee operation patients weren’t treated until they were in severe pain. Cataract operations and hearing aids were restricted to one eye or ear (who needs two anyway?). Vasectomies, erectile dysfunction treatment and diabetes monitoring were scrapped or severely restricted in growing numbers of areas. In response, NHS hospitals increasingly turned to offering ‘self-pay’ options to private patients.
Hunt oversaw years of historically low funding increases (around 1%, compared with an average of 6% in the years between 1997 and 2010, and compared with the 4.3% recommended by the Office of Budget Responsibility and the likes of the Kings Fund, Health Foundation and Nuffield Trust, as the minimum to keep up with health inflation and increasing demand). Perhaps most damagingly, he oversaw a significant cut to the amount that hospitals were paid per procedure (payments which make up three quarters of their income).
Hunt’s response was to send out “failure is not an option” missives to hapless local NHS executives, instructing them (on pain of having their entire board suspended) to clear their financial shortfalls, while making sure they did so “without compromising patient care”. So that’s all right then! Even when “extra” money was found, as it was to some extent after the 2015 election, it came with so many strings attached that frontline patient care received little benefit, and was often in the form of loans that mean, remarkably, hospitals are now more ‘indebted’ to the government, than they are to the PFI deals that are still squeezing them. Hunt’s parting gift, the NHS ‘Brexit Dividend’ birthday present, is also full of strings and inadequacies, as we’ll see below.
Hunt’s reaction to this was to introduce what I dubbed a “Hospital Closure Clause” into an unrelated piece of legislation, which stripped away many of the requirements to consult local people on future closures. Further closures, land sell-offs and down-grades to services and opening hours have followed. And justifications that the land sold off by hospitals would be used to provide homes for nurses have proved utterly hollow when it turned out that only 17% of the houses built – fewer than 1000 homes – would be ‘affordable’. The trend is likely to continue, given that Hunt’s much trumpeted ‘NHS birthday present’ (of which more later) did not cover capital funding for buildings and equipment.
In 2019, the NHS had a £6bn backlog of essential maintenance and repairs, as under Hunt £4.3bn was raided from capital budgets to pay daily bills. And hospitals were told (by the Naylor review) that the way to make up this shortfall was to sell off more land and buildings, and enter into more private finance arrangements.
This policy failure, during a funding squeeze, is perhaps not surprising – the reality is that care at home requires more, not less, funding than care in hospitals, as reviews by the University of Manchester, the British Medical Journal, the National Audit Office and even the Department of Health itself have shown. Hunt repeatedly ignored the many experts warning him that this was the case. In the end, though, billions of pounds of ‘transformation’ money supposedly set aside to deliver the policy change, instead had to be quietly re-purposed into keeping cash-strapped hospitals just about afloat.
Meanwhile, in vital but neglected areas such as general practice, maternity and mental healthcare, Hunt routinely over-promised and under delivered.
In October 2017, Hunt told MPs: “We’ve got 30,000 more people working in mental health today than we had when [Labour] left office” – a claim that was revealed to be false. Not long before leaving office, he won headlines for promising that mothers would get a ‘dedicated midwife’ throughout pregnancy and birth, although later reports suggested that this wasn’t, in fact, the case, and that women were just being promised ‘one of a team’. In other words, no change.
Perhaps GP demoralisation wasn’t surprising – Hunt described the years of underfunding of GPs as their “penance” for the contract the Labour government signed with them. And just as importantly, GPs’ professional autonomy and connection with the patients was repeatedly watered down. In some areas, they were offered cash incentives to refer fewer people to hospital – including cancer patients. Those who weren’t swayed, nonetheless saw increasing attempts to second-guess their referrals by ‘referral managers’ who haven’t even seen the patients but aimed to reduce their referrals by as much as 30%.
Privatisation – the wrong ‘solution’
Not long before his departure, Hunt told Parliament that NHS privatisation “is not happening” and was “fake news”. But his actions suggest he was as ideologically wedded to continued competition and privatisation (in various guises) as his notoriously destructive predecessor, Andrew Lansley. An enormous amount of clinical and management energy was wasted in having to work to keep services from being chipped off by the private sector – even though such privatisation is a hugely costly process with no proven benefits.
