Two Speeches, 10,000 Words and No Answers

It was Jeremy Hunt’s big day yesterday, and I was there, at both the King’s Fund speech and in Parliament, to hear him. But after two major speeches and plenty of eye-catching rhetoric, it’s unlikely he will have convinced anybody of his extraordinary claim that the Tories are “the true party of the NHS”...

Arguing that today’s health service can trace its origins back to a 1944 White Paper by the then-Tory Health Minister, Henry Willink, the Secretary of State offered a heavily rose-tinted view of his party’s history.

But while he may have neglected to mention the ferocious opposition Willink encountered from his fellow Tories at the time, the rest of us haven’t forgotten that the Tories stood against the creation of a National Health Service when it mattered, voting against the Labour Government’s NHS Bill no fewer than 21 times, at every stage of its passage.

Of course it’s more than just certain chapters of the history books being ignored by the Tories these days. Increasingly it’s the needs of NHS patients and staff getting cast aside by Ministers in their pursuit of headline-grabbing initiatives.

My concern here is not so much about the smaller baubles on the Christmas tree (look everybody, it’s Martha Lane Fox helping patients access the web!) as they are about the possibility that the entire structure ends up collapsing under the weight of the expectations being heaped onto it. In this case I am referring, of course, to the vaunted “seven day NHS”, which like so many Tory policies is based on an appealing idea that has not been remotely thought through in practice.

Of course no-one would argue with the idea that good quality health care should be available whenever it’s needed. But without the money and manpower to drive such a fundamental change, a seven day NHS will remain just that – an idea and nothing more.

The first and most obvious roadblock, as always, is money. Jeremy Hunt never misses an opportunity to remind us of his promise to invest an additional £8 billion a year into the NHS by 2020, as the Chief Executive of NHS England, Simon Stevens, called for in his Five Year Forward View. £8 billion sounds like a lot of money and it is. But it is not the end of the story.

To begin with, £8 billion was Stevens’ baseline estimate of the bare minimum needed to keep the NHS ticking over at existing levels of service. At no point has there ever been a suggestion that funding at this level would in itself be enough to support a dramatic expansion of services. What’s more, in return for the £8 billion cash injection, Trusts are expected to identify an astonishing £22 billion per year in efficiency savings – a target few people, inside the health service or outside, seem to consider remotely realistic.

So the Tories’ funding commitments create more new questions than they answer old ones.

Is the £8 billion annual investment to begin immediately, or to be reached gradually over a five year period? And what will happen if NHS Trusts cannot make their efficiency savings add up to the astronomical sums that are being asked of them? In either case there will be a significant shortfall in NHS finances, and the Secretary of State has failed to explain how he would expect services to be expanded to seven days when many hospitals and surgeries are struggling even to stay open for five days.

This is not scaremongering, it’s realism. According to the King’s Fund, two thirds of hospital trusts are currently in deficit. This is important not least because, as the Chief Executive of University College Hospital Trust recently told me, clinicians are far less likely to sign up for change when they’re struggling just to balance their books.

And all this is before we even get started on primary and social care.

The Government may talk the talk on rebalancing the NHS towards a greater emphasis on preventative care, but the reality is that under the Tories the burden of providing social care in the community has fallen entirely on local authorities at exactly the same time as they’ve been faced with unprecedented cuts to their funding. In the case of my local council in Islington, total funding levels will by next year be just half what they were in 2010.

For GPs, who deliver 90% of NHS care, the outlook is hardly any brighter. During the last five years the number of GPs has remained flat, while the share of the total NHS budget which goes towards funding primary care has actually fallen. But in the same period demand has increased dramatically, meaning that the same number of GPs are now providing around 150,000 more consultations every day than they were just five years ago.

Not that any of these problems were even acknowledged by Jeremy Hunt yesterday, much less answered. Instead of solutions he gave us platitudes about a “more human” NHS and a move towards “intelligent transparency”. If this is the kind of waffle like that leaves you scratching your head, you’re not alone.

It turns out he was talking about challenging local NHS providers’ decisions about the kinds of services they fund. The example I heard yesterday from Chris Wood from Action on Hearing Loss was a case where improved transparency allowed patients to challenge a local CCG’s decision not to provide funding for hearing aids. Important as it obviously is for patients to have the information they need to challenge decisions they see as unfair, it seems to me that the risk here is that we lose sight of the bigger picture, which is, surely, why we aren’t funding hearing aids to begin with.

When the dust settled, Jeremy Hunt’s big day could almost be seen as encapsulating the entire Tory approach to the NHS – all mouth and no trousers. Instead of meeting his challenges head on, Hunt retreated into the Tories’ union-bashing comfort zone. Presenting the BMA as a “roadblock” to reform, simply because its members have had the temerity to disagree with him, is not an advisable way to proceed with changes of such significance as Hunt is proposing.

With two speeches, more than 10,000 words and who knows how many headlines, we might have expected more substance than spin. But listening to Jeremy Hunt yesterday was more like eating a huge plate of junk food – which looks appealing at first, and fills you up, but leaves you feeling dissatisfied and slightly sick.


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