In the month since our last issue was published we have seen the appointment of Boris Johnson as Prime Minister after a vote by Tory Party members, and the formation of a new cabinet composed only of ministers willing to toe the Johnson line, whatever that might be. Among them is Health and Social Care Secretary Matt Hancock.
There has also been a change in advisors shaping the decisions of the new PM, chief among them being Dominic Cummings, who orchestrated the Vote Leave referendum campaign. Johnson’s health advisor is former McKinsey man Will Warr, who has little if any background in health, but nonetheless argues “more money is not the solution” to transforming the “hopelessly ill-equipped” NHS from “the monolith we have today,” and is even more fanatical than Matt Hancock about the use of technology and apps to replace health care as we know it.
Soon after selecting his cabinet Johnson began making announcements about the NHS which have proved to be misleading. In early August news media trumpeted the story that he had “announced a one-off cash boost of £1.8 billion for NHS hospitals in England – about a tenth of the extra £350m a week the Leave campaign and the famous bus promised would flow to the NHS after Brexit.
The BBC and others loyally repeated the government claims that this was “money coming from the Treasury, and is not a reallocation of funds from the Department of Health”.
The Sunday Times more accurately described the purpose behind Johnson’s new policy as seeking to win electoral support, headlining “Boris Johnson drops £2bn NHS ‘cash bomb’ to woo female voters.”
But within hours this story started to unravel: just £850m could be claimed to be extra spending, and this is far less than the billions that have been squeezed out of hospital budgets in so-called savings in recent years.
The day after Johnson’s announcement, Nuffield Trust analyst Sally Gainsbury, who had immediately questioned the “new money” on Twitter, explained in the Guardian how the better-placed trusts had been persuaded to cut back on spending and run surpluses to help cover deficits elsewhere, and promised this would mean they could spend extra money on capital investment:
“Then came the catch. The Department of Health was happy to bank the trust efficiency savings …. But when it came to trusts actually spending the cash they had earned through the scheme, the department realised it would bump into the Treasury’s cap on investment spending.”
As recently as July NHS England wrote to trusts demanding further cuts, reducing their capital spending plans for this year by 20% – equivalent to about £1bn.
As a result, Gainsbury argues: “For this year at least, what the prime minister’s announcement really means is simply reversing the broken promise made to trusts when they cut their costs in return for cash they were told they could spend.”
That same day Chris Hopson, the chief executive of NHS Providers, the membership organisation for NHS trusts, agreed that health think tanks were partly right to argue more than half of the money was not new: “some of the extra 2019-20 capital expenditure enabled by this announcement will be funded through cash surpluses currently sitting on provider balance sheets. That spending can legitimately be described as money that trusts already had, but were told they couldn’t spend and are now able to spend.”
Whether or not the money is new, it’s also only a fraction of what it would really cost to upgrade 20 hospitals, according to Nuffield Trust boss Nigel Edwards, who described the money as “a welcome down payment on the staggering £6 billion needed to clear the backlog of NHS maintenance.”
The scale of the problem is underlined by the news as this article is written that two NHS trusts have had to close 170 beds, and in one case ensure hourly fire inspections because of unresolved fire safety issues requiring capital spending.
Shadow Health Secretary Jonathan Ashworth was not only critical of the amount on offer but sceptical, pointing out that since 2017, 145 new spending schemes for hospital beds, buildings, medical equipment and information technology have been announced, totalling £2.5bn: but only 3 percent (less than £100m) of these schemes had actually been delivered. ‘We will see if this money is ever delivered.’
Anita Charlesworth of the Health Foundation criticised Johnson’s approach from a different angle, arguing that “the NHS urgently needs money to upgrade facilities. But capital investment must be driven by what patients need, and as part of a coherent strategy — not piecemeal announcements that make good headlines.”
With debate still raging over the bigger announcement, Johnson followed up with another swiftly discredited, but much smaller promise, of an “extra” £25m for hospices on August 20, which was shown the next day by the HSJ not to be new money at all.
Three days later Johnson was again keen to cash in on the NHS as a vote-winner, making sure pictures of him with celebrity chef Prue Leith were linked with the re-announcement of the review of hospital food that had been set rolling by Matt Hancock in June after patients died of listeria after eating infected sandwiches. Johnson further alarmed cardiologists with the suggestion of feeding patients “hot buttered toast”.
The Daily Mail swiftly afterwards revealed that Leith’s son Danny Kruger is Johnson’s secretary and fixer in Downing Street, while other news media looked back at the £50m-plus wasted on various previous headline-grabbing efforts to enlist celebrity chefs to help improve hospital food, all of which have foundered on chronically low funding per meal and the lack of hospital kitchens.
So if we can’t trust Johnson to speak the truth on relatively small sums of money or deal seriously with problems of hospital catering, can we rely on his commitment, or those of his ministers not to include the NHS in trade talks with the USA after Brexit?
And what does his henchman Jacob Rees Mogg mean when he says on Radio 4 that the government will “bring forward legislation on the NHS”?
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