Yes Mr Hunt, this is unacceptable

One of the few positives to note about Jeremy Hunt’s perennial tenure at the Department of Health, is that he’s actually been there long enough to witness his own policies, and rhetoric, unravel. Take the decision last year to scrap bursaries for student nurses. At the time it was obvious to seemingly everyone outside of the Cabinet that encumbering future nursing students with huge private debts would harm applications and jeopardise recruitment, not free up 10,000 new places as was spun at the time. Now the figures are bearing those warnings out – applications for nursing and midwifery training places for September are down 23% year on year. Of course, it wasn’t entirely down to Hunt – if anyone could pluck David Cameron out of the cosy lifestyle in which he’s now ensconced, we could ask him too. Then there’s A&E. Countless warnings over the years have been largely dismissed with casuistry and creative number-play. It takes a leak to the BBC to reveal that January’s A&E figures are likely to be the worst ever, with emergency departments falling dramatically short of their targets throughout England. Take your pick from the horror stories: the 500,000 hours spent by paramedics waiting to get into A&E; 12-hour waits for beds; photos of chaotic corridors reminiscent of, well, the last time the Conservatives were in power. In short: with each year that passes with Jeremy Hunt in charge of the NHS, A&E departments in England get steadily worse. With each year that passes […]

Vaccine “free for all” market

This article  first appeared on the newstatesman.com in March 2016 Take a look at the World Health Assembly’s action plan on tackling the barriers to global vaccination, and time and time again, the almighty dollar comes up. The resolution, passed by all 193 countries present at the Assembly last summer, raises deep concerns about the “increased financial burden of new vaccines”; that “many low- and middle-income countries may not have the opportunity to access newer and improved vaccines, particularly because of the costs related to the procurement and introduction of these vaccines”; and that “globally immunization coverage has increased only marginally since the late 2000s”. Behind the resolution, on the floor of the Assembly, apparently the language wasn’t so polite. Delegates from almost 60 countries spoke out vituperatively against the high prices of vaccines as being the main culprits for the sickening lingering of killer diseases, and urged the global community to act. Take pneumonia. It is the biggest cause of childhood death under the age of five globally, claiming the lives of almost one million children each year – one every 35 seconds – yet in 2016 70 per cent of all the world’s children remain unprotected. The reasons why are complex and many, but humanitarian agency Médecins Sans Frontières (MSF) says that it can name one for sure: the cost of vaccinations is prohibitively high. The life-saving pneumococcal conjugate vaccine (PCV) is big business. And the entire market, worth $30bn to date, is sewn up by just two companies: […]

Whistleblowing doctors

How the government is leaving whistleblowing doctors to twist in the wind By Benedict Cooper To the untrained mind the sheer incomprehensibility of legal talk can make courtroom proceedings seem like a thick layer of cloud: featureless and unremarkable. But every now and then, a thunderbolt darts down and catches you by surprise. Sitting in Courtroom One of the Employment Appeal Tribunal (EAT) two weeks ago, on the second floor of Fleetbank House, Salisbury Square – in the heart of the legal establishment – I had one of those moments. I was there to report on the latest stage in the legal odyssey of whistleblowing junior doctor Dr Chris Day, and frankly a lot of it was going over my head. That is until the barrister representing Health Education England (HEE) made a startling admission. It’s pretty remarkable that I was even there. Day is a rare species of doctor – perhaps an endangered species, if the judgement doesn’t go his way – who has held his nerve through two years of pressure since he ‘blew the whistle’ one night. Most never get half as far as he has, and it’s not hard to see why. The fulcrum of the case is a gap – or “lacuna”, to get into the legalese – in the laws protecting junior doctors when they blow the whistle. A gap which exists because of an ambiguity as to who is ultimately responsible for their career, and which Day’s case has revealed. The status quo […]

