Labour leader Keir Starmer under pressure to commit to higher taxes for super-rich as Tory government prepares spending cuts

https://www.theguardian.com/politics/2022/nov/03/labour-mps-press-keir-starmer-to-set-out-wealth-tax-plans

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.

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.”

https://www.theguardian.com/politics/2022/nov/03/labour-mps-press-keir-starmer-to-set-out-wealth-tax-plans

Continue ReadingLabour leader Keir Starmer under pressure to commit to higher taxes for super-rich as Tory government prepares spending cuts

‘A real and present danger’: NHS cuts will put lives at risk, health leader warns

The lying EU bus promoting money for the NHS when all the anti-EU shites are anti-NHS Neo-Liberal shites.
The lying anti-EU bus promoting money for the NHS when all the anti-EU shites are anti-NHS Neo-Liberal shites.

https://www.theguardian.com/society/2022/oct/23/a-real-and-present-danger-nhs-cuts-will-put-lives-at-risk-health-leader-warns

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”.

https://www.theguardian.com/society/2022/oct/23/a-real-and-present-danger-nhs-cuts-will-put-lives-at-risk-health-leader-warns

Apologies for bad news Sunday, this blog doesn’t do denial of reality.

Continue Reading‘A real and present danger’: NHS cuts will put lives at risk, health leader warns

Guardian Exclusive: 90% of schools in England will run out of money next year, heads warn

https://www.theguardian.com/education/2022/oct/22/exclusive-90-of-uk-schools-will-go-bust-next-year-heads-warn

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.”

https://www.theguardian.com/education/2022/oct/22/exclusive-90-of-uk-schools-will-go-bust-next-year-heads-warn

Apologies for bad news Sunday, this blog doesn’t do denial of reality.

Continue ReadingGuardian Exclusive: 90% of schools in England will run out of money next year, heads warn

Historic Failure

Led by Donkeys: A historic failure

Jeremy Corbyn: A warning to Truss and Hunt: people see the chaos and unfairness – and they won’t accept it

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 austeritythe 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.

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.

Continue ReadingHistoric Failure

Meet the real Jeremy Hunt, the man who ruined the NHS

Republished from OpenDemocracy.net under Creative Commons Attribution-NonCommercial 4.0 International licence

Jeremy Hunt: Next PM could be the man who ruined the NHS

As the former health secretary vies for No.10, the truth of his ministerial past puts paid to his ‘sensible’ image

caroline m.jpg

Caroline Molloy

8 July 2022, 12.00am

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.”

It isn’t the first time Hunt has vied for the leadership; when he ran in 2019, The New Statesman was impressed by his “empathy” and “compassion”. The Guardian described his “genial disposition” and “record of departmental diligence and attention to detail”.

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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”.

NHS rules say 95% of patients visiting A&E should be seen within a maximum of four hours. When Hunt took over, the performance was just below target – 94.9%. Performance worsened steadily during his tenure and was 84% by the time he left, with the target having been missed every winter since 2013/4, and every single month since July 2015. That meant three times more patients waiting over four hours to be seen in A&E when Hunt left office than when he started.

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%.

Other targets – notably cancer referral times and waiting times for planned operations – also went from being comfortably exceeded to being missed every month under Hunt’s watch.

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).

Hospitals now receive on average 10% less for treating a patient than the treatment actually costs the hospital (by the admission of the head of the then regulator, Ian Dalton). And when cash-strapped hospitals missed financial and performance targets that the Public Accounts Committee said were ‘unrealistic’, they were fined, something that – unsurprisingly – has been shown to do nothing to improve performance.

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.

Throughout the period, hospital campaigners were run ragged trying to defend their local services from closure. One of Hunt’s first big decisions involved trying to close over half the services of the (top performing and much loved) Lewisham hospital, including its maternity and acute wards and downgrading its A&E departments, to boost a PFI-indebted neighbouring trust. Campaigners defeated Hunt in the High Courts (twice), successfully arguing that Hunt had acted outside his powers, and the local community had not been adequately consulted.

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.

Meanwhile, it’s been quids in for the private companies routinely used to provide beds to make up the shortfall. In June 2019, NHS England boss Simon Stevens finally admitted that the policy of bed closures had gone too far, leaving NHS beds “overly pressured”.

Save Lewisham Hospital campaigners celebrate a High Court ruling preventing services being reduced at the hospital.
Save Lewisham Hospital campaigners celebrate a High Court ruling preventing services being reduced at the hospital. | PA Images

Plans developed during the Hunt years, most notably “Sustainability and Transformation Plans” claimed that hospital bed closures would be made up for by improved ‘care in the community’. But numbers of community matrons, district nurses and school nurses continued to decline under Hunt, and there had been a dramatic drop in the number of community health visitors by 2019.

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.