While various privatisations collapsed, failure seemed to be rewarded. In 2013, a privatised treatment facility in Stevenage run by the company Clinicenta was bought back by the NHS following the deaths of three patients during routine surgery, with local officials raising concerns about “serious failings” and “evidently substandard” care. But just as Clinicenta was collapsing, its parent company – Carillion – was rewarded with further NHS contracts including major PFI schemes at Royal Liverpool Hospital and Midland Metropolitan Hospital.
After Carillion itself collapsed, The Guardian revealed documents that showed that, “civil servants working for Jeremy Hunt successfully lobbied the Cabinet Office to stop failing Carillion hospital projects from being overseen by an independent watchdog”.
Other novel forms of privatisation were also pursued during Hunt’s tenure – from the NHS creating separate businesses for portering and facilities management to “personal health budgets” – an updated version of Thatcherite health vouchers, in which seriously ill patients are handed fixed sums for their healthcare needs and encouraged to ‘shop around’ across the public and private sectors.
The tech bonanza is another novel form of privatisation. Hunt’s successor Matt Hancock has been criticised for an overly credulous attitude to technology, but Hunt laid all the groundwork. The NHS signed substantial contracts with the likes of health app firm Babylon under his oversight, as well as running into a massive controversy over the care.data project in which Hunt and his tech Tsar, Tim Kelsey, were unable to adequately reassure a concerned public that personal data would not be sold to private firms. In what he described as his “most important speech as health secretary”, Hunt boasted that; “The future is here… 40,000 health apps now on iTunes… this is Patient Power 2.0.” The announcement was somewhat overlooked as it was also the speech in which he launched his astonishing attack on doctors (more below). But perhaps Hunt envisaged a future with fewer doctors – not long afterwards, he faced fierce criticism by doctors for issuing “potentially fatal” advice to parents to use “Doctor Google” to diagnose their children’s rashes.
David Cameron sold the controversial 2012 Health and Social Care Act by claiming that it put doctors in charge of decision-making. In reality it put privatisers in that position, along with commercial providers taking over and sub-contracting to the NHS. In 2016, openDemocracy reported on a version of these arrangements called “Accountable Care Organisations”, an idea based on US hybrid insurer-hospital organisations such as Kaiser Permanente. This gives private providers involvement in decision-making about what treatments patients do or don’t receive, and financial incentives to minimise treatment (as Michael Moore’s film ‘Sicko’ exposes). Hunt visited the US firm at least three times.
In social care (which Hunt repeatedly promised to ‘integrate’ with the NHS, though he was not directly in charge of social care until the last few months of his tenure), once again, Hunt’s commitment to market ‘solutions’ meant that the discussion was rarely about the real problems. Many of these were, in truth, decades old – including the Tory 1990s legislation that paved the way for much healthcare to be gradually redesignated as social care, thus privatised, means-tested and charged for.
However, Hunt did little to promote the real solution – reintegrating social care under the NHS’s public, free provision. Instead, he suggested that the ageing population was a massive “commercial opportunity” – and ‘integration’ began to look to campaigners like merely code for ‘helping the private care sector get its hands on more NHS cash’.
The underlying issues were left unresolved, the promised social care green paper was delayed no less than five times (and counting), experiments to ‘integrate’ ran into frequent problems, and the social care sector continued being just another convenient scapegoat for delays in discharging people from hospital. Hunt is still pursuing market solutions, suggesting during the leadership campaign that while social care cuts had gone too far, the answer is to ‘incentivise’ individuals to save for their own social care.
Perhaps none of this is surprising. Back in 2005, Hunt co-authored a book called ‘Direct Democracy’, which stated; “Our ambition should be to break down the barriers between private and public provision, in effect denationalising the provision of healthcare in Britain” and that the NHS was “no longer relevant in the 21st century”, although he has since distanced himself from the book’s vision.
Hunt adopted three key strategies to ensure that the NHS wasn’t his career graveyard, as it had been for many Tory predecessors: hiding, hiding, hiding the figures, and (most of all) hiding behind someone else. His biggest talent is also, in fact, Boris Johnson’s: ducking accountability. The strategies are somewhat different, of course. Johnson’s bluster makes you suspect you’ve been had (but it appears that Britain, or at least the Tory part of it, includes a lot of masochists who rather enjoy that). Hunt’s smoothness means you don’t even notice. And the success of these tactics tells us much about technocratic attitudes to democracy, accountability, leadership and so-called public service ‘reform’.