The attack on Kunduz Trauma Centre

This article was first published on OpenDemocracy in November OUT OF THE DARKNESS of the Afghan night, in the skies over the Kunduz Trauma Centre, the faint drone of propellers could be heard. Then, the bombing began. The intensive care unit (ICU), where the most critically ill adults and children silently lay, kept  alive only by ventilators, was first to be hit. For the next hour the American AC-130 gunship circled its target, unleashing “concentrated volleys” of rockets on the medical centre. As staff escaped the building and fled, they were cut down by machine gun fire from above. What they saw in that terrible hour on October 3, and in the grim aftermath, was enough to test the most conflict-hardened medic. Patients burning to death in their beds in ICU; two killed while lying on the operating table; the decapitated body of a colleague; the charred remains of children lying in the blood and the dust. Frantic efforts to temper the chaos followed: a desk in the undamaged administrative building was converted into an operating theatre to perform emergency operations on staff and patients left dismembered, with open chest wounds, ruptured abdominal blood vessels and severe shock. While the sun came up, the hell continued. As the wounded were rushed out to ambulances dispatched by the Ministry of Public Health to take them to hospital, fresh clashes erupted outside the compound leaving one ambulance riddled with bullet holes as it took patients away. _ What isn’t up for question […]

Hunt thinks junior doctors lack “professionalism…

…and a sense of vocation”? Is he kidding? If Jeremy Hunt isn’t trying to rile the medical profession, he’s got a funny way of going about it. With tensions high and strike action on the cards, saying that contract reforms, the very source of the strain, will bring back “professionalism and a sense of vocation” to a career that attracts some of the most talented and dedicated people around is either a whole new level of crass or it’s designed to inflame. And inflame it has: on Saturday the BMA’s Junior Doctor Committee voted to ballot its members over strike action (or some other form of protest), which could happen within a few weeks. There could, and hopefully will be some agreement before then, but if NHS Employers are going to keep cancelling meetings with the BMA as they did Monday evening – possibly to avoid protests that were set to take place outside – it’s not looking too good. Ostensibly the reforms are about working towards a ‘7-day NHS’ service – nothing wrong with that. But let’s call this what it is: a way to pay doctors less and reduce the overall bill, plain and simple. Speaking in July at the Department of Health-sponsored procurement conference, P4H, which bills itself as the “largest event bringing buyers and sellers of the NHS together”, John Warrington, deputy director for policy and research in the procurement, investment and commercial division at the DH, said: “All the work that Lord Carter has done […]

Addenbrooke’s hospital is just the canary in the coal mine as far as the NHS is concerned

First published in the New Statesman A toxic cocktail of under-pressure local authorities and low staffing has the NHS on the brink. By Benedict Cooper Among the grim litany of charges laid out in the Francis Report into the Mid Staffordshire scandal, time and again short staffing came up. “It should have been clear,” the report said, “from the history and the nature of the deficiencies being reported, particularly in relation to staffing, that a dangerous situation had been allowed by the Trust leadership to develop and that urgent action and intervention were required”. It went on: “The complaints heard at both the first inquiry and this one testified not only to inadequate staffing levels, but poor leadership, recruitment and training”. Two and a half years later, have the lessons of that dark episode been learned? Today’s Independent would suggest not. It reports that out of 89 acute hospitals inspected between 2014 and 2015, three quarters raised concerns over staffing levels. Yesterday Addenbrooke’s Hospital in Cambridgeshire became the latest acute hospital to be branded “inadequate” by the Care Quality Commission (CQC) and the trust that runs it placed into special measures. “Inspectors found a significant shortage of staff in a number of areas including critical care services,” the CQC said in a statement. “This often resulted in staff being moved across different services, with gaps back-filled by bank or agency staff. After the long recess, it’s always a good time to reflect. Just as Parliament broke Jeremy Hunt was facing […]

