Saturday, 22 April 2017

What does this snap election mean for health in the UK?

Like the majority of the country, I was gobsmacked by the announcement that an election was to take place in June. My immediate reaction was to think ‘well this lady is for turning’ as Theresa May went back on her original statement that an early election was not planned. First the U turn on National Insurance for the self-employed – and now this. Comparisons with the ‘non turn-able’ Mrs Thatcher are inevitable and one can’t help wondering if this could be a trend for the current premiership.

But Politics aside - my main concern is what this snap election means for the National Health Service and healthcare in general. When forming her new cabinet last year, the Prime Minister indicated that the NHS seems a low priority. She had the ideal opportunity to remove a bloodied  but not bowed Jeremy Hunt from the front line and replace him with a minister with a more conciliatory approach. Ask any clinician, support worker, or even administrator in the NHS and they will all tell you that the NHS is already ’24 hours’ for emergency and critical care but to extend this to non-urgent treatment would be spread already thin resources to a non-sustainable conclusion. The toxic relationship between the Secretary of State for Health and the junior doctors has reached a point where divorce is the best option and a new relationship needs to build. Ignoring something that is broken means that it will become beyond repair.

I have some sympathy for government fiscal policy and agree that a strong economy is vital for a ‘healthy’ NHS but the chronic underfunding of the state provision cannot be ignored.

I was working on service improvement projects in the NHS at the time that the 2012 Health and Social Care Act was being implemented and experienced at first hand the genuine distress caused by Andrew Lansley’s ill-conceived reforms. At that time it was predicted that General Practitioners would leave the service in their droves and this is proving to be the case. Just this week a survey of 15,000 doctors demonstrated that at least a third of GPs were planning on retiring within the next five years while 19% of trainee GPs were considering work abroad. This is particularly worrying in the context of Philip Hammond’s autumn statement – funding more GPs to take the pressure off Accident and Emergency departments. Where will these GPs come from? Joined up thinking is required but clearly seems to be absent.

Talking of joined up thinking – the increase in Insurance Premium Tax (IPT) from 10% to 12% announced last year and planned for June will have an indirect but potentially devastating effect on the NHS. We will all have to pay extra for our motor, home and other essential insurances, and one could argue that the treasury’s finances have to be boosted from somewhere – but this tax also applies to private medical insurance. Before people start leaping in with criticism for private healthcare and ‘why not tax the rich’ – they should be aware of some crucial information (supplied by Laing & Buisson UK Market report thirteenth edition):

·    6.9 million individuals are currently covered by private medical insurance (PMI) policies
·     10.6% of the population has access to private medical care through PMI
·   These policies cost a total of £4.7m in 2015
·  £3.6m claims were paid for private treatment in 2015
75% of these people insured are members of company paid schemes as an employment benefit. These employees are liable to tax on the benefit so for an average single rate of over £1,000 annually an additional £120 will be added for IPT and the employee pays tax on £1,120 – the total cost of their cover.

Thanks to improved survival rates, improved diagnostic technology and life extending treatments, medical inflation runs at 10% year on year. This is, of course, the reason that the NHS needs constant uplift in funding. Add another 2% this year to the cost of private medical insurance and some subscribers (both company paid and private clients) will find the costs of private cover unaffordable and may well opt out of their private schemes.

So where will these people seek treatment in the future? The NHS. This is almost a ‘duh’ moment. Come on Mr Hammond, think about it – how would the NHS cope with a flood of extra patients who previously accessed private care.  Could this be a tipping point for the state funded system?

Back to the snap election. As we all know – during the pre-election build up, the business of government goes into a state of suspended animation and parliament will be dissolved on 3rd May. This is particularly disappointing for the Association of Medical insurance Intermediaries (AMII). We had launched a petition to appeal for a change in government policy regarding IPT for private medical insurance. I strongly believe that a robust private medical system in the UK can complement and supplement the NHS rather than compete with it. Increased taxation can only hinder this symbiotic relationship.We shall regroup as soon as parliament sits again and the delay is irritating rather than catastrophic but we are committed to pursuing our aim of maintaining the affordability of private medical care.

Jeremy Corbyn's plans for the NHS also ignore the value of cooperation between the public and private sectors with his bold claim of stopping all NHS work in private facilities. He fails to mention how this will be achieved, ignoring the shortages of NHS staff, building collateral and need for investment in new facilities. Chuck in an extra day's bank holiday and his plans become even less realistic.

I will refrain from commenting on the potential outcome of the upcoming election.  But I hope that whichever party or coalition is in power after June 8th,  they will use the opportunity to a) change the Minister of State for Health who will b) adopt a cooperative rather than confrontational approach to the clinical staff threatening strike action and c) listen to NHS leaders before acting further and d) engage with private medical providers to ease the pressure on the NHS.

It’s not too much to ask for – is it?