Hunt’s complaints about Johnson refusing to debate him rang hollow to those of us who have followed him closely. Hunt is famous for dodging debates, whether with junior doctors, angry hospital users, in parliament or on the ‘Today’ programme, on which Hunt was a regular no-show during NHS crises. Where he did appear, he often restricted his appearances to issues over which he had no actual control, such as promoting a sugar tax. In fact, he became so notorious for shirking debate that hospital campaigners launched a “Hunt the Hunt” campaign, and junior doctors camped out on his departmental doorstep.
Blaming the patients
Hunt had no end of people that he (and his media cheerleaders) could blame for the problems besetting the NHS.
First off, patients. Be they old people, for being too old (“a challenge more serious than global warming”, Hunt said, even though this narrative doesn’t actually reflect the reality that health needs are highest in your last years of life, whenever that comes). It is true that health needs are rising among the poorest – and health inequalities increasing sharply – but blaming austerity policies and inequality for rising health demand wouldn’t have endeared Hunt to anyone in the Tory party. Instead, he relied on the ‘ageing population’ line routinely, when pressed on failures to meet NHS targets – such as an interview with the BBC’s Laura Kuenssberg, where he said, “the targets you talked about are because of the pressures of an ageing population”.
To add insult to injury, under Hunt’s tenure, the dehumanising labelling of old people as “bed blockers” returned, even as he did nothing serious to solve the issues of social care. Then there were children – and parents – blamed for being too fat, even as public health funding to address such issues was slashed. And smokers, who, along with overweight people, started to be banned from routine surgery under Hunt’s watch. Such patient-blaming decimated the NHS’s core values of universalism and comprehensive care, to the horror of doctors and nurses.
I asked Hunt about this at an Institute for Government event not long before he left office. He told me blandly that, “this shouldn’t be happening”. But there was no sign of him taking any action to stop what he routinely blamed on ‘local decisions’ (as we’ll see again with rationing of care).
Always top of the scapegoat list, of course, are migrants. From 2013 onwards, Hunt’s department worked closely with the Home Office on a string of initiatives to impose the ‘hostile environment’ (a policy which the former head of the NHS described as a “national scandal”). That led to cases like Albert Thompson, the Windrush victim who was denied cancer care. Hunt went pretty unscathed when these scandals finally broke through into the public consciousness, and these restrictions are still largely in place – along with the upfront charging systems now set up in hospitals, which many have observed could now easily be rolled out to others.
Junior doctors camp outside the Department of Health in Whitehall, London in the hope of questioning Hunt over his proposed new contract. | PA Images
Blaming the staff
Blaming the staff is, of course, another favoured tactic of politicians, and one that Hunt embraced wholeheartedly (though he would no doubt like to think of it as ‘delegation’).
In terms of senior staff, in 2013, Hunt hired his Oxford contemporary, Simon Stevens, as chief executive of the NHS. Stevens quickly adopted the role of media frontman whenever the going got tough.
In hiding behind Stevens, Hunt benefitted from the post-2012 legal framing of the NHS as a standalone organisation (or rather, a tangle of competing, squabbling standalone organisations), given its money and left to get on with it. When problems arose, it was down to ‘the NHS’s own plan’, and ‘local decisions’. No longer did the secretary of state have a duty to provide or secure healthcare for us all.
Hunt got away with these tactics to a surprising degree, because the 2012 Health and Social Care Act that he inherited was poorly understood by journalists (and had been poorly explained by a Labour opposition then keen to hide its own Blair-era role in laying the groundwork). The Act was a nonsensical, destructive muddle, partly as a result of coalition compromises, so the implementation was critical – and the content and tone of that was down to Hunt. His first move was to add in the secondary legislation that gave the act its full privatisating force – including the Section 75 privatisation regulations that more or less forced local commissioners to offer any changes to local provision, out to tender.
But on the whole, Hunt outsourced strategic policy thinking (and ‘heavy lifting’ to shift public attitudes on charging, privatisation and hospital closures) to costly and wasteful management consultants including the Big Four accountancy firms (despite promising to rein in this spending), not to mention a collection of sirs, lords and commissions, regulators, right-wing think tanks, and in-house consultants dubbed “ninja privatisers” who were responsible for numerous expensive failures. (To be fair to Hunt, quite a bit of this policy outsourcing strategy was developed by his health secretary predecessors, both Tory and Labour).
