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The Jury is still out on the Tory Governments latest plans for a complete shake-up of our beleaguered NHS, but their timing couldn’t have been worse so does that have ominous implications. So far at there are a few naively optimistic commentaries, but from NHS professionals cautious warnings too. In the Politico Article entitled, “NHS shake-up finds Boris Johnson ready to ditch ideology,” Charlie Cooper comments on how the, “Second health service reorganization in a decade marks a direct break with pro-market Conservative predecessors. London — The coronavirus pandemic is far from over and England’s National Health Service is not yet out of the woods, but its next big reform has already been set in motion. The obvious question being asked by some of the exhausted health care staff on the frontline is: Why now? It’s the second time in a decade that the U.K. government has ordered a reorganization of the NHS and the latest plan gives a hint at how the Conservative party under Boris Johnson is changing.” I think not!
Politico reports that, “The last round of reforms, led by the-Health Secretary Andrew Lansley in 2012, proved deeply controversial. They had, at their heart, ideas firmly rooted in Thatcherite orthodoxy. Private-sector competition with state-run health services was an inherent good, and central government should be at one remove from public services on the ground. The fresh proposals, set out by current Health Secretary Matt Hancock in a government white paper, represent a major about-face. They do away with the legal requirement for competitive tendering of health services in the NHS, and place significantly more power in the lap of the health secretary himself.” Am I the only one to smell danger here? Matt Hancock has developed a special take on the ‘Friends and Family’ benefit program, so increasing his lock on unaccountable public money squandering is not a ‘healthy choice’ as the endemic Tory corruption will not stray far beyond his circle of ultra wealthy elitist chums at the expense of the British public.
Putting trust in this Tory Government’s shambolic control of the NHS is nieve, but according to Politico, “it’s a sign of how Johnson’s government is less driven by ideology than many of its Conservative predecessors, and far more opportunistic. Though founded by the Labour Party on principles contrary to Johnson’s espoused pro-market leanings, the prime minister has made the publicly-funded, free at the point of use NHS central to his political identity.’ Much of what is in the white paper has been proposed by NHS England’s leading officials and has been in the works for some time. The previous Lansley reforms saw the establishment of GP-led clinical commissioning groups, which were handed public money and tasked with buying health care services for a local area from either NHS or private providers. The reforms were ‘only ever really understood’ by Lansley himself, said Nigel Edwards, chief executive of the Nuffield Trust think tank. They were never warmly embraced by Lansley’s Conservative successors or the NHS.”
Politico quote Edwards saying, “‘Politicians and the NHS go in cycles of falling in and out of love of different types of mechanisms. There has been a disenchantment with quasi-market mechanisms as a really major lever for change.’ The new ‘integrated care systems’ that will now be responsible for the funding of health care are already up-and-running in some parts of the country.” This would all seem remarkably positive if it had not been proposed by a pathological liar whose attention to detail is so poor that policies he approves are ill-conceived and with a dictatorial absolute control of his cabinet there is zero challenge or scrutiny. But Politico’s optimism gathers pace as they enthusiastically describe how, “Johnson is willing to embrace changes drawn up by NHS leaders and casually sweep away pro-market thinking inherited from his Conservative predecessor David Cameron is characteristic of a prime minister who sees himself in the tradition of ‘Tory Democracy’.”
Politico describe Johnson in glowing terms, “He is pro-market, but relaxed about state intervention where it seems to work and (crucially) is popular.” They rightly say, “there are few areas of public life in which British government’s stand to gain, or lose, as much popularity as on their handling of the NHS.” But here they buy into that other Tory con to describe the PM’s priority as, “Eyes on 2024,” as if Johnson is not now in a perfect position to call or not cal an election whenever he chooses. The abolition of the Fixed Term Parliament Act was a Tory Manifesto pledge, but there was no hint as to the order of future elections and nothing to prevent Boris from proroguing Parliament for as long as he wants whenever he wants. There will be further disenfranchisement efforts in place and other restrictions to reduce turnout and simplify corrupt ballot stuffing. Due to our dire reluctance to question, challenge or fully Investigate the unfathomable result of the Covert 2019 Rigged Election we remain unable to monitor the system.
