Wes Streeting’s new package of “reforms” seems set to deepen inequalities in health and access to health care. It includes a return to ‘league tables’ to rank trust performance, threats to cut pay or sack senior management in struggling trusts, and incentives for those who are already doing well.
This approach is not new or clever. As Lowdown has warned, Streeting is revisiting policies and bringing back people who have failed and been discarded in the past.
The appointment of former New Labour Health Secretary Alan Milburn as ‘lead non-executive member’ to the board of the Department of Health and Social Care has dredged back up a failed politician. Milburn saddled the NHS with two decades and more of paying inflated bills for extravagant Private Finance Initiative-funded hospitals, a costly and wasteful “market” apparatus, and a plethora of contracts for private providers before he went off to make millions in the private sector.
The DHSC press release on Streeting’s latest plans (revealed months ahead of any findings from the much-vaunted appeal for the public’s views on the way forward for the NHS) was headlined ‘Zero tolerance for failure under package of tough NHS reforms.’
It is packed with tough-sounding rhetoric, promising a “no holds barred sweeping review of NHS performance across the entire country”. Streeting insists there will be “no more turning a blind eye to failure,” and asserts “We will drive the health service to improve.”
Of course, the wielding of the big stick involves the token brandishing of the occasional carrot: while hit squad ‘Turnaround teams’ will be “sent into struggling hospitals,” the “best performers” are promised “greater freedoms” over funding to modernise technology and equipment.
This is a reminder of the “star ratings” system ranking trusts under New Labour and of Milburn’s other pet project: changing the law to establish Foundation Trusts, separating trusts with the strongest finances from the rest and freeing them from any accountability to local, regional, or national NHS structures—or ministers.
The full autonomy Milburn initially hoped to give FTs was reined back, not least by Treasury reluctance to allow Foundation Trusts to borrow from the private sector and by almost all FT management prudently making no attempt to set their own local pay scales. Subsequent dire financial pressures that have pushed many FTs into deficits alongside common or garden NHS trusts have largely broken down this independence, with many needing financial support.
Exactly how the proposed system of turnaround and rewards might work out, given the continued tight limits on funding after an inadequate increase in last month’s Budget, is, of course, not explained.
Failing trusts and Integrated Care Boards are generally failing because of historic underfunding or higher local levels of ill-health. A quarter of the 42 ICBs are already subject to a turnaround regime, the latest to be put on the naughty step being Norfolk and Waveney ICB, chaired by former New Labour Health Secretary Patricia Hewitt, formerly a management consultant with Anderson Consulting (now Accenture).
Sending ‘turnaround teams’ into every failing trust will inevitably have a substantial cost attached, since most, if not all, of the teams will come (at considerable expense) from the big management consultancy firms that have failed for so many years to deliver real improvements in trust finances or performance.
So it’s not clear where the funding for any “greater freedoms” for already well-financed and better-performing trusts might come from or how struggling trusts can afford the fees for turnaround teams or be lifted higher in league tables, which will inevitably have a relegation zone as well as a top tier.
How are patients supposed to respond to finding their local hospital rated bottom of the league? Will they be reassured to find the existing local management has had their pay cut or been summarily sacked and replaced by some externally appointed stooge—possibly from McKinsey—whose main claim to fame is their lack of any local accountability and their willingness to cut and cut again to balance the books?
Subsequent warnings from bodies representing NHS management underline just how unlikely these new plans are to deliver. They will add an extra burden to senior managers, who are often already desperate.
Almost all NHS trust leaders in England (96 per cent) have told NHS Providers they are ‘extremely’ or ‘moderately’ concerned about the impact of seasonal pressures over winter on their trust and the local area. The most common concerns were financial constraints and staffing provisions.
The survey shows trust leaders believe the top three greatest risks to the provision of high-quality patient care over winter were delayed discharge (57%), social care capacity (49%), and acute bed capacity (43%). The previous government ignored these problems, and they appear not to have been a priority since Labour took office. However, unless these issues are tackled, the promised reductions in the waiting list cannot be delivered.
