Proof that government complacency in the face of an escalating NHS crisis knows no bounds, and that BBC (and many other) journalists are woefully ill-informed was displayed on BBC Radio 4’s Today programme on April 6.
As the so-called “health and care levy” took effect, a Sajid Javid interview followed on a grim account of the reality on the ground from a care home operator, who did not mince his words.
He said that while the additional funding to cope with the pandemic has now ended, care homes were still grappling with the increased costs of Covid, and would now have to pay for tests. On top of this the National Insurance increase will cost his business £44,000 per year, and bills are soaring for energy and food, while local authorities lacked the funding to pay any increased fees.
He warned the situation is “a perfect storm” for social care, after the sector has been “underfunded for three decades,” and was now “the worst I have ever known.” He went on to argue that the £5 billion to flow over three years to social care from the ‘health and care levy’ was too little and too late, with care homes likely to fail in the next few months. Social care was still very much the poor relation: he favoured a merger of health and social care into one system.
Cue Sajid Javid, speaking from the “New QE2 Hospital” in Welwyn Garden City – which turns out to be a £30m rebuild on the old hospital site that once had 257 acute beds and 54 maternity beds, but now has no beds at all, and serves only as an over-priced “outpatient and diagnostic hospital, which also has a 24/7 urgent care centre.”
Nothing could dent Javid’s chirpy complacency as he parroted the glib assertions from the government press releases (which have been uncritically regurgitated by ill-informed journalists in newspapers and broadcast outlets as far afield as Glasgow.) In fairness to him, he was never pressed at all hard by interviewer Mishal Husain, who clearly had no useful information in front of her to enable her to ask a challenging question.
One obvious question that should have been asked is how much is actually to be raised by the levy, and how is it being spent. According to Javid and the press releases, the levy has mysteriously grown from £36bn when it was announced last September to £39bn today. There is no explanation of how this has happened.
But we do know that out of the initial £36bn, £6bn was set aside for devolved governments in Edinburgh, Cardiff and Belfast. Javid of course is only health and social care secretary for England. So for him to claim either £39bn or £36bn is available is deceptive.
We also know that £9bn has been allocated to the Department of Health & Social Care to cover various non-NHS ‘health’ budgets – although where this money is supposed to go has not been clearly explained.
This left £21bn (or £24bn out of £39bn) – over three years – to be divided up between the NHS and social care, with NHS England initially allocated three quarters (£15.6bn, £5.2bn per year) and social care the rest £5.4bn (£1.8bn per year).
By most standards this sounds like a lot of money: but after a relentless decade of frozen or falling real terms funding for the NHS, and cutbacks in social care budgets, it’s nowhere near enough to deliver all the promised improvements rattled off by Javid. Social care once again gets an especially raw deal: Stephen Chandler, president of the Association of Directors of Adult Social Services, has warned that only two per cent of the funding to be raised by the levy will go to pay for social care.
To make matters worse, the allocations were fixed before the massive spike in inflation, which is set to rise to 8% or more. This will slash the real value of the levy. The National Insurance rise will also hit both NHS employers and NHS staff, whose quite reasonable demand for an inflation-beating pay increase has been brutally rebuffed by Javid’s Department as well as the Treasury – raising fresh questions on the ability of the NHS to retain existing staff as well as recruit new ones.
Javid glibly claimed that the levy comes “on top of the extra funding and support during the pandemic” – but he was not reminded that all of the extra Covid funding stopped on April 1, along with free testing, while Covid is still very much alive. The costs and disruption for the NHS continue with over 300 people per day dying of, or with Covid, and over 16,000 frontline beds filled with Covid patients (April 8).
Mishal Husain did not question Javid’s assertion that the NHS was being given “the biggest catch-up fund in history” – though she could have pointed out that Tory governments since 2010 have also created the biggest NHS waiting list in history, the worst-ever delays in cancer treatment, the biggest backlog maintenance bill in history, and reduced England’s NHS to the lowest provision of hospital beds of almost any comparable country, making any “catch-up” almost impossible.
She appeared unaware that the NHS England Delivery Plan does not aim to end waits of more than a year for treatment until 2025, or waits of over 65 weeks until March 2024. It only aims to restore cancer waiting times to the unacceptable level they were before the pandemic, when the 62-day target to start cancer treatment had not been hit for six years, and more than one in five waited more than two months for their first treatment.
As Javid rolled out extraordinary and quite implausible claims of what the levy would pay for in the NHS (somehow “raising activity levels to 130% of pre-pandemic levels … at least 9 million additional scans and procedures …) Husain did at least ask him who would deliver these services, given the 100,000-plus (in fact 110,000) vacant posts in England. The same point has been raised specifically on the plans for a massive, belated, expansion of diagnostic services in “community diagnostic centres”.
However Javid simply switched gear to dodge the issue, rattling on about the “fantastic” NHS workforce which he claimed was at its “highest level ever” with more doctors and “more nurses than ever.”
These generalisations completely ignore the increased population, and the services and departments under strain. 40,000 of the vacant posts are for nursing staff – with mental health nursing having by far the greatest vacancy rates ranging from 12% to almost 22% in the south east: indeed while overall nurse numbers have increased, there are still fewer mental health nurses than there were in 2010. Overall staff numbers also ignore the continued high level of NHS staff sickness due to Covid, with 67,000 off at the end of January.
Husain did briefly try to get Javid to address the real world when she challenged the government’s refusal to accept an amendment to the Health and Care Bill backed by former Tory ministers and over 100 organisations, requiring the government to publish, every two years, independent assessments of required health, social care and public health workforce numbers for England for the following five, 10 and 20 years. She did not appear to be aware that the NHS has no money allocated to implement any expansion of the workforce.
But Javid would not be deflected from the PR notes he had been handed. He ignored the question and instead boasted proudly that after twelve years of Tory governments he had just asked NHS England to draw up the “first ever workforce strategy”. The obvious question as to why this had not been done by this or previous governments was not asked: Husain, bombarded by irrelevant facts and misleading claims, and lacking any equivalent brief from BBC researchers to equip her with the facts, seemed to have given up the will to live.
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