It’s a close-run thing when Chancellor Rishi ‘The Brand’ Sunak and NHS England/Improvement (in Julian Patterson’s excellent formulation, NHS Engroovement) contend with each other for the week’s least reality-based statement, in an optimism-off.
NHS Engroovement issued updated guidance for winter. There is a new bit, which is daily reporting of capacity unavailable due to infection prevention and control measures. As well as D&V/Norovirus closures, the top of the office now wants dailies on Covid19, RSV and lab-confirmed flu. While this is new, that’s not the stupid bit.
The organisation that runs the NHS in England this week sent out a letter (promptly leaked to HSJ) saying that ambulance handover delays had to stop immediately: “we are now asking you to work together as a system and agree what actions you would need to take to immediately stop all delays. We appreciate that this may involve some difficult choices, and that we will need to discuss and involve colleagues, including the Care Quality Commission, where helpful.
“Today we also are asking trusts and their systems to report the actions that they have put in place to ensure delays have been eliminated in all board meetings, taking time to discuss the challenges with data to support the issue”.
The letter also describes “corridor care” as “unacceptable as a solution”, and says ambulances should not be used as “additional ED cubicles”.
It seems that NHS Engroovement’s new approach is to use Jay and Lynn’s ‘The Politician’s Logic’:
1. Something must be done.
2. This is something.
3. Therefore we must do it.
There is no iota of a clue how this is to be achieved. The notion that ‘A&E arrival lounges’ will solve the problem is pure displacement activity, both literally and metaphorically. It’s like Facebook rebranding itself as Meta, and thinking it’ll make any difference.
What fun it is to welcome back our old policy friend, the ‘And Then A Miracle Happens’ approach to healthcare.
Having promised in the media run-up that this budget would “usher in a new age of optimism”, Mr Sunak’s Budget speech described how “the health capital budget will be the largest since 2010 … 40 new hospitals; 70 hospital upgrades; more operating theatres to tackle the backlog; and 100 community diagnostic centres, all staffed by a bigger, better-trained workforce, with 50,000 more nurses and 50 million more primary care appointments”.
There are, of course, no 40 new hospitals. Neither, of course, is there any workforce plan worthy of the name.
Mr Sunak goes on, “we have taken some corrective action to fund the NHS and get our debt under control, but as we look towards the future I want to say this simple thing to the House and the British people: my goal is to reduce taxes”. Yet it is clear from analysis by the Office for Budget Responsibility, the Institute for Fiscal Studies and the Resolution Foundation that the national direction of travel is towards higher taxes.
IFS director Paul Johnson observed “health spending was topped up again, partly because of a higher inflation forecast, and partly because the OBR expects the health and care levy is to raise a couple of billion more than the Treasury thought last month. The latter is a nonsense. We can be sure of two things. The amount the NHS needs is entirely unrelated to how much the levy will raise. And NHS funding would not have been cut if revenues had moved in the other direction”.
The Johnson you can trust concluded that “Mr Sunak has bowed to the demands created by public services which have suffered a decade of cuts, and to the inevitability of increased spending on the NHS”.
Mr Sunak’s failure to fund a workforce plan was noted by the Kings Fund and Health Foundation, with the Nuffield Trust reviewing progress to date towards workforce targets. As ever, Isabel Hardman hits the reality-based nail squarely on the head in her i column. It is also vital to read Andrew Rawnsley’s excellent analysis of the fiscal consequences of our low economic growth in the decade of austerity.
In the middle of Mr Sunak’s fiscal drag act of a Budget, smart observers such as HSJ noted that the key determinant of NHS progress – workforce staffing and training budgets – remained pointedly un-addressed. Hey-ho.
Tackling the backlog
In his first appearance before the Health And Social Care Select Committee, on Tuesday 2 November, 11.00, Secretary of State for Health and Social Care Sajid Javid will be questioned on his main priorities to clear the backlog of cases caused by the pandemic.
Get your popcorn in now.
On this subject, the Independent Healthcare Providers’ Network’s letter to Sajid Javid about spare and NHS-unused private sector provider capacity was leaked to the Telegraph. The article, by Telegraph Sunday political editor Edward Malnick, contends, contends that “the overall number of daily admissions of NHS patients to private hospitals was seven per cent lower compared with two years ago, having dropped from 2,327 per day to 2,166”.
That’s jolly interesting, as far as it goes.
What it isn't, however, is proof that the independent provider sector has that spare capacity. An actual journalist might have asked that question
The ISPN letter also claims that “despite the welcome introduction of confirmed funding for the second half of 2021/22 to deliver higher levels of activity, many NHS systems are struggling to meet the challenge of achieving higher utilisation of independent sector capacity.
“This means that every day, staffed independent sector capacity which could be made available to treat NHS patients is going unused”. Once again, it’s an assertion, unsupported by evidence.
