In 1958, the managing editor of a widely read women’s magazine rejected a romantic novel for serialisation by arguing: ‘I have a theory that fiction must never disturb the faith and trust a woman feels for doctors and/or nurses.’ He was not alone in his concern that fictional representations of healthcare professionals had the capacity to undo readers’ and viewers’ devotion to the health service and its employees.
Over the last few days, it has emerged that the foundation set up in Captain Tom’s name (not NHS Charities Together) not only paid out more in management costs than it did in grants during its first year, but also paid over £50,000 to two companies run by Ingram-Moore and her husband. The revelation has provoked outrage. But more illuminating, really, is what happened to the £33 million that Captain Tom raised himself, and what it tells us about the NHS’s increasing reliance on charitable giving.
The Parliamentary and Health Service Ombudsman found last month that Averil Hart, who had anorexia nervosa and died in December 2012, was failed by ‘every NHS organisation that should have cared for her’. ‘Sadly these failures, and her family’s subsequent fight to get answers,’ the PHSO report says, ‘are not unique.’ In October 2009 I went to see my GP to ask for help with my anorexia.
When Sylvia Plath's marriage to Ted Hughes foundered in August 1962, her family assumed that she would move herself and her children back to America. ‘The worst difficulty is that Ted is at the peak of his fame,’ she wrote to her mother on 21 October, ‘and all his friends are the ones who employ me.’ Aurelia Plath published her daughter’s Letters Home in 1975. ‘I opened a joint account in a London bank,’ she wrote in a note, ‘so she could use it in any emergency, hoping she would consider returning to the United States. We, as a family, were prepared to set her up in her own apartment here.’
There are no good news stories about computers and the NHS. The reporting of Friday’s malware attack may, however, be usefully different from the typical bad news story, in which hubristic politicians or nameless bureaucrats waste millions, if not billions, of public funds on projects which go over budget, fail to deliver, prove to be unusable or collapse under pressure. In this instance it seems that, for once, inaction and underinvestment have led to something sufficiently focused to be newsworthy, showing that there can be a political as well as a human cost to doing nothing.
Hello. My name is Jeremy Hunt, the elected Politician responsible for the good Running of Britain’s National Health Service. It has come to my attention that Criminals have entered a Number of NHS Hospitals through old Windows. This is a Disgrace and an Outrage. It is the Responsibility of Hospital Managers to make sure that their Windows are sound, secure and absolutely proof against Intruders, as well as Draughts. It is the responsibility of Nurses and Doctors, in the long Hours they must have between dealing with Patients, to carefully note down all cracked, broken or out of date Windows they see, and report them to their Supervisors (not to me, obviously, as I am too busy working to make the NHS fit for the Ranks of exciting developing Nations like Ukraine and India which we are about to join post-Brexit).
As well as enough money to build a new hospital every week post-Brexit, the Leave campaign promised to relieve the NHS of the pressure it is put under by 'health tourism' and the arrival in Britain of hundreds of thousands of public-service-hungry migrants each year. It now seems the NHS is as unlikely to benefit from restrictions on EU immigration to Britain as it is to receive an extra £350 million a week. The amount that would be saved by not treating EU migrants would make no dent in the NHS’s financial problems, while a lack of EU workers would mean fewer staff on overworked NHS wards.
In the run up to the EU referendum, the Leave campaign promised that a funding bonanza for the NHS would be one of the many benefits of leaving the EU. Official Leave campaign posters notoriously pledged that £350 million a week would be used to fund the NHS instead of being sent to Brussels. Now it seems that Brexit will deliver the opposite of what was promised: instead of gaining £350 million a week, the NHS will be making a loss of £365 million a week by 2030, according to a new Health Foundation report. And that’s the optimistic outlook, based on an assumption that the UK will be allowed to join the European Economic Area. If it’s excluded from the EEA, the NHS in 2030 may be running a deficit of £540 million a week.
