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Critical Examination: Jeremy Hunt's Assertion on NHS Patient Numbers and Funding—Chancellor Called to Account

Tuesday, 21 November 2023 09:36 Lifestyle

As the Tories prepare for the autumn statement, it seems another opportunity to deflect blame, conveniently ignoring 13 years of failures and austerity cuts. Winter looms, and with it, the familiar strains on the National Health Service (NHS). However, tomorrow's announcement from the chancellor is unlikely to deliver the much-needed £1 billion to address the escalating cost of strikes. Meanwhile, NHS debts soar, and nearly 7.8 million people in England languish on waiting lists.

Jeremy Hunt stands ready with a counterattack, armed with fresh ammunition for the upcoming election. Alarming reports from the Institute for Fiscal Studies (IFS), parliament’s public accounts committee, and the House of Commons library all echo the same sentiment: NHS productivity has dwindled despite increased funding and staffing. Over the last five years, the NHS has received a boost in funds and a 20% surge in doctors and nurses, yet the number of hospital patients treated has decreased compared to the pre-Covid era.

The chancellor's potential response is poised on a delicate argument: demanding value for money while grappling with the challenge of measuring service productivity. The difficulty lies in the nature of measurement—what is easy to measure may not always reflect the reality of what is happening or what truly matters. A simple metric may suggest increased productivity, but the intricate dynamics of healthcare delivery are far more nuanced.

It's worth noting that GPs present an exception, demonstrating measurable productivity as they contend with increased patient loads under intense pressure. Primary care services, including GPs, contribute to 90% of all NHS treatments. Yet, the rise of "virtual wards" and the intensive treatment of patients at home under hospital supervision escapes conventional productivity metrics.

Several factors contribute to the decline in hospital throughput, as highlighted by thoughtful reports. A reduction in available beds, the persistent presence of Covid-19 patients occupying over 2,700 beds in England, and heightened infection control measures post-pandemic all play a role. The absence of Boris Johnson's long-awaited plan for social care has further strained the system, leaving over 13,000 hospital beds occupied by individuals medically fit for discharge.

In the midst of these challenges, hospitals are likened to "lobster traps" by the president of the Royal College of Emergency Medicine—easy to enter for the frail, yet difficult to exit. As the autumn statement unfolds, the intricate dance between funding, productivity, and the complex landscape of healthcare delivery takes center stage in the ongoing saga of the NHS.

The grand promises of the Tory manifesto, envisioning the NHS as the "best place in the world to give birth," now ring hollow in the face of damning Care Quality Commission (CQC) reports on maternity units. Beyond these measurable shortcomings lies a murkier territory—the toll on NHS staff. The exhaustion and the dwindling experience levels of healthcare workers tell a tale of sacrifice during the height of the pandemic, followed by burnout and departures. The seasoned hands that once navigated the complexities of healthcare have been replaced by novices, inevitably resulting in a decrease in the number of operations performed by new surgeons.

Sickness absence is on the rise, and the once-willing workforce, often extending themselves with extra hours, paid or otherwise, now hesitates. The government's attempt to weaponize pay demands has led to damaging strikes, leaving a workforce disheartened in its wake. Compounding these issues are alarming cuts to spending on crucial elements such as buildings, diagnostic equipment, and IT. Trusts are mandated to divert their capital budgets to day-to-day care, committing the fiscal sin of mortgaging the future. The promised 40 new hospitals appear to be more phantom than reality, with doubts surrounding their actual construction.

Financial woes have cast long-term scars, as years of meager budget increases collided with a growing patient population. The 2.9% average annual budget increase for the five years leading to 2024-25, as highlighted by the Institute for Fiscal Studies (IFS), falls significantly short of the NHS's lifetime average of 3.6%, not to mention the 7% during the Labour years that left the NHS in its prime. The patient demographic adds another layer of complexity—they are older, sicker, and the prolonged wait for treatment exacerbates their conditions. Long Covid has become an additional challenge, weakening many, and reports indicate a heightened severity of illness, necessitating longer hospital stays. The once-improving life expectancy gains are now slowing, and, for some, in reverse.

The regional disparities in health outcomes mirror the wealth gap, with 68% of hospitals in London receiving inadequate or requiring improvement ratings from the CQC. Anticipate the government's attempt to deflect blame onto the NHS and its dedicated staff, conveniently sidestepping the austerity years and the tumultuous Andrew Lansley reforms of 2012. The NHS, fragmented by these reforms, is still grappling with the aftermath, undergoing further restructuring in a bid to repair the damage. As the finger-pointing unfolds, perhaps Jeremy Hunt should reflect on the six years he helmed NHS England during this protracted period of declining performance.

