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| Pity the NHS, but it’s not time to get rid of Jeremy Hunt | Pity the NHS, but it’s not time to get rid of Jeremy Hunt |
| (about 17 hours later) | |
| Mon 15 Jan 2018 06.00 GMT | |
| Last modified on Mon 15 Jan 2018 08.10 GMT | |
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| A minister presiding over a service in meltdown should expect to be sacked. Instead, on the NHS’s 70th birthday, Jeremy Hunt will be the longest-serving health secretary ever. And that’s a good thing. He is reviled by an NHS whose senior doctors and managers he has bullied, blamed and beheaded for the underfunding they repeatedly warned him against. Yet better the devil they know. | A minister presiding over a service in meltdown should expect to be sacked. Instead, on the NHS’s 70th birthday, Jeremy Hunt will be the longest-serving health secretary ever. And that’s a good thing. He is reviled by an NHS whose senior doctors and managers he has bullied, blamed and beheaded for the underfunding they repeatedly warned him against. Yet better the devil they know. |
| When 68 of the most senior heads of A&E from the largest trusts tell the prime minister that patients are dying in corridors, that’s not shroud-waving or crying wolf, that’s real “prematurely” dead bodies. The current level of safety is “intolerable”, they write, with emergency departments “in a state of emergency”. | When 68 of the most senior heads of A&E from the largest trusts tell the prime minister that patients are dying in corridors, that’s not shroud-waving or crying wolf, that’s real “prematurely” dead bodies. The current level of safety is “intolerable”, they write, with emergency departments “in a state of emergency”. |
| The missed targets and overflowing beds are unprecedented, with 5,000 more kept waiting in ambulances in the run-up to new year. All the statistics are hair-raising, as understaffed units report exhausted doctors working back-to-back 13-hour shifts. Today the Guardian reports that unqualified student doctors are being urged to help out struggling A&Es. | The missed targets and overflowing beds are unprecedented, with 5,000 more kept waiting in ambulances in the run-up to new year. All the statistics are hair-raising, as understaffed units report exhausted doctors working back-to-back 13-hour shifts. Today the Guardian reports that unqualified student doctors are being urged to help out struggling A&Es. |
| Look at the extraordinary spectacle of the Care Quality Commission stopping routine hospital inspections. What’s the point of harassing staff about appalling conditions? At last the CQC recognises the NHS crisis not as individual hospital failings but as a systemic failure. | Look at the extraordinary spectacle of the Care Quality Commission stopping routine hospital inspections. What’s the point of harassing staff about appalling conditions? At last the CQC recognises the NHS crisis not as individual hospital failings but as a systemic failure. |
| He’s a lightweight and a serial blame-passer – but what’s the point of moving him? | He’s a lightweight and a serial blame-passer – but what’s the point of moving him? |
| What could ease the immediate crisis? Nothing much, says Richard Murray, the King’s Fund head of policy. The block on using agencies could be lifted – already some hospitals breach rules on agency staff. The King’s Fund has canvassed agencies that say nurses are “rare as hens’ teeth”; they are so exhausted they won’t work extra agency shifts, except for “mortgage-changing” sums. No emergency bung to the NHS can easily rescue it for now. | What could ease the immediate crisis? Nothing much, says Richard Murray, the King’s Fund head of policy. The block on using agencies could be lifted – already some hospitals breach rules on agency staff. The King’s Fund has canvassed agencies that say nurses are “rare as hens’ teeth”; they are so exhausted they won’t work extra agency shifts, except for “mortgage-changing” sums. No emergency bung to the NHS can easily rescue it for now. |
| The £337m winter cash the government boasts about came with an order that half of it be used to service debt – debt that will never be cleared. With most hospitals massively exceeding debt limits, they now face heavier losses. The cancellation of 55,000 operations in January will lose them millions, and it may be repeated in February. Their income depends on those operations, while every extra emergency admission costs dear, as they are paid a fixed sum regardless of rising numbers. High-paid specialist surgeons kick their heels, their beds subsumed by emergencies. Sending an ophthalmologist, say, to A&E where they haven’t worked for years, to care for elderly respiratory patients is risky. But that’s what’s happening. | The £337m winter cash the government boasts about came with an order that half of it be used to service debt – debt that will never be cleared. With most hospitals massively exceeding debt limits, they now face heavier losses. The cancellation of 55,000 operations in January will lose them millions, and it may be repeated in February. Their income depends on those operations, while every extra emergency admission costs dear, as they are paid a fixed sum regardless of rising numbers. High-paid specialist surgeons kick their heels, their beds subsumed by emergencies. Sending an ophthalmologist, say, to A&E where they haven’t worked for years, to care for elderly respiratory patients is risky. But that’s what’s happening. |
| Hunt, over the years, has tried to control the burgeoning crisis. He bullies and browbeats senior managers and doctors with Monday morning meetings summoning back-sliders, naming and shaming and calling for rolling heads. The biggest beast he fired for debt over-runs in December to frighten everyone else was Bob Kerslake, the chair of King’s College hospital and a former civil service head. On his wall Hunt parades his noticeboard listing “never events” of shameful hospital accidents, but no comparable board lists exceptional acts of brilliance and resilience. | Hunt, over the years, has tried to control the burgeoning crisis. He bullies and browbeats senior managers and doctors with Monday morning meetings summoning back-sliders, naming and shaming and calling for rolling heads. The biggest beast he fired for debt over-runs in December to frighten everyone else was Bob Kerslake, the chair of King’s College hospital and a former civil service head. On his wall Hunt parades his noticeboard listing “never events” of shameful hospital accidents, but no comparable board lists exceptional acts of brilliance and resilience. |