As a result of the 2012 Act, Hunt had just one last bit of legal and parliamentary accountability for the NHS – the “mandate”, which required him to put the NHS’s annual objectives before parliament. But in 2015, when the scope of the mandate was being revised for the next five years, his department issued a public consultation that Hunt somehow failed to actually tell anyone about (it wasn’t even published on their departmental consultation page) – a ruse that caused something of a backlash after OurNHS got wind of it, particularly given the hints about widespread withdrawal of treatment.
Frontline staff became Hunt’s favourite whipping boy
While senior staff and outsourced policymakers were convenient stooges, frontline staff became Hunt’s favourite whipping boy. He kicked off his tenure by telling parliament that “cruelty became normal in our NHS and no one noticed”, implying that the criticisms of the terrible Mid-Staffs scandal were normal for the million plus NHS workers.
But all this was just a foretaste of what was to come for doctors, nurses and other health workers.
In 2015, Hunt and Cameron promised a “seven-day NHS”, but Hunt was condemned in May 2016 by parliament’s Public Accounts Committee, which deemed the plan “completely uncosted” and said that Hunt’s department had made “no coherent attempt” to address the staffing impact of this pledge.
Instead, the burden fell on junior doctors, upon whom Hunt attempted to impose a contract to work more anti-social hours. The first junior doctor strikes in 40 years took place in response in 2016, and forced Hunt back to the negotiating table. But Hunt went on to impose the contract despite another ballot with a clear rejection of the deal.
After the junior doctors’ strike, in 2017, nurses threatened to strike for the first time in history. Hunt saw the strike off by promising what appeared to be a relatively generous offer of 3% rise for everyone. But days after he finally left office in July 2018, OurNHS uncovered how staff had had the wool pulled over their eyes and many were getting much less than they’d thought or been led to believe. Nurses were outraged and the head of the Royal College of Nursing had to resign over her role in selling the deal.
Although Hunt liked to portray his victory over junior doctors as boding well for any potential negotiation with the EU, the legacy of that dispute (and his management of the NHS’s workforce in general) was in fact one of enormous ill will and brain drain, with frontline doctors and nurses leaving the NHS at alarming rates. Nursing had a record vacancy rate of 41,722 nurses (11.8% of the entire nursing workforce) the month before Hunt departed. While Brexit was a factor, there was also huge demoralisation among NHS staff aware that they were struggling to provide safe care for patients. Meanwhile, Hunt scrapped the nurses’ training bursary, which resulted in applications to study nursing dropping two years in a row.
Hunt veered close to accusing anyone standing in his way of being responsible for “avoidable deaths”
Perhaps what aggravated and demoralised doctors and nurses more than anything else, was Hunt’s audacious use of tactical shroud-waving. Previous Tory health ministers frequently accused their opponents of using deaths to make political points. But Hunt repurposed this trick against his opponents, veering close to accusing anyone standing in his way of being responsible for “avoidable deaths”.
Announcing his intention to impose a new contract on doctors, Hunt claimed that “around 6,000 people lose their lives every year because we do not have a proper seven-day service in hospitals… No one could possibly say that this was a system built around the needs of patients – and yet when I pointed this out to the BMA they told me to ‘get real.’ I simply say to the doctors’ union that I can give them 6,000 reasons why they, not I, need to ‘get real’.”
Margaret McCartney, a GP, author and broadcaster, told me: “It’s dangerous to keep on misrepresenting data even when experts have told you that you are making a mistake… Hunt’s claim about weekend deaths, used to justify changes to the junior doctor contracts, has been debunked (patients admitted at the weekend tend to be sicker).”
The shroud-waving was a tactic he had already deployed effectively against his first parliamentary opponent, Andy Burnham, and indeed against interviewers. Questions about failures to meet targets on waiting times, when not being excused by the “ageing population”, were often met with impassioned statements about patients failed by the NHS in Mid Staffs, Morecombe Bay, Gosport and elsewhere – a strategy he also deployed consistently in media interviews (such as his interview with the BBC’s Laura Kuenssberg, when he was challenged on LBC by an angry doctor in the same week).