The Spokesman

An article I co-wrote with Zenn Athar for the Nottingham We Deserve campaigning newsletter was reproduced in The Spokesman, the publication founded by Bertrand Russell. The article is below.   The city has been on the front line of some of the most radical and, many argue, damaging reforms to the NHS since its creation. The Nottingham We Deserve investigates. by Benedict Cooper and Zenn Athar When five of the UK’s leading dermatologists quit the QMC in December, Nottingham was thrust into the middle of a gathering storm of political debate. To many their departure was the latest symbol of a health service breaking down, and a workforce under increasing pressure.The doctors wouldn’t be drawn on the issue, but sources quoted deep discomfort about a big decision that had quietly happened away from the public’s eye: the unit was to be run by Circle, a private company. Unite head of health Rachael Maskell says the case in Nottingham was a key moment for many campaigning against the growing influence of private healthcare companies like Circle in the service. “It showed the strength of feeling people have towards the NHS,” she says. “It’s not just an ideological step they took, it’s also a clinical point of view. The consultants were willing to forfeit their careers to protect care in Nottingham”. So why the strength of feeling? And what made the doctors quit? As activists in Nottingham and further afield know, the QMC case is just the tip of the iceberg. Everywhere […]

There is no closure – just grief

New Statesman, August 28th 2015 The headlines about “parity of esteem” between mental and physical health remain just that, warns Benedict Cooper. I don’t need to look very far to find the little black marks on this government’s mental health record. Just down the road, in fact. A short bus journey away from my flat in Nottingham is the Queens Medical Centre, once the largest hospital in Europe, now an embattled giant. Not only has the QMC’s formerly world-renowned dermatology service been reduced to a nub since private provider Circle took over – but that’s for another day – it has lost two whole mental health wards in the past year. Add this to the closure of two more wards on the other side of town at the City Hospital, the closure of the Enright Close rehabilitation centre in Newark, plus two more centres proposed for closure in the imminent future, and you’re left with a city already with half as many inpatient mental health beds as it had a year ago and some very concerned citizens. Not that Nottingham is alone – anything but. Over 2,100 mental health beds had been closed in England between April 2011 and last summer. Everywhere you go there are wards being shuttered; patients are being forced to travel hundreds of miles to get treatment in wards often well over-capacity, incidents of violence against mental health workers is increasing, police officers are becoming de facto frontline mental health crisis teams, and cuts to community […]

The right wing does the NHS

I realise that Douglas Murray, associate director of the Henry Jackson Society and polemic Spectator columnist, may have ideological even political reasons to bemoan the “perils of a socialised [healthcare] system”. That’s hardly going to come as a shock. What is surprising is that such an elevated journalist as he is willing to let so many innacuracies stand in this careless denigration of the health service. But it’s a useful exercise – it proves that certain stripes within the right have set out to manipulate the truth about the NHS for ideological means. And why they’re wrong. (Incidentally my own writing on medical politics appears mainily on the New Statesman). Murray believes that “George Osborne refuses to seek savings in [the NHS] budget and promised an unbudgeted further £9 billion”. Perhaps he is not aware of the fact that the Simon Stevens’ plan to which he (presumably) refers, and to which the government is committed, also calls for £22bn worth of cuts as a quid-pro-quo? Much of the NHS has already been cut, drastically in fact. Not least Public Health -a fact, surely, he should be happy about. After all, most of his piece is taken up by a loathing for the role of the state in tying to educate the public about the perils of obesity, smoking and other killers, which he considers paternalistic sermonising. Murray says that the NHS is the “only untouchable force in the state”. Perhaps he is not aware of the implications of the Health and Social […]

