Politics

Jeremy Hunt’s NHS: For Corporations Or Patients?

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“A week is a long time in politics” pontificated Harold Wilson. Allegedly. The same could well be said for the past seven-days in the NHS; so much has occurred, especially surrounding the junior doctors, if you blinked you may have well missed it. But the overall thrust? Another week, another example of the disregard by Jeremy Hunt for us, the patients.

Talks resumed between the British Medical Association (BMA) and the Department of Health (DoH) over the controversial junior doctors contract on Monday, signalling an apparent, if somewhat modest, thawing of relations in what has been an historic period of protracted industrial action for the NHS.

With neither the Government nor the BMA issuing statements surrounding the talks, ACAS chief Sir Brendan Barber said the negotiations were “highly intensive” but had been conducted in “a positive and constructive atmosphere, (where) some real progress had been made to address outstanding issues. However, he felt “that a limited amount of additional time would be needed to give the process a chance of reaching a successful conclusion” and “that the talks should be continued up until next Wednesday”.

All of this is highly non-committal from Barber, and gives no real indication of the nature or success of the negotiations. What we do know, crucially, in this is that any contract offer will be put to the junior doctors in the form of a referendum – so even if the BMA considers the outcome of talks successful, it will be down to the frontline staff to ultimately agree. Or not.

But in a speech on Saturday, the BMA junior doctors section chair Dr Johann Malawana said that a “more conciliatory tone” had been struck, and that “our attitude in these negotiations has been not to trade grievances but to resolve them… (the) aim has been to rediscover the common ground that is so great but so easily neglected – the shared interest of everyone in the health service to improve care for our patients.”

Commendable words from Dr Malawana, but whether the paramount interests of the DoH and Jeremy Hunt are the NHS’ patients remains to be seen.

This is most apparent when viewed through the prism of a Public Accounts Select Committee (PAC) meeting, which also took place this week.

Questioning took place over the “Clinical Supply of Staffing in the NHS” – and as the excellent Dr Ben White tweeted, its conclusions painted a decidedly bleak picture.

This damning evidence about the current and future state of the NHS workforce is most profound when juxtaposed with the fundamental premise of a seven-day NHS – which the PAC found to be, in layman’s terms, hokum.

Chair Meg Hillier slammed the DoH and NHS England plans, saying:

Taxpayers are being asked to accept uncosted plans for a seven-day NHS – plans which therefore present a further serious risk to public money. It beggars belief that such a major policy should be advanced with so flimsy a notion of how it will be funded – namely, from money earmarked to cover all additional spending in the NHS to the end of the decade. Taxpayers are entitled to ask questions about the financial security of the NHS and the level of service it is able to provide both now and in the future.

To those following the saga of the Conservative Government’s plans, this will come as no surprise. As I reported previously:

There is also the matter of a Guardian expose from February this year. The article, based on a leaked Department of Health report, shows that a “7-day NHS” may not have any impact on weekend mortality rates. The DoH report “Seven-day NHS – update on progress and plans”, from January, says that it will cost an additional £900m to fund Hunt’s plans after taking out the “benefits such as reduced length of stay and reduction admissions”.

So, while the junior doctors have the public’s best interests at the forefront of everything they do, whether the same can be said for the government is, at best, debatable. To put forward such plans without even costing them is, at best, catastrophically bad mismanagement from the government – and throws into question the whole premise of the scheme.

Furthermore, more revelations surrounding the seven-day NHS plans emerged – namely that Jeremy Hunt, the DoH and NHS England has been “selective” to say the least with the data and consultations they chose to shore-up their arguments for the reforms.

Two separate academic studies, by Oxford and Manchester Universities, concluded that the evidence surrounding increased weekend mortality was fundamentally flawed.

The report from the former by Professor Peter Rothwell stipulates that the claimed difference between weekday and weekend mortality rates is based on errors in the recording of hospital admissions. It shows that over a third of Monday to Friday admissions classified as a stroke were actually routine, low risk, procedures. Furthermore, it argues this applies to a ‘range of conditions’ and without the mistakes there is no ‘weekend effect’. This echoes similar conclusions by Manchester university.

Speaking to Scisco Media, Dr Ben White said:

The government have ‘cherry picked’ data to suit a political agenda, when there are far more methodologically-sound studies (around 20), which indicate that the weekend effect is not actually real. The increasing evidence leads to the conclusion that the government has systematically misled the British public and endangered lives. It is time for an independent inquiry.

Many may argue that there needs to be any independent inquiry into the NHS more broadly – and looking at the other news from the past week, you may see why.

