Some time back, I predicted a fresh wave of assaults on the NHS based on reports I was seeing in the media and on statements coming from the mouth of the then-Health Secretary, Andrew Lansley. Unfortunately, I turned out to be correct in my analysis, as announcements of the closures of wards and even whole hospitals followed the very next day.
Lansley – just as the rest of his government colleagues are wont to do – telegraphed (excuse the pun) his intentions by orchestrating comments from the government and the press – in particular the Daily Telegraph – as a ‘softening-up’ exercise to get public opinion ready for his measures.
The Telegraph has already been documented as collaborating with private healthcare in order to sway public opinion in order to get the Health and Social Care Act passed, and without question it does exactly the same for a Department of Health run by people who are well-documented to have close financial links with the private healthcare industry.
Well, I’m seeing exactly the same kind of signs now, leading me to believe that Jeremy Hunt is planning a further, massive wave of assaults on NHS health provisions, involving a massive shift of resources to Tory heartlands as well as a rationalisation of remaining resources into specialist centres so that local hospitals and clinics can be cut back or closed.
Hunt wants to make his mark – to satisfy his ego, which is too big to allow him to be content with simply implementing reforms initiated by his predecessor, and also both in order to channel further funds to his friends and backers in private healthcare and to ensure that Tory voters do not feel the impact of the destruction of the NHS, so that they will continue to support the Conservative party.
I draw this conclusion from two things: the nature of coverage in the press, leading up to and after Hunt’s speech at this week’s party conference, on a close reading of the speech itself – whose full text you can see here, and a follow-up interview Hunt did with Andrew Neil on the BBC’s ‘The Daily Politics’. Here are the conclusions, and the reasons for them:
On 12 September, the Telegraph reported conclusions by the Royal College of Physicians that many NHS wards were ‘on the brink of collapse‘ and that a “radical reorganisation of the NHS is needed” that “may include shutting the worst-performing hospitals to expand care at better ones, with more staff coverage at nights and weekends“.
On 5 October, the Telegraph carried a story that wards in up to a fifth of hospitals face the axe as Accident & Emergency, children’s, geriatric and specialist wards are closed by health authorities seeking to save cost by concentrating care in a smaller number of centres. While the article covered some ‘fears’ of health campaigners, the balance of the article emphasises the idea that the move is necessary, will offer better healthcare and is backed by senior health professionals.
Yesterday, the Telegraph’s line was that the lack of consultants available at weekends puts patients’ lives at risk: “At most, four in 10 hospitals currently meet this “gold standard” [of consultants available at least 12 hours per day, every day]. Frequently smaller district general hospitals which have problems filling weekend rotas, fail to do so.” While the RCP, who commissioned the report, state that more consultants are needed to provide this cover, the thrust of the article is clearly aimed at supporting the idea of rationalisation into a smaller number of larger centres.
Now for the corresponding parts of Hunt’s speech. First, he attacks the size of the NHS – but leaves the comment hanging, not drawing any clear conclusion from his statement:
“The centralised structures that have run the NHS since 1948 make it famously the fifth largest organisation in the world, smaller than the Red Army but bigger than the Indian Railways.”
Then, later in the speech:
“So let me ask this: why are our survival rates from the big killer diseases still not the best in Europe? All of us know families who have lost a precious loved one sooner than expected. Those golden years snatched away by what is seen a cruel twist of fate.
But in truth many such tragedies are avoidable, much more avoidable than we think. We have the most admired health system in the world so we should surely be getting the best results.
We’ve made good progress in heart disease. But sadly our cancer survival rates are lower than the European average, deaths from liver disease are going up and we lose more people to respiratory diseases than anywhere else in the EU15.
If our mortality rates for the five major killer diseases were as good as the best in Europe, we would save 20,000 lives a year. 20,000 personal tragedies that we could be avoiding – but are not.”
It might not be immediately apparent, but this is Hunt setting the scene for rationalising the NHS into regional ‘centres of excellence’, with a focus on ‘major killer diseases’ and consultants available 24/7.
In his interview with Andrew Neil on The Daily Politics after his speech, Hunt applauded Lansley’s health reforms but went on to speak of the need to create new ‘structures’ and the need for those structures to deliver results on the major diseases. When Neil challenged him on the closures of A&E and labour wards, Hunt went on to elaborate:
“There are parts of the country where local doctor groups are saying they want to run services differently because they think they can get better outcomes for patients.”
Hunt’s thinking is obvious. Local health authorities in places like Manchester are making to close local facilities and consolidate them into one central provision. These are currently independent decisions being made by local health authorities in response to the massive cuts being imposed across the country – but Hunt intends to make his mark by making such measures national government policy. The right-wing press has already been briefed and is already helping Hunt prepare the ground – especially the Telegraph.
The effects of this change will be many, but some of the obvious ones are:
– the majority of people will be further from healthcare, which will cost lives in acute cases, and in chronic cases will have a massive impact on families who will have to travel further to visit patients, and on patients who will be more isolated from family support.