Politico ask, “But why now, in the teeth of a pandemic? The answer, said Richard Sloggett, founder of the Future Health think tank and a former adviser to Hancock, lies in the coming challenges for the NHS and the Tories’ desire to address them in time for their public reckoning at the 2024 general election.” They return to the 2024 Election fantasy, they claim that, “The government wants to get this through now so it can be in place by April 2022. With the next election in 2024 that gives you a couple of years for these reforms to start delivering,’ said Sloggett. “‘The big thing they’re going to have to deliver is the reduction in waiting times. We’ve got hundreds of thousands of people now waiting over a year for treatment after the significant disruption caused by COVID.’ Precisely how, or whether, the new structures can deliver remains to be seen.” There are thousands of retired staff who were lured back to work to help the NHS through this crisis, but they will want out again soon and the NHS is already desperately short of staff.
Politico report that, “Sloggett said the key reform to watch would be the additional powers accrued by the health secretary; an aspect of the overhaul that was not based on pre-existing NHS plans and came as a surprise to many observers. While the management body NHS England will retain ‘clinical and day-to-day operational’ independence, Hancock has said reforms would empower him to ‘set direction for the NHS and intervene where necessary.’ In other words, Hancock wants to be able to pull a lever in Whitehall and for the NHS to respond on the ground. With a rapidly growing waiting list for treatment that could become a major election issue in three years’ time, you can see why he might want that.” Or if you are a tad more sceptical you might think twice about increasing the power of a thoroughly untrustworthy, unprincipled Tory only interested in profiteering for the benefit of himself, his family and wealthy Tory donor friends.
Although Politico described the timeline according to Edwards as “’optimistic’ to think the reforms could have any effect by the time of the 2024 election, and highlighted a chronic workforce shortage in the NHS as the real problem with the health service that needs fixing,” the real challenge will be rampant Tory corruption. Has no one noticed the obscene track record of this Government with their ability to squander public money with impunity on everything from inadequate PPE, to inappropriate equipment and dysfunctional systems? Why the sudden vote of trust in the PM and Matt ‘sleight of Hand’ cock? But Politico reports that, “What they will discover is that you can pull the levers all you like, if there’s no orthopaedic surgeons it doesn’t really matter,’ said Edwards. ‘There’s a flawed theory about what the issues are … that somehow performance is a management problem or a lack of will; when actually the real problem there aren’t enough staff’.”
According to Politico, “There is another risk for Hancock and Johnson contained within the reforms.” Really? Just one? “’If the government wants to take more control of the health service, there is an opportunity for Labour to take a greater focus on the performance of the health service and to try to tie that more closely to Conservative ministers,’ said Sloggett. At the 2019 election, despite a range of NHS performance problems to highlight, Labour placed more emphasis on the claims that the U.K.’s post-Brexit trade deal with the U.S. would see parts of the health service sold off to American private healthcare; the kind of political attack that was par for the course when the Lansley reforms were being introduced. ‘Now, they might now change tack a bit,’ said Sloggett.” As if we can now all breathe a huge sigh of relief in the delusional hope that our NHS will no longer be in danger of being sold off to powerful US Healthcare Corporations… This is still very much on the Tory agenda.
Politico finish on a note of caution saying, “So while more ministerial control might (in theory) help drive down those ballooning waiting lists, as Hancock hopes, the risk is that the reforms do not deliver the boost he’s hoping for. If the problems persist long after the pandemic has ended, the buck will now, indisputably, stop with him.” The Tory obsession with centralized, privately outsourced services assigned to inappropriate companies with no experience in healthcare will continue as they prioritize the elitist buddy system. This is compounded by poor leadership with Johnson trusting the important Track and Trace Service to Tory chum and serial failure, Dido ‘Tallyho’ Harding, refusing to remove her or decentralize and abandon the shambolic contract despite repeated criticism and strong evidence. A failed Track and trace App disappeared without a trace taking squandered money with it. Why should we trust Handcock not to milk the system for all its worth; I am surprised the PM hasn’t assigned it to failing Grayling!