He had deployed the tactic too, against Lewisham campaigners, when his administrator’s report suggested closing the hospital and related changes would “save around 100 lives a year”.
Indeed Hunt has made the “patients’ champion” persona his own. He told the New Statesman that he had made patient safety his “life’s mission” and that when he left frontline politics; “I want to write a book on patient safety. I would like to do for patient safety what Al Gore has done for climate change…”
In reality, having wielded the Francis report into the Mid Staffs scandal as a weapon from the get-go, he junked most of its key recommendations.
Having promised in 2013 to bring in minimum standards of safety for ratios of nurses to patients, two years later he and Simon Stevens quietly tore these promises up as too “mechanistic”, to the concern of the report’s author, Robert Francis. Hunt’s repeated promise to put the patient at the centre of everything that the NHS did, including in its constitution (another Francis report recommendation) was similarly junked a year after its headline-garnering work was done. Promises to protect whistleblowers resulted in just another toothless system. Moves towards openness were undermined by increased reliance on the market and private sector provision, with nothing done to address the destructive ethos of competition between and even within hospitals that Francis had identified as a key part of the problem at Mid Staffs.
Phil Hammond, the doctor and broadcaster who has written extensively on patient safety, told me: “Hunt developed a selective interest in some aspects of patient safety… so although he will be able to cherry-pick to make it look as if some aspects of safety got better…. Hunt repeatedly refused to introduce mandatory safe staffing levels… There are of course some brilliant NHS staff who are very dedicated to safety, who have improved the situation in their particular hospital or GP practice, but I don’t really see how Hunt can take credit for that. Finally, despite his strong words about no more cover-ups in the NHS and better support for NHS whistleblowers, many of them say the situation hasn’t improved and they are still not being listened to and are being persecuted.”
So much for Hunt’s “patients’ champion” persona.
And of course, much else that happened to the NHS under his watch wasn’t very good for patients, either – in terms of safety, but also access to healthcare, privatisation and rationing. And this is where the last of his strategies came in very useful.
Playing with the figures
Part of Hunt’s pitch is that he is “on top of the detail”. In reality, he has worked to make it harder or impossible for the rest of us to check-up on the detail. Once A&E waiting targets were routinely being missed, he simply stopped publishing weekly data on the failures and dropped hints that the target would soon be dropped. Similarly, in response to regularly missing the target on maximum 18-week waiting times for planned operations, that target was quietly dropped. In response to alarming headlines regarding the rising number of hospitals declaring ‘black alert’ (unable to guarantee life-saving emergency care, and having to divert patients elsewhere), the ‘solution’ was to ban hospitals from using the term ‘black alert’.
In June 2017, Hunt was summoned to the Commons to answer questions about whether he had sought to cover up a damning report that found a private contractor had failed to process over 700,000 pieces of medical correspondence, a scandal that reportedly may have harmed the health of at least 1,788 patients and has cost at least £6.6m. A year later he was criticised by charities for waiting up to four months to tell the public about another error that meant 450,000 women hadn’t received breast screening invitations and – as Hunt admitted in parliament – 270 may have died as a result.
Under Hunt, the Department of Health routinely refused to answer parliamentary questions and Freedom of Information requests about which private companies the NHS’s money was going to on the basis that they didn’t centrally collate it. And it was also reluctant to release raw, uncollated spending data, being the last department to do so and only giving in after a petition to release it. Inconveniently timed information on the financial crisis engulfing hospitals was tucked away from view too.
And what of Hunt’s defining claim in the leadership campaign – that he was “the person who secured a historic funding boost for the NHS” just before leaving office in July 2018? While Hunt claimed that the deal was “one of the single biggest increases in funding for a public service in our history”, numerous experts pointed out that most NHS increases were generally “the biggest yet” (due to inflation), that this increase (at most, 3.4% a year) didn’t match the level of actual health inflation and higher need, and hadn’t made up for the shortfall in funding in preceding years. In the words of the National Audit Office, the funding boost was “inadequate” and left the NHS “unsustainable”.