It’s wrong to jeopardise patient care, even if it means working very long hours for mediocre pay. That’s why junior doctors will often turn up to work if they are themselves ill, and why they haven't gone on strike for forty years. The leader of the BMA Junior Doctors described today as ‘the saddest day in our profession’s recent history’. It’s difficult to disagree. This is not because emergency care was compromised. The service provided by junior doctors today was on a par with that of a bank holiday (the marriage of Prince William and Kate Middleton was more disruptive to the NHS). Around 3500 patients had elective procedures cancelled, though, and this dispute isn’t their fault.
I was one of ten thousand people who marched on Westminster to protest against the unjust and unsafe imposition of a new deal for junior doctors by an arrogant government. The reforms treated us like cogs in a malfunctioning machine, abolishing our autonomy and any consideration for family life. We cheered as the leader of the opposition spoke up for us, told us how much the NHS meant to him, and explained how the government had got it wrong by undervaluing junior doctors. The year was 2007, and the speaker was David Cameron.
In Yes Minister, 'one of the best run hospitals in the country' turns out to have a major advantage: it has no patients. This week, the Care Quality Commission said that the hospital I work at, Addenbrooke's in Cambridge, is 'inadequate', despite acknowledging that the care provided to patients is 'outstanding', with one of the lowest standardised mortality rates in the UK. This outstanding hospital is so inadequate that it's been placed in what are euphemistically termed 'special measures'.
The UK has introduced a healthcare surcharge for immigrants from non-EEA areas. Adults have to pay £200 a year for access to the NHS whether or not they make use of it; students have to pay £150. UK citizens who want to bring their partner to the country must apply for a 30-month residency visa: the NHS surcharge on this is £500, almost doubling the previous cost of the visa (£601). Skilled migrants can be stuck with bills of more than £1000. An applicant with a dependent spouse and three children could be charged £5000.
In his speech to the Conservative Party Conference, David Cameron vowed to protect current levels of health spending. He also stressed that ‘you can only have a strong NHS if you have a strong economy’ – something Labour 'will never understand'. In other words, the salvation of the NHS depends on a Conservative victory at the next election. That sentence has a strange ring to it. But everyone claims to be the saviour of the health service these days. Both camps in the Scottish independence debate claimed it. The Labour Party claims it. The Conservative Party claims it.
At the centre of Monday night’s Panorama programme on fraud in the NHS was an interview with Jim Gee, an expert on the financial cost of healthcare fraud. Gee showed the presenter a newly published report, of which he was the first author, and talked about its findings. He turned to a key page and the camera picked out a bar chart as the two discussed some of the figures it contained. The report was also given wide coverage in the print media this week. Stories were run in all the broadsheets and across the tabloids with many local papers picking up the story and giving it a local spin. The figure, highlighted in Panorama, that most journalists seized on was the estimate that fraud was costing the NHS around £7 billion a year, enough – the Express pointed out – to pay for 250,000 nurses.
According to the front page of yesterday’s Guardian, the NHS is to start selling our confidential medical records. Every doctor has a duty to keep patient-identifiable data secure, and only share it as far as is in the patient’s immediate best interests. At the same time, in order to run healthcare organisations or to carry out medical research, it is necessary to compile statistics about diseases and treatments. It therefore makes sense for some information collected in the course of caring for patients to be made more widely available – shared with managers, bureaucrats and researchers – but only if it is anonymised.
NHS doctors are planning to take industrial action on 21 June over pension reforms that would see them working until they're 68 and paying twice as much in contributions as other public sector staff on a similar pay-grade, for the same eventual pension.
The majority of GPs, consultants, junior doctors, staff, associate specialists and specialty doctors as well as public health and community health doctors who voted in last month’s ballot said they were even prepared to go on strike, but the British Medical Association has ruled that out: ‘doctors will ensure that patient safety is protected’ on the day by continuing to supply urgent and emergency care, only postponing non-urgent cases.