In the Royal College of Nursing Article entitled, “Safe staffing and nursing leadership must take precedence in NHS shake-up, insists RCN,” they set out safety priorities with regard to the policy shift. RCN insist that, “Proposed changes to the NHS in England aim to tackle bureaucracy and encourage health and social care services to work more closely together. The UK government’s health and care white paper, which sets out its legislative plans for the NHS in England, has been published. It proposes reversing some of the reforms introduced by the Health and Social Care Act 2012, which saw the creation of NHS England to run the health service, and the scrapping of primary care trusts in favour of clinical commissioning groups to organise local services.”
The RCN report that, “The white paper sets out changes it says will help deliver the aims of the NHS long term plan. These include giving integrated care systems a statutory footing by removing barriers to collaboration and removing incentives to compete; reducing bureaucracy with reforms to tariffs to ensure the NHS and local authorities can work closer together; and introducing measures to officially merge NHS England and NHS Improvement. The RCN is clear that nursing leadership must be recognised more clearly in integrated health care systems, not just because nursing is the biggest workforce, but because of the skills and expertise nurses bring to meeting the holistic needs of patients.”
The most alarming things that the RCN report are that, “The paper also proposes powers for the secretary of state for health to abolish a regulator, remove a profession from regulation and regulate senior managers. The RCN is firm in its position that nursing should remain a regulated profession and will work with the Nursing and Midwifery Council on these proposals.” This is typical Tory deregulation to reduce scrutiny and abolish all accountability. In other areas of governance this is what led to the huge loss of life at Grenfell Tower, deregulation, reduction in ‘red tape,’ fewer inspections of work standards and the materials used: do we want such deadly mistakes made in healthcare? Former Mayor, Boris Johnson, bore zero responsibility for gutting the London Fire Service. There must be robust pushback from the RCN and all UK professional Medical bodies during the committee stage of the bill passing through our disempowered Parliament to prevent vital regulatory safeguards from being removed by reckless Tory Ministers.
The RCN highlight another problem, “In addition, there are plans for the health secretary to take more direct control over NHS England with ‘enhanced powers of direction for the government’ to ‘ensure that decision makers overseeing the health system at a national level are effectively held to account’.” Holding Tories to account just does not happen any more, ever; when they seriously screw up they stay in post to await their next efficiency bonus awarded for squeezing money out of an already depleted system that they consciously disabled. They don’t even have the courage to apologize, even when their policies cost thousands of lives. The NHS is targeted to be run down before it is pronounced unviable and sold off. Having a corrupt, self-serving Tory with zero Medical knowledge set the direction of the NHS is like handing the Captaincy of a 3000 passenger cruise ship over to a drunken cabin boy!
“The RCN has been campaigning to get accountability for safe staffing written into law in England as part of its Staffing for Safe and Effective Care campaign.” The reality is that, before new staff have been recruited and trained, there will be a depletion of staff as those returned to help out leave exhausted but all that this year has demanded of them. RCN “wants a legal framework that clarifies roles, responsibilities, and accountability for the supply, recruitment, retention and pay of nursing staff. It also wants guarantees for a fully funded workforce strategy. The white paper falls short of the RCN’s asks but the legislative process will provide opportunities to influence and lay amendments to the draft bill as it goes through the parliamentary stages. The RCN has produced a member briefing about the proposed changes and will be working with members to shape its response to them. It will also seek support from MPs and others to make amendments to the draft bill at each stage of its legislative journey.”