Also worrying, it turns out (in the long term plan) that Hunt’s deal was conditional on the NHS achieving significant savings through the use of technology (something that many experts were dubious about), reducing face-to-face appointments by one third, and also on there being no additional pressures from the social care sector (that was on the verge on collapsing). And this 3.4% doesn’t apply to capital expenditure, staff training and pay, or public health budgets – all of which would remain up in the air until the next spending review. Theresa May promised the “Brexit dividend” would fund the increases. That didn’t quite pan out though, did it? As a Nuffield Trust health expert put it, “The NHS would be wise to hang onto the receipt for this particular birthday present.”
There are many more facts I could throw at you to help you see Hunt’s legacy. Public satisfaction with the NHS fell during Hunt’s time in office, for example. Both maternal deaths at childbirth and infant mortality started to worsen again towards the end of Hunt’s tenure, after decades of improvement. And one last statistic is perhaps the most damning. In an interview with the New Statesman, he quoted Stephen Pinker as saying that “life expectancy has gone up!”. While this is true globally, the story in Britain is different. Since 2015, projections for life expectancy in the UK have fallen by more than a year.
It tells you much about British politics that a man with Hunt’s record was promoted to foreign secretary, and after losing one leadership bid, again now stands a small chance of becoming prime minister. It tells us a huge amount about the state of the British press that Hunt is treated as a serious candidate.
And it’s worth remembering, that whoever succeeds Johnson will face the same advantages that Hunt has always had: an establishment that doesn’t care too much what happens to ordinary people’s services, so long as no one makes a fuss, and a pliant media, always ready to believe the spin of some old public schoolboy.
Speaking after Labour said it was still poised to back a ‘People’s Vote’, despite not pushing for one this week, Mr Hunt said “the wind is in the sails” of referendum backers and they were almost two-thirds of the way there.
He told the BBC’s Andrew Marr Show: “We have an opportunity now to leave on March 29 or shortly thereafter.
“It’s very important we grasp that opportunity because there is wind in the sails of people trying to stop Brexit.”
…
[I quite liked that;)
Following Mr Hunt’s comments, Hard Brexit-backing Tory MP Steve Baker issued a thinly-veiled threat to those pushing for a second referendum.
He said: “The people who would stop Brexit should know just this: what you do, you’ll have do in public now.
“And everyone will know just what you have done.
“Stopping Brexit will be on you, not Brexiteers. Don’t kid yourselves otherwise.”
…
Comment by dizzy: Those opposed to Brexit, including myself, are participating in the democratic process. It is the strength of argument that is defeating Brexit. Making personal threats shows this Brexiteer to be inadequate as an MP.
Maintaining anonymity on this blog costs in the region of £10 a year and it’s due about December. I decided that I couldn’t afford it one year and my name appeared briefly on the domain name registration. I assumed that GCHQ, MI5 or some similar organisation was paying for it. I am very proud of my name – it’s a very good mostly Welsh name although lately I quite like Simples.
11/3/19 Done some research on Steve Baker now. He’s number two.
12/3/19 Simples is a reference to Theresa May’s response when asked essentially what happened to Brexit. It has a deeper meaning and has since been spun as something different
Even middle England can see that privatisation costs, rather than saves, billions. Will MPs take a historic chance to undo this market mess that’s crippling our NHS, this Friday?
The experts turn the nostrums of market efficiency which the free-marketeers have inculcated us with over the last 30+ years, on their head, writing:
“Privatised services cost the NHS and taxpayer far more than when provided by our publicly owned and publicly run NHS. That is because public health systems don’t seek profits. They don’t need to pay dividends to shareholders. They don’t have the added costs of private sector loans. And they don’t have privatisation’s heavy and unnecessary marketising costs of contracts, billings and all the extra administration involved.
The huge commercial costs and chaos caused by the ongoing NHS fragmentation are the direct result of privatisation. This is endangering the quality and safety of our public healthcare. That is why we need the National Health Service bill.”
And – noting how so much is being sneakily privatised under the NHS logo, they add:
“NHS services and assets, including blood supplies, nurses, scanning and diagnosticservices, ambulances, care homes, hospital beds and buildings – which the British public own – are being handed over to UK and foreign private companies. This is being done without a public mandate.”
I only really got hold of this when I had an MRI scan last September. From quizzing the radiographer, my GP and scanner suppliers and researching the purchase, manning and maintenance costs it seemed clear that my scan – provided by a private company – cost the NHS at least 25% more than if it had been provided by a nationalised NHS.