Sunday, 15 January 2017

Dear Mrs May ... We need to talk about the NHS

 This letter is sent to you with good intent, with no political bias. Although I have been a Tory voter for most of my adult life, when I was working in the NHS during the 2010 election, I felt that a labour victory would have been poor for the economy but preferable for the NHS. I believe that the two previous Labour Health Secretaries, Alan Johnson and Andy Burnham understood our state funded health system while their two Tory successors, Andrew Lansley and Jeremy Hunt, have done more harm than good.
I fear that during your short tenure as Prime Minister so far, you are getting it terribly wrong when it comes to a service genuinely under severe pressure and I have some very simple advice for you – so please take note:
Avoid mixed messages: In your first speech outside No.10 just after accepting the Queen’s direction to form a new government you channelled a mix of Mother Teresa and the three musketeers with your commitment to make Britain a ‘country that works for everyone…. Do everything we can to help anybody, whatever your background..’ Maybe you were trying to emulate Margaret Thatcher as she quoted St Francis of Assisi’s prayer when she came to power, but like Maggie, you appear to have quickly turned from school welfare officer to Headmistress. This is not always a bad thing – as long as you still have the welfare of our community well in hand but this doesn’t seem to be the case.
There is no quick fix for the NHS: But something does need to be done as a matter of urgency. You need a short, medium and long term plan. It is vital that primary, secondary, tertiary care and social services are all linked but we know this is a highly complex process that will take time. Resources need to be increased at every stage of the patient pathway (including prevention to stop them becoming a patient in the first place) as each area is of equal importance. In the short term you must..
Admit there is a crisis: If you don’t believe doctors, nurses, NHS managers or even patients and their relatives – look at the statistics. The targets for  Accident and Emergency departments and hospital waiting lists are reasonable and achievable in an appropriately resourced facility  but if a hospital is short of staff (clinical and administrative), beds, equipment or places to safely transfer patients within the community, they will start to miss targets as a matter of routine and this is happening. Now.
   Austerity and a state funded health system don’t mix:  Service improvement and efficiency
   measures can help but they are not enough. Choose your metaphor – the dead horse has been   
   flogged, the blood has been squeezed out of the stone, the NHS has streamlined its services and
   yes there is room for further improvement, but additional resource (funding) must be made
   available. We are already lagging behind many of our neighbours on % GDP spent on health and
   last year in his article on health spending the Kings Fund’s Chief Economist, John Appleby placed
   the UK at 13th out of the original 15 EU members. Like it or not – we may have to accept an
   increase in tax to allocate additional resource where it is vitally needed.
   Don’t ignore private healthcare: Subcontracting to local private facilities is already assisting
   some NHS Trusts with capacity issues and are a realistic option to be considered by clinical
   commissioning groups. As I am sure you are aware, for example, hip replacements undertaken in
   a nearby private hospital with spare capacity can be a cost effective way of freeing up local NHS
   beds  for trauma cases and ease pressure on A&E. This is not privatising the NHS and is not a long
   term fix but it can certainly help in the short term. And how about reducing insurance premium
   tax on health insurance subscriptions – do you really want some of the 10.6 million people with
   private health insurance to relinquish their cover and put even more pressure on the NHS? It is
   their right after all.
If you don’t trust your Health Secretary, choose a new one: It seemed strange that when forming your cabinet last year you missed an opportunity to remove an unpopular Health Minister and introduce a new era of cooperation with a carefully selected individual who could build bridges and work with key decision makers within the NHS. Instead you seem to have taken on the role of health spokesperson yourself, unhelpfully berating GPs and making sweeping statements that suggest that you don’t really understand the key elements of the service. I would assume that you will be pretty busy with ‘Brexit means Brexit’ and would respectfully suggest that you either give Jeremy Hunt back his mandate or pick a new Minister. If you are going to continue to make statements about the NHS then please…
Listen: …To those that are in the know, even if you don’t like what you hear. Organisations like the independent think tank, Kings Fund, people like Simon Stevens, Head of NHS England, Clare Gerada, and Helen Stokes Lampard, former and current chairs of the Royal College of General Practitioners, Janet Davies, Chief Executive of the Royal College of Nursing. The list is endless – and these people know what they are talking about. Trust them
Watch: Forget Sherlock or Call the Midwife, if you only watch one series this year I beseech you to tune in to BBC2’s exceptional documentary, Hospital. The first programme provided a level, calm but absolutely no-holds-barred view of what it really is like to work in a major Hospital Trust. After I watched the programme, I wept tears for not the patients – who without doubt received excellent care, but for the wonderful clinical staff, managers and administrators who work under almost unbearable pressure every day. On second thoughts – maybe you should watch Call the Midwife which shows how health and social care was before the state system was properly funded..
And finally…
Apparently you want your legacy as PM to be more than overseeing Brexit. Please make sure that your legacy is not that you were in charge when the NHS finally ceased to be fit for purpose.