My scepticism here is driven by the high-profile 2015 claims made by the same body, that the independent sector was then freeing up capacity for 250,000 operations and diagnostic tests for the NHS to use. When NHS commissioners went to look for this alleged spare capacity at that time, however, they did not find it.
The Office for National Statistics’ latest survey concludes that 1,102,800 people in England had COVID-19 (95% credible interval: 1,043,900 to 1,161,200), equating to around 1 in 50 people.
The latest national surveillance report on flu and Covid19 from the UK Health Security Agency show that:
· Case rates were highest in those aged 10 to 19, with a weekly rate of 1201.2 per 100,000 population.
· The number of acute respiratory infection incidents (suspected outbreaks) in England was 583 in week 42, compared to 576 in the previous week.
· The hospital admission rate for week 42 was 8.44 per 100,000 population, in the previous week it was 7.50 per 100,000 population.
Robin McKie of The Guardian covers the confusion about the current picture well here. Cases may be falling, but there is also a half-term effect to consider.
The creaking system
Analysis of NHS Digital workforce data by the Liberal Democrats shared with The Guardian suggests that general practice is facing a workforce meltdown. The data on retirement trends “suggest that with 6,421 GPs aged 55 or over, on average almost every surgery in England could soon lose one of its doctors”, the piece suggests.
The urgency of tariff reform was highlighted by a cross-party letter shown to The Times regarding the perverse incentive of providers being paid per radiotherapy session.
The focus on GPs took an interesting turn, with this report in The Times suggesting that the Government has U-turned on its plans for a monthly league table of GP practices’ appointments broken down as to face-to-face versus digital.
The Anaesthetics National Recruitment Office seems to be making some spectacular errors in its allocation of training places, according to reports on social media.
The Telegraph’s Sarah Newey highlights analysts’ concerns about the coming flu season may have “severe” consequences.
Cronyvirus and Coronamillions update
Further to the Immensa Health Clinic laboratory failures over PCR test accuracy, The Independent’s Samuel Lovett has a story on the state of the laboratory. It highlights “the site’s chaotic working conditions, revealing how machines were poorly maintained, concerns over quality control dismissed and untrained staff regularly “left to their own devices”. Samples at the privately run Wolverhampton lab, owned by Immensa Health Clinic, were wrongly processed or cross-contaminated, leading to incorrect test results, while faulty air conditioning and fluctuating humidity levels within the site also led to spoiled tests, one source said.
“Another said that focus was placed on “quantity over quality”, with staff – many who had never worked in a lab before – under pressure from senior management officials to process as many tests as possible each day”.
The National Audit Office’s report into supply chain finance in the NHS as practiced by David-Cameron-advised Greensill Capital concludes of the Department for Health But Social Care’s approach “there is no evidence that the predicted benefits and savings from introducing supply chain finance into pharmacy reimbursement processes in 2013 were realised.
“The Department’s business case was approved by HM Treasury in December 2012. Based on advice provided by Lex Greensill, the Department assumed that the NHS could achieve savings of £100 million per year in pharmaceutical supplies through supply chain finance. The Department is unable to provide evidence of realised benefits”.
Mmmmmm. If not mmmmmmmmmmmmmmm.
Adjacent to the Cronyvirus/Coronamillions agenda, Open Democracy note that 2020 was the worst year yet for secrecy or refusal by Government to obey the law as regards the Freedom Of Information Act. Topically, the Good Law Project has won the first stage of its litigation against the Government’s actions using Signal and WhatsApp messagesin this regard.
Getting the Bill (Health and Social Care)
The Bill Committee is due to sit again tomorrow.
Other important things
Would appear here.
Recommended and required reading
The International Journal of Integrated Care publishes a key review by Richard Lewis and colleagues. ‘Integrated Care in England – what can we Learn from a Decade of National Pilot Programmes?’ concludes that “ while staff were generally positive about their achievements, pilots had mixed success especially in reducing unplanned hospital admissions. Common facilitators to achieving pilots’ objectives included effective senior leadership and shared values, simple interventions and additional funding. Barriers included short timescales, poor professional engagement, information and data sharing problems, and conflicts with changing national policy.
“There was little stable or shared understanding of what ‘integrated care’ meant resulting in different practices and priorities. An increasing focus on reducing unplanned hospital use among national sponsors created a mismatch in expectations between local and national actors … pilots in all three national programmes made some headway against their objectives but were limited in their impact on unplanned hospital admissions”.
Dr Tony Goldstone has updated his pensions calculator for the BMA. This issue of the taper tax and annual allowances is just not going away.
Nuffield Trust CE Nigel Edwards’ analysis of the Government’s NHS strategy for the BMJ is a bracing and spot-on read.
Professor David Oliver gets all the cheers for this piece for BMJ about the Onanists’ Gazette, AKA the Daily Mail.
Professor Colin Talbot’s blog on the Spending Review and the genre in general is a good read.