The inflated costs are everywhere – from PFI (£1bn a year) to profits made by private providers, to the vast costs of running the NHS as a ‘market’ (in fact, as a privatisers’ bureaucracy) – costs that are fiercely denied by pro-market advocates and carefully obscured by government – and independently estimated to waste anywhere between £4.5bn and £10bn a year – or more.
The economic case for renationalising the NHS and restoring it as a publicly owned and run entity seems unarguable. It should be the Labour Party’s trump card.
So why is the Corbyn leadership being so slow to grasp this gift horse? Why hasn’t it yet publicly embraced the NHS Bill which clearly sets out its intent to strip away the expensive market bureaucracy the NHS can ill afford?
Is Corbyn being “got at” as a well-placed observer suggested at the NHS Bill group meeting I attended a few days ago? Is his party running scared of fuelling the Greens, whose solo MP Caroline Lucas has been the tabler of the NHS Bill in Parliament and of whose renationalisation-studded Election manifesto the President of the RMT Peter Pinkney barked last March “If that isn’t bloody Socialism I don’t know what is!”
Or is the mantra of electability and the City-honed Damocles sword of Labour’s economic ‘incompetence’, which the Mandelson camp followers have held to the party’s throat for so long, still keeping even its newbie lefty(ish) leadership kneeling in an NHS policy desert?
A member of my West London 38 Degrees group, a lifelong Tory now lapsed, has no such hesitation. She supports the Bill and doesn’t mince her words in her letter to our local Tory MP; “We are not idiots; this government is pushing the country into private hands in every direction – and you only got 24% of the vote. I doubt any of you will get another term in office and the opposition parties are not any better.”
Signing herself “a sad, disillusioned resident of Fulham and ex-believer in the Conservative Party” she’s a powerful example of the simmering rage at the privateers’ long unfettering. “All they think of is money. What’s more important? Being aware of other people or just making money?” she asked me rhetorically.
This quiet rage at the corrupting monetisation of our political and civil institutions runs deep and wide and courses across party lines. And it’s up for grabs by a Labour Party prepared to stick its neck over the parapet and see a landscape budding with potential and surprising allies.
Suddenly this weekend there are straws of hope in the wind for NHS campaigners. The Socialist Health Association (SHA), like ex-Shadow Health Minister Andy Burnham, have been purveyors of the Blair/Mandelson City-sugared line on the NHS, which would leave it vulnerable to continuing privatisation under international trade and competition agreements. Accordingly they (the SHA) have been long-time opponents of the Bill.
But on Saturday their AGM voted by 30-1 to strongly back the Bill and do everything they could to encourage Labour MPs to back it. Does this signify a ‘left turn’ within the SHA? And – given some of its senior figures are rumoured to be amongst Heidi Alexander’s close advisors – what might all this portend for her future positioning on the NHS?
More importantly Shadow Chancellor John McDonnell has publicly re-confirmed his support for the Bill. The Shadow Health team have agreed to attend its Second Reading and debate next Friday 11th. Campaigners understand that there have now been discussions between Jeremy Corbyn, Heidi Alexander and Caroline Lucas.
Filming Joanna Adams in Darlington two days ago for the continuing saga of my documentary series Groundswell about her and the 999 Call For The NHS campaigners, I asked this organisation’s founder what she made of the Labour Party’s post-Corbyn shapeshifting. An acute campaigner, Joanna senses a sliding of the sands from under the Blairite sword-wielders of old and their followers.
But for now she’s staying with the Greens. If Labour can’t win back grassroots supporters like her from Labour’s old heartlands then its future as a party with a working majority seems bleak. It is in danger of being outgrown by the ‘new’ politics of internet-savvy, issue-driven grassroots. For them the 2008 crash and bank bailouts were a game changer – exposing not only the dirty secrets of the privateers and bankers, but the how whole the Blair project depended on the rigged, debt-inflated airbagging of Western economies which has been the developed world’s economic cornerstone since the late 1960’s and has now been punctured.
The NHS Bill is a game-changer, too, for the Labour Party. As its co-author Peter Roderick has said, it’s a gauntlet thrown down to the party and its moribund inheritance. Friday’s Day Of Action is an early staging post in the long struggle ahead to save the NHS from the bankers and privateers.