– health-workers will suffer, losing jobs locally and being forced to either travel long distances to work, or else move nearer to the new centres, which will primarily be located in areas with higher living costs. With wages frozen and many NHS employers now trying to cut pay, for many people working in the NHS will become a vocational choice on a par with taking vows of poverty if they want to continue to help patients and do the jobs they love and trained hard for.
– a smaller number of centres will mean an overall reduction in the numbers of doctors and particularly, specialists. The concentration of these specialisms will mean a smaller overall pool of experience and expertise in the country’s medical system, to the detriment of patients as a whole.
So far, you might just think I’m stretching my conclusions. But here’s where the Telegraph’s collusion becomes very clear – thanks to a slip-up by the ‘newspaper’. On 8 October – the day of Hunt’s speech – the Telegraph ran a story under the headline “Geriatric and mental health wards threatened by NHS cuts“. The story purports to express concern about the effects of NHS cuts on care for the elderly and mentally ill, and even states that “David Cameron faces a growing backlash against NHS cuts and the closure of A&E departments as it emerges that specialist dementia, mental health and geriatric wards are also under threat“.
However, the article then changes tack and starts talking about poor care in wards for the elderly. Bear with me and it will very soon be clear where this is going:
“The figures, which raise new questions about the quality of care in hospital wards, reveal that a further 287 patients were malnourished at the time of their death, and 558 were very dehydrated.
A similar situation was occurring at care homes last year, where eight people died from a lack of food last year and 21 from thirst.
Patients in hospitals and care homes also died with a variety of avoidable conditions including bed sores, skin ulcers and septicaemia, which normally occurs in people with infected wounds.
Michelle Mitchell of Age UK described the figures as “deeply distressing” and said hospital and care home staff must be trained to spot the warning signs of malnutrition.”
It then starts describing how the closures are intended to improve care – in complete contrast to the putative purpose of the headline:
“The spate of hospital ward closures is part of an attempt to reduce department numbers in favour of creating fewer, better-staffed units at larger hospitals, with the aim of cutting costs and improving night and weekend care.”
Now, here’s the thing. You might think this is just slightly disjointed writing or a mixed message. But it’s actually the express aim of the article. How do I know? Here’s how:
An editing mistake has left in an instruction from the newspaper that sub-editors must leave in the section on malnutrition – which, in the context of the headline, can only mean that the aim of the article was to appear to be criticising the government but actually to tee up the NHS for criticism of its ‘failings’ in terms of geriatric care.
Oops. And I’m not the only one who spotted the tactic. A former NHS surgeon commented:
And this is not an isolated article, but part of a concerted campaign – an ‘orchestrated’ campaign, just as the Telegraph ‘orchestrated’ a campaign to help support the passage of the Tories’ NHS Bill on behalf of the group of private healthcare providers.
On October 10, the Telegraph’s Rebecca Smith again published an article attacking the NHS for its ‘Liverpool Care Pathway’ – the same tactic used to help prepare the public for the last escalation in the assault on the NHS. (Please read the linked article, as it gives a far truer context for the use of the LCP in the NHS).
On 6 October, the Telegraph published an article by the same journalist which quoted the head of the British Medical Association (BMA). Dr Mark Porter’s comments outlined the need for more money to be made available for elderly care in the NHS. But the slant of the article as it concluded was very different:
“The NHS Confederation, which represents most health service organisations, has said patient care must be delivered in more efficient ways which should mean rationalising specialist services into fewer larger hospitals.
Department of Health spokesman said there was enough money for the NHS to cope.
“The NHS may need to make some difficult decisions, but overall patient care should not be affected.
So, a medical expert appeals for more money, but the article concludes with – yet again – the conclusion that the NHS needs to be rationalised into a smaller number of centres.
Are you spotting a theme? I hope so, by now.
And, sure enough, Hunt’s speech to the Tory conference strikes the same chord – rationalise (as already outlined above) and concentrate on elderly care.
No fewer than 12 times throughout his speech, Hunt returned to the theme that the key challenge for the NHS is caring for the elderly:
“So looking to the future, our biggest priority must be to transform what we offer to meet the challenge of an ageing population”
“If Andrew is the Health Secretary who helped give us the structures for a modern NHS, I want to be the Health Secretary who helped transform the culture of the system – to make it the best in the world at looking after older people.”
And so on.
And why? Because people who live in the wealthier areas of the country live longer – and vote Tory. By making elderly care ‘our biggest priority‘, Hunt is preparing to resurrect Andrew Lansley’s discredited idea of focusing NHS funding in the wealthiest areas (as these have the greatest number of elderly people) – instead of in the parts of the country where most people die sooner and need good healthcare to live longer (but are likely to vote Labour!).
You are, of course, entitled to draw your own conclusions – and I’d love to be wrong. But I think the facts are really beyond doubt. Jeremy Hunt wants to make his mark – and to do so, he’s preparing a massive, 2-pronged attack on the NHS (which he called irrelevant and a 60-year-old mistake) that will reduce provision for the majority, concentrate care in a small number of centres, and will channel funding away from those who need it most to those who are most likely to vote Tory.
If you agree with my conclusions, spread the word and join the Resistance!