#weneedtotalkaboutjeremy

New Statesman, July 28th 2015 We need to talk about Jeremy: why doctors are so angry with Jeremy Hunt [1] Jeremy Hunt is at the centre with another row with the medical profession. What’s going on? by Benedict Cooper [2] Published 28 July, 2015 – 09:35 First, do no harm. Photo: Getty Images The long summer break can’t have come too soon for Jeremy Hunt. In the last 10 days alone, two separate waves of vitriol from the medical profession have come crashing down on him, and as he scarpers off to sun himself he must be wondering what type of mood he’ll be coming back to. First there was the #Iminworkjeremy [3] campaign, a fierce rebuttal of Hunt’s attack on the BMA [4] over consultants’ supposed unwillingness to work seven days. This must have seemed like a breeze though, compared with the last week’s bruising.  Cue #weneedtotalkaboutjeremy [5], an even angrier backlash sparked by the government’s response to a petition which has gathered more than 200,000 signatures (and rising), calling for a debate of no confidence in the Secretary of State. The reply was meant to silence the mob – it’s had the opposite effect, and been branded as “manipulative and misleading” by Dr Hamed Khan [6] who I know speaks for many doctors out there. The whole saga has yet further uncovered a bitter divide, a growing rift between the Secretary of State for Health and the medical profession. Yes, the government’s response to the no-confidence petition made […]

Nursing in crisis

This piece appeared in PRN Magazine in July 2015 Nursing in crisis: The disappearing numbers   A pay-freeze, a row over safe staffing and new rules to kick thousands of nurses out of the country: it’s been a stormy summer in medical politics. Benedict Cooper reports. You’d be forgiven for thinking that the government has it in for the nursing profession. In the last two months alone, a string of policies have put pressure on a workforce already in strife, and laid some shaky stones to step over next.First NHS England asks NICE to halt an investigation into safe staffing – to the approval of the Department of Health but the dismay of safe staffing campaigners. Then the Home Office chips in with tough new rules to deport non-EU migrants earning less than £35,000 a year, which the RCN says could lead to the loss of 7,000 nurses. And, finally, to round off a torrid month, in his budget the Chancellor delivers the news that the pay freeze on all public sector workers is to continue – for four more years. “Getting tough on migrants might play out well with the public, but anyone who has worked in an NHS hospital knows how crucial these workers are for the service.” Take any one of these decisions in isolation, and you will find nurses reeling as a result. Take them all together, and it begins to feel like a concerted effort. Getting tough on migrants might play out well with the […]

The quiet exodus of GPs

This article appeared in the New Statesman in July 2015 George Osborne quietly slipped into his budget some news that the medical staff perhaps dreaded, perhaps didn’t even imagine was possible: the public sector pay freeze will continue. For another four years. I’ll just let that sink in. For months, doctors and nurses have been begging the public and the government to take notice: pressure on the wards is building to dangerous levels. Medical staff are overworked, under-appreciated and underpaid, and now there’s this insult to injury – a further slap in the face from a Chancellor unwilling to reward their graft with a share of the recovery, for which they have already sacrificed so much. It’s so far from justice, such a total misdirection of priorities, it’s taken this long to process. The Conservatives are on such a high at the moment that judgement seems to be on hold. Back in April at the health election debate, Jeremy Hunt barely managed to defend the Health and Social Care Act, on which the Conservative government’s entire health record will be judged. But last week he unveiled a policy that could only have made it into the X-rated version of the Health and Social Care Act. And his explanation for why printing the cost of a prescription, with the words ‘Funded by the taxpayer’ on the box would help patients and not just leave them guilt-ridden as well as sick, was so unconvincingly delivered on Question Time that I doubt it would […]

The time bomb at the heart of the NHS

This article appeared in the New Statesman on July 1st 2015 Staffing: the time bomb at the heart of the NHS There’s an unnerving continuity at the Department of Health: a maddeningly consistent split between two realities. First there’s what’s going on in the wards, in the hearts and minds of the profession. Then there is what ministers like Jeremy Hunt and Ben Gummer say at the despatch box. The DoH must be aware, for example, that on Tuesday the Royal College of Nurses (RCN) voted 99.4 per cent in favour of a motion to lobby to reinstate the investigation by the National Institute for Clinical Excellence (NICE) into staffing levels, scrapped by Simon Stevens earlier this month. It was one of the urgent recommendations of the Francis Report after Mid-Staffordshire: someone needs to look into safe staffing levels, now. Not long later, NICE got on the case. Results had started to come in, guidance was being formulated. Jeremy Hunt, Ben Gummer and others must know that the RCN, safe staffing campaigners and other experts were incensed by the decision to halt this investigation, announced by Stevens without warning in a speech to the NHS Confederation in Liverpool. But in case they missed it, the full wording of the RCN motion was pretty unequivocal: “That this meeting of RCN Congress deplores the decision to halt the current work by NICE on safe staffing and calls for RCN Council to lobby for the reversal of this decision that puts patients at […]