It’s a significant moment for the party that brought the NHS into being and an opportunity for it to further the necessary reconnection with its origins that the Corbyn ‘phenomenon’ has signalled.
How you can help: We’re asking everyone to ask their MP to attend the debate on Friday (details on the NHS Bill website) and, if you can, to come to the rally outside parliament from 11am on Friday, details here, and/or earlier outside the Department of Health at 9.45am, details here.
A fuller Q&A can be downloaded here, and leaflets to distribute in advance or on the day, clearly spelling out what’s at stake, can be downloaded here. This article is published under a Creative Commons Attribution-NonCommercial 4.0 International licence. source
Being a doctor – or any public sector worker – shouldn’t be such a battle. That’s why we must support junior doctors in their planned strikes.
For the last 9 years I have been the medical director of an NHS service providing confidential help to doctors and dentists with mental health problems, seeing a rising number of doctors week on week.
But our patients have changed.
In our early days the ‘typical’ patient was an older male (GP or psychiatrist) with alcohol problems.
Now nearly half of all new patients are under 30 years old. They come to us with depression, anxiety and symptoms akin to posttraumatic stress disorder. Many have worked in the NHS only a few years. They started out bushy tailed and bright eyed, but end up ‘burnt-out’ (a polite euphemism for depression) after only a few years working. Our youngest patients are only a few months qualified and many are in their Foundation years.
Patient after patient talks of feeling betrayed and bewildered by their loss of enthusiasm about a profession that they had strived to enter (often since their early teens). How their desire to care for patients is sapped by every working day. The language they use to describe their work is that of the battlefield. Being on the ‘front-line’, of ‘surviving’ another shift, being ‘at war’ with management. They talk of feeling abandoned by the NHS. Of working intolerable shifts that appear to have been designed by robots with no concept that humans will need to work them. Of having no sustenance – literally and metaphorically – as they try their best to deliver care to patients.
They talk of working in an unforgiving environment – where every error will lead to punishment and where every move is watched and recorded. They describe the fun having gone out of their profession. They say that they cannot see a future any more in medicine.
Hardly surprising therefore that the numbers progressing through training (from the early Foundation Years to the start of specialty training) is reducing. That now nearly half of doctors are not progressing. And that this is against a background of fewer of our brightest entering medicine in the first place.
Our junior doctors are striking for more than pay and conditions – important though these are. Their planned strike is consciously or unconsciously action to shine a light on what is going on within the NHS – to shine a light on the conflict between idealism and industrialization.
Increasing privatisation has changed the relationship doctors have with their patients. Constant reorganisation has fragmented services, and shattered long-standing teams. At a series of NHS listening events I held in 2014, the overwhelming term used by all NHS staff to describe their working environment was ‘Fear’.
The pay of junior doctors has never been good – not when calculated across the hours worked, the responsibilities they have and when compared to their non-medical peers.
But this was part of the compact we all had – we gave our all for our patients and the organisation we worked in gave their all to us – cared for us, nurtured us, trained us. We also knew that the intolerable hours would end as we climbed the medical career ladder. Now all of this has been fractured.
The new junior doctor contract will erode not just pay but also the current safety net against exploitative hours of work. Saturdays will be counted the same as week-days (tell their children that when they are off school and wanting to see Mum or Dad). Women and others who take career breaks will be discriminated against. Junior doctors have been forced to look into the abyss and chose between pain today (strike action) or pain tomorrow (agreeing to an unfair and unsafe contract). They are being treated as children rather than the committed adults they are – their please ignored, instead accused by Jeremy Hunt of being ‘extreme’, ‘militants’, and even unpatriotic.
The junior doctors are not alone in their discontent. The nurses who are marching this Saturday, the teachers and social workers, in fact most public sector workers have seen insecurity, exploitation, fear, and subtle discrimination as the backdrop to their working lives.
The junior doctors are fighting for fairness for all of these workers. They are leading the charge for a restoration of the values that should drive our public services. For a change by those who employ them – ultimately our Government – who have a moral duty to protect those who care for some of the most vulnerable in society.
Without this change, goodwill will disappear forever and with it the glue that binds our public services together. The government must now stop their bullying tactics and accept that something is profoundly wrong the NHS today and act before it is too late.
This article is published under a Creative Commons Attribution-NonCommercial 4.0 International licence.