Hunt called general practice the “jewel in the crown” of the NHS, and in 2015, said: “We want 5,000 more GPs by 2020” – but he backed away from the commitment within days, talking of the need for “flexibility”. According to Channel 4’s Factcheck, the actual number of additional GPs he achieved in the following three years was… 162. By the last year of his oversight, the BMA described the number of GPs leaving their jobs as a “crisis”, with half a million patients seeing their GP surgery close last year.

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”.

Similarly, Circle’s privatised Hinchingbrooke hospital collapsed after inspectors found shockingly poor care – but Circle has since been rewarded with other contracts, including the takeover of a dermatology clinic in Nottingham that led to virtually every consultant resigning rather than work for the private firm. The unit, formerly a national centre of excellence, was forced to scale back its services and to recruit overseas locums at a cost of up to £300,000 each. An independent report labelled the contract an “unmitigated disaster”. Then, Nottingham NHS bosses decided to take Circle’s local treatment centre (which provides a range of operations) back in-house, and Circle sued them in response.

From ambulances to eye operations, out-of-hours care to the NHS’s 111 medical helpline, drug treatment and prison services to musculo-skeletal services, private firms cherry-pick cash and ‘easy’ patients from the NHS – leaving the NHS underfunded and struggling to survive.

Virgin Care won almost £2bn of contracts during Hunt’s tenure, including highly controversial contracts to look after children and frail, chronically ill people in many parts of the country. One of his first acts was to personally intervene to help Virgin’s takeover of swathes of services in his own Surrey area. 2018 saw a 57% rise in privatisation cash overall. Hunt also pushed repeated, though ultimately fruitless, attempts to privatise NHS Professionals – the NHS’s own in-house agency and its last line of defence against profiteering temporary agencieseven as he told hospitals to reduce their reliance on agency staff.

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.

Hunt told MPs in 2016 that his department was “finding our way forward to the kind of budgetary arrangements that you would have in Kaiser Permanente”, although given the backlash against Accountable Care Organisations, they were… renamed as “Integrated Care Providers”. Hunt also gave the US medical centre chain, Virginia Mason, £12.5m to teach NHS hospitals about safety, calling it “probably the safest hospital in the world” – only to see the US organisation fail its safety inspection a few months later. For all Hunt’s plaudits, neither Virginia Mason nor Kaiser Permanente have anywhere near the cost-efficiency per head of the NHS. During Hunt’s period, concerns have been swirling about the impact of a US trade deal – and the reassurances that the NHS will be excluded from such deals are simply not plausible.

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.

Devon’s 2014 attempt to ban smokers and obese people from all routine operations, regardless of clinical recommendations, generated a huge backlash. But in the next couple of years, Clinical Commissioning Groups (the NHS organisations that allocate local health funding) followed suit, with consultations geared towards removing certain types of services, in particular from the ‘undeserving’. A number of areas have now implemented these policies.

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.
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.

Blaming staff – and roping in the media to help – was pretty bad form seeing as their goodwill (including ‘donating’ £1.5bn a year in unpaid overtime) was the only thing keeping the show on the road during the post-2010 squeeze on NHS funds and staff pay. In October 2014, 450,000 NHS staff walked out in the first strike by health workers in 32 years.

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’.”

Experts took apart Hunt’s claims, showing that his use of weekend mortality data was “a shambles”. Hunt’s suggestion that the BMA was “turning medicine into a Monday to Friday profession” alienated the doctors who provide 24/7 emergency care (check out #ImInWorkJeremy), and he was even accused by doctors of having put at least 14 patients at risk by incorrectly implying that 24/7 emergency care wasn’t available.

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.

In terms of money, in 2015, the UK Statistics Authority told Hunt to stop saying NHS spending was up, and a year later a committee of MPs found he had misled them on this point and he admitted he had played with the time periods.

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.

Continue ReadingMeet the real Jeremy Hunt, the man who ruined the NHS

Jeremy Hunt warns that there’s “wind in the sails” of people trying to stop Brexit

Stop Brexit process could be in place within weeks, Jeremy Hunt declares

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

I am reconsidering my endorsement.

16/3/19 The endorsement persists.

Continue ReadingJeremy Hunt warns that there’s “wind in the sails” of people trying to stop Brexit

Our NHS can’t afford privatisation – why MPs must back the NHS Bill this Friday

Continue ReadingOur NHS can’t afford privatisation – why MPs must back the NHS Bill this Friday

NHS in crisis :: Unpatriotic militants? No, Jeremy Hunt – doctors are just fighting to be able to care for us all.

Clare Gerada on the strike by junior doctors.

 

Image of George Osborne asking where is the money to be made in the NHS

Unpatriotic militants? No, Jeremy Hunt – doctors are just fighting to be able to care for us all.

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.

Instilling ‘fear’ in doctors, teachers, nurses and other public sector workers is deliberate government policy – as explicitly set out by Cameron’s policy guru, Oliver Letwin, in 2011.

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.

 

Continue ReadingNHS in crisis :: Unpatriotic militants? No, Jeremy Hunt – doctors are just fighting to be able to care for us all.

