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The Guardian view on the English NHS: the seven-day daydream The Guardian view on the English NHS: the seven-day daydream
(about 14 hours later)
The Conservative election victory was very much David Cameron’s personal win. Despite the wear and tear of five years in office, he has continued to outpoll his party. During the campaign, we were reminded why. Particular Tory policies – on human rights, say, or on welfare – might have been immoderate, but Mr Cameron was always able to wrap them up, often pretty convincingly, in the language of pragmatic common sense. After achieving his new mandate, he has stuck with this winning tone when he spoke of a one-nation government. Thentoday he used his first big speech as a majority prime minister not to wallow in the Conservative comfort zone, but instead to address the issue that the Tories often find most thorny: the NHS. The Conservative election victory was very much David Cameron’s personal win. Despite the wear and tear of five years in office, he has continued to outpoll his party. During the campaign, we were reminded why. Particular Tory policies – on human rights, say, or on welfare – might have been immoderate, but Mr Cameron was always able to wrap them up, often pretty convincingly, in the language of pragmatic common sense. After achieving his new mandate, he has stuck with this winning tone when he spoke of a one-nation government. Then today he used his first big speech as a majority prime minister not to wallow in the Conservative comfort zone, but instead to address the issue that the Tories often find most thorny: the NHS.
A centrist speech reasserted NHS values, offered a reassuring (if decidedly vague) undertaking not to privatise, and restated a campaign commitment to find the £8bn that the English NHS is officially deemed to require. The particular problem that the PM highlighted – the rigid organisation of services around office hours – also fitted comfortably within the Cameronian commonsensical pitch. It is, as he said, appalling that mortality rates can be 16% higher on a Sunday, and it would surely be better – as he also suggested – if services were organised around spikes in demand, not weekend rotas for skeleton staff. A centrist speech reasserted NHS values, offered a reassuring (if decidedly vague) undertaking not to privatise, and restated a campaign commitment to find the £8bn that the English NHS is officially deemed to require. The particular problem that the PM highlighted – the rigid organisation of services around office hours – also fitted comfortably within the Cameronian commonsensical pitch. It is, as he said, appalling that mortality rates can be 16% higher on a Sunday, and it would surely be better – as he also suggested – if services were organised around spikes in demand, not weekend rotas for skeleton staff.
The all-important question, however, is what the prime minister imagines he can do about this. The “what counts is what works” pose is all very well, but citizens waiting longer in A&E corridors will have been more struck by what Mr Cameron didn’t talk about than by anything he actually said. There was no acknowledgement of rising delays for in- and out-patients, nor of the great wave of rationing that two in five commissioning groups are signalling that they might soon embark on. There was a nod at the ageing society, but no understanding that this will consume all of the vaunted £8bn and more.The all-important question, however, is what the prime minister imagines he can do about this. The “what counts is what works” pose is all very well, but citizens waiting longer in A&E corridors will have been more struck by what Mr Cameron didn’t talk about than by anything he actually said. There was no acknowledgement of rising delays for in- and out-patients, nor of the great wave of rationing that two in five commissioning groups are signalling that they might soon embark on. There was a nod at the ageing society, but no understanding that this will consume all of the vaunted £8bn and more.
That figure dropped out of a plan by the NHS England chief, Simon Stevens, a plan that’s made to add up only with the help of a truly heroic £22bn in efficiency savings, which include the assumption that pay can be screwed down for years without disrupting the service. While private-sector wages were on the floor, this was often possible. But today, there are already shortages in nursing and general practice, and – as the economy recovers – filling vacancies without paying better might become impossible. Meanwhile, the £17m deficit that has just appeared in the books at St George’s, in south London, is emblematic of what the Health Service Journal describes as a pattern of “major financial holes … opening up all over the acute sector”, holes totting up to £2bn or so.That figure dropped out of a plan by the NHS England chief, Simon Stevens, a plan that’s made to add up only with the help of a truly heroic £22bn in efficiency savings, which include the assumption that pay can be screwed down for years without disrupting the service. While private-sector wages were on the floor, this was often possible. But today, there are already shortages in nursing and general practice, and – as the economy recovers – filling vacancies without paying better might become impossible. Meanwhile, the £17m deficit that has just appeared in the books at St George’s, in south London, is emblematic of what the Health Service Journal describes as a pattern of “major financial holes … opening up all over the acute sector”, holes totting up to £2bn or so.
How, in this context, are the resources going to be found to put 24/7 care in place? If instead the idea is sweating existing “resources” – ie doctors and nurses – to do more, more flexibly, then how is that going to be achieved? The British Medical Association is a union that sometimes needs to be taken to task, but Mr Cameron could not pick this fight at this time and remain on the consensual centre-ground. We would be talking about an industrial relations battle to rival those of the Thatcher years. How, in this context, are the resources going to be found to put 24/7 care in place? If instead the idea is sweating existing “resources” – ie doctors and nurses – to do more, more flexibly, then how is that going to be achieved? The British Medical Association is a union that sometimes needs to be taken to task, but Mr Cameron could not pick this fight at this time and remain on the consensual centre-ground. We would be talking about an industrial relations battle to rival those of the Thatcher years.
The PM who once styled himself as “a man with a plan” is a leader flying by the seat of his pants. This was evident from another gaping omission from his speech: Andrew Lansley’s rewiring of the English NHS. Despite the vast energy this consumed, Mr Cameron is not even pretending it will further his round-the-clock ambitions. It seems fair to conclude that he has concluded that it was a distraction. The PM who once styled himself as “a man with a plan” is a leader flying by the seat of his pants. This was evident from another gaping omission from his speech: Andrew Lansley’s rewiring of the English NHS. Despite the vast energy this consumed, Mr Cameron is not even pretending it will further his round-the-clock ambitions. It seems fair to conclude that he has concluded that it was a distraction.
Indeed, the very idea that it is for the health secretary, prime minister or anyone else in Whitehall to tell hospitals how to run their care runs counter to the marketopian Lansley philosophy. The confused and overlapping patchwork of autonomous NHS structures that Mr Lansley left behind could easily render Mr Cameron’s hopes of seven-day care a daydream. For no single autonomous hospital or commissioner, acting in isolation, could impose weekend working on staff. Without central coordination, employers who tried that would lose staff to others who didn’t. If he is serious about his latest plan, Mr Cameron might thus need to rip up his previous dismal effort.Indeed, the very idea that it is for the health secretary, prime minister or anyone else in Whitehall to tell hospitals how to run their care runs counter to the marketopian Lansley philosophy. The confused and overlapping patchwork of autonomous NHS structures that Mr Lansley left behind could easily render Mr Cameron’s hopes of seven-day care a daydream. For no single autonomous hospital or commissioner, acting in isolation, could impose weekend working on staff. Without central coordination, employers who tried that would lose staff to others who didn’t. If he is serious about his latest plan, Mr Cameron might thus need to rip up his previous dismal effort.