As many trusts and Integrated Care Boards contemplate measures to cut staffing to balance the books, over half of trust leaders (57%) already rate their current quality of healthcare as average (41%), low (12%), or very low (4%). Much less than half of trust leaders(41%) predicted that the quality of healthcare provided would be ‘very high’ or ‘high’ in the coming two years.
A massive 85% of trust leaders said it is ‘very likely’ (34%) or ‘likely’ (51%) that their trust would have to ‘reconfigure’ services, which often amounts to cutbacks and closures, to manage or improve its financial position.
Moreover, nearly three-quarters of trust leaders (71%)—including 100% of leaders from acute specialist and ambulance trusts—said it is ‘very unlikely’ or ‘unlikely’ that the NHS can meet ‘constitutional standards’ over the next five years. The NHS Constitution, together with its handbook, includes maximum waiting times for elective and emergency care. Wes Streeting has promised to restore the 18-week maximum wait for elective care and 4-hour maximum wait in A&E in Labour’s first term.
So far, there is little to suggest Labour has made any real difference. The most recent figures show a 70,000 (less than 1 percent) drop in the waiting list from 7.64 million to 7.57m, while the number of people attending A&E increased to a new record level for October, 6 percent above the previous highest.
Rory Deighton, acute director of the other main body representing NHS providers, the NHS Confederation, warned that this record demand: “comes after the busiest summer and September on record, so it is very concerning that the health service is running so hot ahead of what is expected to be another very difficult winter.” And worse: “… with record numbers of patients who often have multiple or more complex conditions there is a real risk services could become overwhelmed and fall into crisis.”
Meanwhile, the other developing crisis could shoot down Wes Streeting’s pre-election promise to “bring back the family doctor.” Despite this brave promise, he has stubbornly refused to settle the bitter dispute with GPs over the inadequate funding increase for local GP practices in 2024/25 that is still unresolved, and GPs have conspicuously been excluded from the exemption from the Budget increase in employers’ National Insurance payments.
Streeting has rubbed extra salt in the wounds by arguing that GP are “not formally part of the NHS.” This is in stark contrast to his speech to the Royal College of General Practitioners in October, in which he outlined the vital role of GPs as the ‘front door of the NHS’, and wound up with a call for “every part of the NHS to pull together as one team with one purpose: To be the generation that took the NHS from the worst crisis in its history, got it back on its feet and made it fit for the future.”
Oxford GP Helen Salisbury has summed up the reaction of many GPs to the extra bills dumped onto GPs by Rachel Reeves: “There is deep disappointment and a feeling of betrayal now, with doctors divided as to whether this blow to our practices is deliberate harm or just incompetence.”
She warns that “It is possible that the government will find some way to compensate for this expense, but it is unlikely that this will make good the damage to trust and goodwill inflicted by this budget.”
This latest additional pressure on already overstretched and understaffed GP practices is likely to accelerate the departure of younger GPs and the early retirements of older GPs and increase rather than resolve the problem of GP unemployment.
This, in turn, makes it more difficult to speed patients’ discharge from hospital beds and reduce the number attending A&E.
As the weather gets colder, almost nine in ten A&E doctors who responded to a survey by The Royal College of Emergency Medicine say they aren’t confident that their departments will cope well this winter. Even more, 94% of them think that patients are being put at risk due to the pressures currently being experienced. Just last month, 162,931 people in England alone endured trolley waits of longer than 12 hours in an A&E department.
It seems that rather than heeding the warnings from the overwhelming majority of top managers and professionals, Wes Streeting is set to make matters worse rather than deliver on his promises.
‘Unlikely’ that NHS will meet 18-week waiting time target, say trust leaders
Published: 12/11/2024 by Radio NewsHub
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