Victoria Atkins steps into the daunting role of overseeing the health and social care department, inheriting a complex landscape marked by challenges. While she exudes optimism and a commitment to engaging with doctors, one can only hope she negotiated the terms wisely, ensuring swift resolutions before the impending pressures of winter flu and sickness contribute to ambulance queues stretching outside hospitals.

The burden she shoulders extends beyond party lines; it's a legacy that transcends political affiliations, with Labour sharing in the responsibility. As waiting lists continue to climb, the prospect of significant improvement in the near future appears elusive. In response, Wes Streeting unveils plans to allocate the £1.6 billion tax recouped from non-domiciled individuals toward bolstering mental health staff, district nurses, health visitors, and other essential roles.

Drawing inspiration from Harold Wilson's vision of the "white heat of technology," Streeting outlines Labour's health plans, emphasizing the transformative potential of genomics and artificial intelligence. Grounded in community-centric approaches and a focus on prevention, he echoes the insights of epidemiology professor Michael Marmot, underscoring that health outcomes are shaped more by social conditions than by the treatments offered by the NHS.

Navigating the constraints of a tight spending leash, Streeting is determined to uncover improvements and efficiencies that pay for themselves. Dr. Kariem El-Boghdadly's innovative program at Guy's and St Thomas' NHS Foundation Trust, featuring high-intensity theatre lists on Saturdays, stands as a testament to maximizing operational efficiency. The lightning-fast turnaround of just 30 seconds highlights the potential for streamlining procedures without compromising safety.

Leeds Teaching Hospitals Trust offers another success story, with Prof. Phil Wood, the chief executive, orchestrating a reduction in blocked beds from 350 to 200 this year. By eliminating discharge bottlenecks and establishing nurse-led convalescence hubs, the trust has achieved notable progress. Prof. Wood's collaboration with Leeds council, where NHS funds contribute to social care, not only aids in reducing bed blockages but also facilitates the retention of care staff by offering competitive compensation.

As the health and social care landscape undergoes dynamic shifts, Atkins and Streeting navigate the complexities with optimism and strategic foresight, recognizing the need for swift, effective solutions in the face of persistent challenges.

The perennial question echoes through the corridors of every health ministry: why can't everyone aspire to the pinnacle of excellence? It's a query posed by each new health minister, grappling with the elusive goal of elevating all facets of healthcare above the average. However, the aftermath of the Tory "reform" casts a shadow over such aspirations, with the very term carrying a toxic weight within the NHS.

Wes Streeting, eyeing a potential Labour resurgence, envisions a departure from the mistreatment suffered under the Tories. The hope is that, armed with at least some additional funding, Labour can usher in a wave of goodwill, a stark contrast to the previous government's neglectful stance toward healthcare staff—no mere applause but a sustained assault on their well-being.

The key to progress lies in enhancing productivity, irrespective of the metric employed. This necessitates the implementation of efficiencies and innovative work methodologies, proven to exist and ready to be deployed. The challenge is clear, and the stakes are high: failure to institute these changes will leave the NHS vulnerable to renewed assaults from familiar adversaries. In this critical juncture, the path forward demands not just rhetoric but tangible actions to safeguard the integrity and efficacy of the healthcare system.

Polly Toynbee, a Guardian columnist, encapsulates the urgency and complexity of the situation, highlighting that the future of the NHS hinges on the ability to transcend past pitfalls and institute lasting, meaningful improvements.

In conclusion, the pressing question of why healthcare cannot universally achieve excellence reverberates, with each new health minister seeking answers amidst the lingering fallout of Tory "reforms" that have left the term toxic within the NHS. Wes Streeting, anticipating a potential Labour resurgence, envisions a departure from the mistreatment endured under the Tories, hoping for a renewed commitment to healthcare staff's well-being.

The critical need for increased productivity stands at the forefront, requiring the rollout of efficiencies and innovative practices that have been proven to exist. The challenge is formidable, and failure to address it may leave the NHS vulnerable to renewed attacks from longstanding adversaries. As Polly Toynbee aptly emphasizes, the path forward demands more than rhetoric—it necessitates tangible actions to fortify the healthcare system and instill lasting improvements. The future of the NHS hangs in the balance, urging a concerted effort to transcend past challenges and chart a course toward a healthcare landscape that truly prioritizes excellence and the well-being of its dedicated workforce.

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