“RCN Chief Executive & General Secretary Dame Donna Kinnair said: ‘We are inching closer to getting ministers to take responsibility for ensuring safe and effective care with enough nursing staff. But these proposals are only worthwhile if the UK government makes this issue a priority and matches that with investment. ‘For years, nursing staff have been kept waiting with the promise of a workforce strategy from ministers and the NHS. The absence of one left health and care services tens of thousands of nurses short when facing a pandemic. This workforce strategy must be produced without delay, with legal teeth, to demonstrate a clear commitment to investing in the people who make patient care safe. ‘New NHS structures will need to include senior nurses bringing their expertise and leadership and our members will want that reassurance when the detail is published. Politicians have to be accountable for the NHS, but nobody wants that to mean political interference’.”
In the BBC News Article entitled, “NHS shake-up ‘risks diluting patient power’,” Health reporter Nick Triggle, warns that, “Patients risk having less of a say in the running of the NHS in England under the proposed shake-up, eight leading health charities say. GPs are being given control of much of the NHS budget under the changes laid before Parliament last month. Part of the reasoning was that it would help empower patients, but the groups, including the British Heart Foundation, said it could weaken their involvement. The government insisted the changes would give patients “real clout”. The intervention by the health charities – in a letter published in the Times, follows widespread criticism of the reforms by health unions and MPs last month when the bill paving the way for the changes was published.”
There are concerns over accountability BBC News report that, “Managers working for primary care trusts (PCTs) are currently responsible for planning and buying local services, but GPs working together in consortia would take on responsibility for this from 2013 under the reforms. Pilots are already starting and once the process is complete, two tiers of management, PCTs and the 10 regional health authorities, will be scrapped. The letter, which was also signed by the Alzheimer’s Society and mental health charity Rethink questioned the powers and resources being given to the local Health Watch bodies, which will be set up across the country to represent patient interests in the new NHS structure. It states: ‘If the new NHS is to properly serve patients and the public, this democratic deficit must be addressed and the voices of patients heard by those making crucial decisions affecting their lives’.”
The BBC note that, “The letter also said the proposed scrutiny arrangements, local authorities are being put in charge of monitoring GP consortia – meant the lines of accountability were ‘too weak’. Andrew Chidgey, of the Alzheimer’s Society, told the BBC the issues needed addressing now that the bill was working its way through Parliament. ‘If we don’t do this well and thoroughly we could end up with patient and public involvement weaker than it is and no-one really wants that.’ The eight signatories to the letter are the Alzheimer’s Society, Asthma UK, Breakthrough Breast Cancer, Diabetes UK, National Voices, Rethink, the British Hearth Foundation and the Stroke Association. Their criticisms represent a new area of concern about the changes.”
BBC News report that, “A Department of Health spokeswoman said the letter raised ‘constructive’ points, adding: ‘We will work together to ensure the bill, which is in its early stages, delivers the reality of improved patient involvement.’ However, she disputed the suggestion that patient power could be diluted, citing the ability of Health Watch to trigger official NHS inspections. Last month, the House of Commons’ health committee said the plans had taken the NHS by surprise and could threaten its ability to make savings. Meanwhile, in another letter, also published in the Times, six health unions, including the British Medical Association, warned of their ‘extreme concerns’ that greater commercial competition in the NHS would end up undermining care. The NHS Confederation, which represents managers, has also suggested hospitals may have to close.”
A decade on from the disruptive damage caused by Andrew Landsley’s unnecessary and ill-conceived reforms the Tories want to inflict more stress on the NHS in the middle of a pandemic. However positive these changes might be the timing is abysmal. Please forgive the powerful wiff of sceptacism, but this was the incompetent team that heralded eugenacist Dominic Cummings Advice to promote ‘Herd Immunity,’ discourage mask wearing and didn’t stop mass sporting events. They failed to procure enough PPE, but discharging infected patients to Care Homes caused a ‘Holacaust in Care.’ A very late lockdown and reckless easing of restrictions, insisting children returned to schools so parents could get back to work, that slaughtered a few more thousand sheeple and they are not done yet. We already have the highest Covid death rate in Europe and very close to that shame globally. Boris Johnson’s one shot vaccine triumphalism could cost more lives; the only way to end the carnage is to Get The Tories Out ASAP! DO NOT MOVE ON!