NHS in crisis :: Not fair, not safe – 6 reasons junior doctors are preparing to strike

Not fair, not safe – 6 reasons junior doctors are preparing to strike
by Nick Carpenter

Image of George Osborne asking where is the money to be made in the NHS

The junior doctor contract governs the pay and conditions of work from doctors’ foundation year to registrar level. All doctors who are not consultants or fully qualified GPs are considered ‘junior’ doctors. This contract was scheduled for renegotiation, but the British Medical Association (BMA) – the largest representative body of doctors – walked away because the offer on the table was not fair to doctors and not safe for patients.

The government’s initial response was brazen, and threatened to impose the new terms without consultation – a position it has had to water down since the BMA decided to ballot its members for strike action. Here’s why the BMA has done so the first time in 40 years:

  1. An NHS in crisis: overworked and undervalued.

Britain’s doctors have had enough. In a stretched and underfunded health system which doesn’t train enough doctors and nurses to meet its own needs – or invest in the infrastructure needed for new hospitals and facilities unless aprivate contractor is taking a nice slice of the pie – the solution seems to have been ‘work harder and take up the slack’. According to the Royal College of Physicians, the NHS “remains reliant on doctors working longer than their contracted hours…the amount of ‘goodwill work’ is increasing year-on-year.”

Trusts struggling to pay their tithes to the private owners of NHS hospital buildings have responded by reducing staff salaries, meaning fewer doctors and nurses are covering more patients and expected to do so for free. The situation has reached crisis point and doctors are experiencing enormous burnout, with more doctors applying to live abroad every year. Into this context came the new contract.

  1. It’s not about the money.

The ‘offer’ of the new contract has been condemned first and foremost as fundamentally unsafe. Just as with the recent tube strike, the new contract threatens to force doctors to work longer and later with fewer safeguards.

The BMA approached negotiations acknowledging financial limitations but determined to improve safety: it wanted no doctor to work more than 72 hours in a week; no more than four nights in a week on-call; a rest day either side of nights before starting back on day shifts; and facilities to sleep-in for those who otherwise make a dangerous long drive home.

The government was unwilling to accept these terms, and furthermore wanted to reduce breaks to just one 30 minute break in a ten hour on-call shift. As a recent viral video asked, could you save a life if you’d been up all night?

  1. But it is, also, about the money.

The new contract would mean a 15-40% pay-cut depending on your specialism, with GPs and emergency care doctors being some of the hardest hit. Let that sink in.

With wages starting beneath the national median anddecreasing yearly like all public sector pay, and out of pocket expenditure for licensing, exams and indemnities, junior doctors earn significantly less than the tabloids would have you believe. Their reports often use a cunning sleight of hand: taking the figures for the pay of those doctors doing the most private work – GPs who run a private practice and some consultants who run private clinics – and presenting the data as proof of ‘greedy’ public sector workers.

There are two ways doctors’ starting wages increase: extra pay for unsociable hours, and pay advancement as you progress through the ranks of seniority and responsibility. Both of these are under threat in the new contract.

The government has suggested that working from 7am until 10pm Monday to Saturday are sociable hours – and therefore should not be paid extra – which is funny considering MPs just reduced their own working hours and increased their own pay. As for pay progression with seniority, no actual offer was made.

  1. The changes hit women hardest.

The contract changes penalise those who take time out to start a family and those who work part-time –overwhelmingly affecting women in both cases. Additionally there are concerns that changes to breaks will make work more dangerous for pregnant women. As noted above GPs will be amongst those taking the largest wage cut, one of the few specialisms with more women than men.

  1. No confidence in Jeremy Hunt.

More than 200k people signed the petition to debate a vote of no confidence in Jeremy Hunt. He wrongly and infamously implied that doctors don’t work at night or weekends. After blaming the A&E crisis last winter on people attending inappropriately (rather than, say, the reduction of roughly 13k hospital beds over the last five years), Mr Hunt felt it was appropriate to take his own children to A&E rather than wait for an appointment like, you know, the rest of us commoners.

But most of all:

  1. This was an imposition, not a negotiation.

Hunt and the government have shown a complete disdain for even the barest semblance of actual negotiation. When the BMA walked away from negotiations a year ago, it wasn’t as a strategy to get better terms, it was because the negotiations were a farce. It has taken the threat of industrial action for a pathetic attempt at reconciliation to come from the Department of Health, full of vague, unconvincing rhetoric. It is too little, too late. No fruitful discussions can continue with Hunt as health secretary. We have no reason to believe in his word or his competence.

We deserve more. Doctors do not take strike action lightly. Whilst we will always maintain emergency and essential services, the BMA will be balloting its members to strike against the contract in the next month. We hope to see you on the picket lines.

 

  • About the author: Nick is a junior doctor. He tweets at @ZastaNick.This article is published under a Creative Commons Attribution-NonCommercial 4.0 International licence.

 

Continue ReadingNHS in crisis :: Not fair, not safe – 6 reasons junior doctors are preparing to strike