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Editorial Wednesday 5 June 2013: NHS Confederation Conference 2013 - a few 'before' thoughts

I'm on a train on the way to the 2013 version of the NHS Confederation Conference. I'm not going to do my traditional mega-write-up and keynote speech coverage.

I will do a write-up, but it will go only to the Health Policy Intelligence subscribers who have been amazingly patient given the halt of service since I was ill back in March-April.

I appreciate subscribers' support immensely: it costs £69 for a year's worth of fortnightly issues. Email andycowper@hotmail.com if you want to subscribe.

So in 2013, my writing from Confed for free consumption will be different and less.

The overall context is one of commissioners and the new system managers finding their feet - and providers feeling the strain.

The recent Kings Fund quarterly monitoring report, Monitor's quarterly report and the new FTN report all show A&E departments under significant, non-temporary strain.

We have a problem.

Jeremy 'Bellflinger' Hunt has a novel explanation: that the "disastrous" 2004 GP contract, and specifically its £6K loss of earnings for out-of-hours offshoring, has caused an A&E crisis in 2013.

It's a fascinating one. Hunt is not a stupid man, and knows that he needs an explanation of why the public service that everyone can still imagine themselves needing to use, which had record public approval ratings in 2010, is now in trouble.

His answer has been to blame the "disastrous" 2004 GP contract.

Yes, he said that out loud, in the real world.

Problems in A&E in 2013 were caused by GPs' new contract in 2004. Not by social care funding cuts; not by the cumulative impact of sicker older people; not by bed and workforce reductions; nor by The Nicholson Challenge (copyright Stephen Dorrell).


A time travel strategy of this kind suggests that Mr Hunt might secretly want to be the new Doctor Who.

It's got about the same intellectual plausibility as blaming New Labour's high public spending, light-touch financial regulation (both of which the PM backed in opposition) and decision to rescue banks that would otherwise have failed on the global financial crisis.

A few people probably do believe that New Labour was running the global economy and banking system, but they also probably think David Icke is the Messiah - to whom Nigel Farage is John The Baptist.

Hunt faces the dodgy builder issue of public confidence: it's a high-risk strategy going "cah, what cowboy put this NHS system in? Naah, gonna cost a fair bit to fix this, guv", when people are quite well aware that the coalition government has been in charge for over three years.

He also faces the public waking up to the fact that he, his party and the Lib Dems all voted for legislation which means he's got very limited powers to intervene in the NHS now problems are manifesting themselves.

(Hunt's time-lag 2004-2013 thesis does offer the fascinating possibility that we will see the impact of 'Liberating The NHS' between 2019 and 2022, though.)

Chairman Mal faces an interesting dilemma of tone, having backed Comrade Sir David so emphatically only for the Comrade-In-Chief to hand in his pliers.

The Comrade-In-Chief also faces the Blair dilemma of pre-announcing his departure with a long lead time. The impact on grip, or 'firm cuddle' as NHS England may want to rebrand it, will be interesting to observe.