The Health and Social Care Bill has now passed, largely unchanged, through the report stage in the House of Lords, and on Tuesday survived by 314 votes to 260 a Labour motion in the House of Commons to scrap it. Despite widespread opposition from doctors, nurses, other NHS workers and the general public, the NHS 'reforms' that prioritise competition over quality of care look set to be implemented. It’s tempting to point the finger of blame at the Lib Dems.
It’s increasingly hard to find anyone apart from Andrew Lansley and David Cameron who supports the Health and Social Care Bill. Most doctors, nurses and other NHS workers are against it. A Cambridgeshire GP who used to be the vice-chairman of his local CCG and an enthusiastic supporter of the reforms has written in the BMJ that GPs were 'duped' and the bill will 'wreck the NHS'.
Andrew Lansley’s Health and Social Care Bill, due to return to the Lords next month, is looking less and less well. A poll of more than 2500 GPs carried out by the RCGP found that 98 per cent were in favour of rejecting the bill if the other Royal Colleges agreed. When Ed Miliband challenged David Cameron with these figures on Wednesday, the prime minister responded by claiming the reforms were not only supported but being implemented by one Dr Greg Conner, a GP from Miliband's Doncaster constituency. A spokesman for Doncaster Primary Care Trust later told GP newspaper that ‘Dr Conner was no longer chairman of the Doncaster clinical commissiong group and he had in fact left the area.’
The Health and Social Care Bill was passed in the House of Commons yesterday by 316 votes to 251. Before the vote, during Prime Minister’s Questions, David Cameron said: We now see the Royal College of General Practitioners, the Royal College of Physicians and the Royal College of Nursing all supporting our health reforms. He may see it, but that doesn't mean it's true. On Monday, the deputy chairman of the General Practitioners Committee said: The BMA is very clear – the majority of doctors have serious concerns with the Health Bill. We want to improve the NHS, but a wholesale review of the current plan is needed, which is why we are calling for it to be withdrawn.
The blog received its first slice of healthcare privatisation spam last night:
Perhaps David Cameron was worried about the dissonance between his pre-election pledge to put an end to top-down reorganisations of the NHS and the post-election labelling of his government’s proposed changes as the biggest reorganisation that the service has ever seen. Perhaps Nick Clegg was unhappy that two months after the key Lib Dem health policy – elected representatives on Primary Care Trusts – was written into the coalition agreement, he was being asked to support the abolition of the PCTs. Who knows, but they must have been pretty unhappy with the politics of NHS reform to have ordered a pause in the progress of the bill to allow for a ‘listening exercise’.
Doctors are not going to go on strike in protest against the health bill. At the BMA special representative meeting in London on Tuesday, 54 per cent voted against a motion to reject the health bill ‘in its entirety’ in favour of continuing the current policy of ‘critical engagement’ with the government. A vote of no confidence in the health secretary, Andrew Lansley, also failed to pass.
Dr Roy Macgregor isn’t the only GP with severe doubts about the merits of the health bill going through Parliament. According to a survey carried out by the doctors’ newspaper Pulse, more than half of GPs have no confidence in the health secretary, Andrew Lansley. Meanwhile, a poll at GPonline is showing that 65 per cent of the profession think GPs should take industrial action against the proposed reforms. So much for the government’s claims that there is ‘overwhelming enthusiasm’ for their plans among GPs.
The popular view of the National Institute for Health and Clinical Excellence (NICE) is that it’s a mean, penny-pinching government watchdog set up by Labour to denysick peopleaccess tolife-saving drugs. So the news that the government will be stripping NICE of its power to determine which new drugs should be available on the NHS has been broadly welcomed. NICE wasn't expecting the move, though perhaps it should have been. The Daily Mail, predictably enough, is ecstatic, claiming a ‘victory for patients’ and heralding an end to ‘the ordeal of tens of thousands of patients being denied life-extending drugs every year’. Avastin all round! Except that just because NICE won’t be responsible for drug rationing from 2014, that doesn’t mean rationing will go away.