| The bullying trickles down: when planning for winter, 59 managers from the worst-performing A&E departments were summoned to London by Hunt, warned their jobs were in peril and made to chant “We can do this!” The Health Service Journal reports they were told to “own their problems, not externalise them”. In other words, don’t blame Hunt. But now there is a new debt defiance – it says: “Go on, minister, tell me not to pay my nurses at the end of the month and see what happens.” | The bullying trickles down: when planning for winter, 59 managers from the worst-performing A&E departments were summoned to London by Hunt, warned their jobs were in peril and made to chant “We can do this!” The Health Service Journal reports they were told to “own their problems, not externalise them”. In other words, don’t blame Hunt. But now there is a new debt defiance – it says: “Go on, minister, tell me not to pay my nurses at the end of the month and see what happens.” |
| Parliament is being misled: then-health minister Philip Dunne, replying to health committee chair Sarah Wollaston’s question on bed occupancy last week, said the Christmas Eve bed occupancy rate was 84.2%, below the 85% target, with no other figures. She protested this was “disingenuous”, tweeting a table showing that was the one and only day all winter. | Parliament is being misled: then-health minister Philip Dunne, replying to health committee chair Sarah Wollaston’s question on bed occupancy last week, said the Christmas Eve bed occupancy rate was 84.2%, below the 85% target, with no other figures. She protested this was “disingenuous”, tweeting a table showing that was the one and only day all winter. |
| Ministers claims the NHS is ring-fenced, but the tiny annual increase is not age-weighted: this is the harshest run of spending years the NHS has ever known. Numbers of registered nurses fell for the first time; training numbers were cut in 2010; 96% fewer EU nurses have registered since the Brexit vote. GP numbers are falling fast, while NHS beds are blocked due to 1,000 care homes closing since 2010, losing 30,000 care beds. This profound damage will take years to repair, even with restored funds. | Ministers claims the NHS is ring-fenced, but the tiny annual increase is not age-weighted: this is the harshest run of spending years the NHS has ever known. Numbers of registered nurses fell for the first time; training numbers were cut in 2010; 96% fewer EU nurses have registered since the Brexit vote. GP numbers are falling fast, while NHS beds are blocked due to 1,000 care homes closing since 2010, losing 30,000 care beds. This profound damage will take years to repair, even with restored funds. |
| Yet Hunt stays. He pleaded with May and made a good case. He’s a lightweight and a serial blame-passer – but what’s the point of moving him? The NHS crisis belongs to the Treasury and all Tory MPs voting through public service-killing budgets year after year. | Yet Hunt stays. He pleaded with May and made a good case. He’s a lightweight and a serial blame-passer – but what’s the point of moving him? The NHS crisis belongs to the Treasury and all Tory MPs voting through public service-killing budgets year after year. |
| A new health secretary brings dread of new turmoil. Every new minister imagines they can re-disorganise the NHS: at least Hunt has seen the damage done by his predecessor Andrew Lansley, while NHS England head Simon Stephens may or may not manage quietly to stitch back the fragments without changing the law. Now Hunt has social care added to his title, a coherent system of local treatment is possible – but social care too needs cash: combining two turkeys doesn’t make a phoenix fly. | A new health secretary brings dread of new turmoil. Every new minister imagines they can re-disorganise the NHS: at least Hunt has seen the damage done by his predecessor Andrew Lansley, while NHS England head Simon Stephens may or may not manage quietly to stitch back the fragments without changing the law. Now Hunt has social care added to his title, a coherent system of local treatment is possible – but social care too needs cash: combining two turkeys doesn’t make a phoenix fly. |
| At least Hunt finally admits it’s all about money, openly calling for a 10-year funding settlement with the £4bn a year Stephens has demanded: a new minister might have taken the job on a promise not to ask for more, spouting ignorant nonsense about the NHS as a “bottomless pit”. Labour’s spending years proved that matching similar countries’ funding cures the NHS of its ills. So two cheers for Hunt remaining. | At least Hunt finally admits it’s all about money, openly calling for a 10-year funding settlement with the £4bn a year Stephens has demanded: a new minister might have taken the job on a promise not to ask for more, spouting ignorant nonsense about the NHS as a “bottomless pit”. Labour’s spending years proved that matching similar countries’ funding cures the NHS of its ills. So two cheers for Hunt remaining. |
| No doubt the prime minister notes that the crisis has not yet catapulted Labour ahead in the polls. Sunday’s Observer Opinium poll puts Labour only level-pegging on 40%. Theresa May is still five points ahead as best prime minister, so even now the NHS is not the pivotal voting issue. But for how long dare she stay so complacent? | No doubt the prime minister notes that the crisis has not yet catapulted Labour ahead in the polls. Sunday’s Observer Opinium poll puts Labour only level-pegging on 40%. Theresa May is still five points ahead as best prime minister, so even now the NHS is not the pivotal voting issue. But for how long dare she stay so complacent? |
| • Polly Toynbee is a Guardian columnist | • Polly Toynbee is a Guardian columnist |
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