In a meeting of the Health Select Committee last Monday, Jeremy Hunt was grilled for several hours over numerous topics, but one stood out from all the rest – his comments on social care.

As The Canary reported, Mr Hunt quite openly said the the current crisis in social care for the elderly was “one of the biggest commercial opportunities” for private firms.

Couple this with the news that the founder of the “Leave.EU” campaign in the referendum has openly stated he would like the NHS privatised – and to say that the vultures are circling around the carcass of an intentionally underfunded NHS may not be as hyperbolic as it first appears.

But perhaps the most important piece of news (that hasn’t actually been reported) is the update surrounding the “Justice for Health” legal challenge to the contract as a whole; news which no-other media was interested in covering – but could actually still put the kibosh on the contract.

In a letter from the group’s legal team, it is made clear that Jeremy Hunt’s position and his dogmatic imposition may well still be illegal.

Giving the Secretary of State’s legal team one last opportunity to rectify his position before the court hearing commencing on the 8 June, it clearly outlines every instance when Hunt has declared that he will be imposing or introducing the new contract, which the Justice for Health Group claim he has no legal power to do.

One such instance was in a speech to the King’s Fund in July of last year, where he specifically said “if we can’t negotiate, we are ready to impose a new contract”.

Furthermore, it cites three instances of records in the House of Commons Hansard library where Mr Hunt has specifically said he will “introduce” or “implement” the new contract, and a letter from NHS Employers to all junior doctors stating that “The Secretary of State has decided that the NHS must now introduce a new contract, without the agreement of the BMA, from 2016”.

This tallies with evidence from the Government’s Legal Department (GLD) and the NHS Confederation, also alluding to the fact that Hunt has the legal power to force the new contract through – but (and crucially) flies in the face of a letter sent from the GLD to the Justice for Health group’s solicitors:

We understand from your letter of 15 April 2016 that the Secretary of State is (in that letter at least) asserting that he was not “imposing the junior doctors’ contract” but merely taking a lead role in negotiations and discussions between NHS Employers and the BMA. Further, that the Secretary of State is entitled to approve the terms of model national contracts for among others junior doctors and “to take steps leading to the introduction of model national contracts by the various employers”.

This is crucial, as the semantics surrounding this could ultimately throw the position of the whole contract into question – as the BMA’s suspension of talks and the ensuing industrial action have been rooted in the fact that an “imposition” was taking place. Furthermore he may well have misled parliament – a legal problem for him – and the BMA, the junior doctors and the public more broadly – a moral problem for him. The latter is probably less of a concern for Mr Hunt, however.

You’d be forgiven for not keeping up with all of the NHS-related news that has emerged in the past week. But, in essence, we have quietly seen a further decimation of the arguments surrounding the junior doctors contract and the proposals for a seven-day NHS, coupled with stark indicators of the future of our health service if this government continues on its current trajectory.

Incidentally, it was also the weekend of the BMA’s junior doctor conference.

In an eloquent and touching column for the Independent, Dr Roshana Mehdian notes that at the conference “I have spoken to so many junior doctors today who told me they had never been to one of these conferences, nor been involved with these sorts of discussions at national levels, yet felt compelled to get involved this year. In the face of everything it is surprisingly buoyant and optimistic”.

Her last statement is crucial.

While the NHS faces its most difficult challenges in decades, possibly in its lifetime, the resolve of the junior doctors and all other staff within the service is to be commended – and duly noted.

Amid a constant stream of often negative news it is easy to get complacent and downtrodden about the continued fight for its survival. But the only way it will survive is if we follow the lead of the junior doctors and we, as a society, remain firmly steadfast but optimistic.

It is, after all, our NHS.

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Steve Topple is an independent journalist, and political and social commentator. Covering a varying range of topics from domestic politics, economics and social/ethnological issues to the Middle East, Europe and Russia, via pop culture and music/literary reviews – his opinions have been cited as “ultra-left and sectarian” by Owen Jones, while many consider him a firebrand of the freelance world, with an acerbic tongue and no-nonsense style. Permanently based at The Canary Says as a contributing writer, he is also UK Political Editor for newly-established Scisco Media and has a weekly Op-Ed column with the CommonSpace. He frequently contributes for the Independent and openDemocracy, has written for the Morning Star, Red Pepper, Occupy and INSURGEIntel amongst others, and can be seen on television as a regular commentator on Russia Today UK and Al Jazeera and heard on Sputnik International Radio and Talk Radio Europe. His "home" is at Consented where he is resident, publishing his analysis of Prime Minister's Questions every Wednesday along with frequent longform and opinion pieces and contributions to their TV channel. Commissions are welcomed on any subject and in any format.

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