Tory donor runs agency fund

‘Chief executive of firm accused of ‘ripping off’ NHS on staffing is a Tory donor’ The chief executive of a private equity firm that owns one of the staffing agencies accused by the government of “ripping off” the NHS is a major donor to the Conservative Party, The Independent can reveal. Ramez Sousou, founder and co-chief executive of transatlantic private equity firm TowerBrook Capital Partners, which owns Independent Clinical Services (ICS), has donated just under half a million pounds to the party since 2010, including more than £75,000 since his company bought ICS last year. Mr Sousou founded TowerBrook in 2005 and retains a stake in the company. His wife, Tiziana Cantoni, who is not connected to TowerBrook, has also donated personal funds to the party. On Tuesday the Government announced a drive to crack down on agencies providing nurses to NHS trusts, which Health Secretary Jeremy Hunt said are ripping off hospitals with “extortionate” fees. Writing in The Daily Telegraph, Mr Hunt said: “We will wrestle the initiative away from expensive staffing agencies that have been ripping off our hospitals with their exorbitant rates, and insist nationally negotiated frameworks are used instead, which make use of the NHS’s collective bargaining power.” The move came after it emerged that a number of companies have experienced a surge in their revenue from supply staff to the NHS over the past four years. Of these, ICS was identified as a major beneficiary, enjoying a 60 per cent increase in revenue between 2011 […]

The market is reaping as Hunt sows

This article appeared on Open Democracy: Our NHS on Tuesday June 2 The market is reaping as  Jeremy Hunt sows Tough talk by the Health Secretary on NHS agency costs belies the fact that the problem occured on his watch – and as a result of his government’s market policies. Today’s announcement on reducing the costs of agency nursing staff sounds like good old Tory get tough stuff. The NHS “needs to deliver its side of the bargain, which is to make efficiency savings”, Health Secretary Jeremy Hunt said today. He continued: “Can we really afford the kind of care we all want? With a strong economy, the answer is yes – but only if we care as much about every pound the NHS spends as every patient it treats. Because money wasted is money that can’t be spent on those needing care.” But Hunt’s greatest efficiency here is with the truth behind the wastage. The Public Accounts Committee repeatedly warned him that Trusts’ finances are being squeezed as they are forced to rely on agency staff. But under Hunt’s watch, the money spent on agency fees soared to record highs. “Hunt ignored agency issue and [is] guilty of neglect”, Alan Maynard, Emeritus Professor of Health Economics at York University commented today. The Royal College of Nursing (RCN) revealed in February how spending on agency nurses leapt from £327m in 2012/3, to £486m in 2013/4 – and is predicted to be just shy of £1 billion in the last financial year. And […]

The blind faith of the right (+what’s left for the left)

‘Sanctioned’ by Dani Lafez. Dani’s artwork is for sale here – proceeds go to arthritis research.  The blind faith of the right  (and what’s left for the Left)   Dani is a very poorly lady. Severe rheumatoid arthritis is attacking her spine, she has a snapped lumbar ligament, and last week after a gruelling eight needles were injected into her vertebra, an x-ray revealed that a hoped operation to fuse two of the disks in her back wouldn’t be possible because the surrounding disks have disintegrated too much. At the age of 26 she is facing the rest of her life taking morphine, by 40 she is likely to be in a wheelchair, and she has been told that the prospects of her body being able to bear a child are almost non-existent. But these aren’t her only troubles. A month ago she was sanctioned by the DWP. It’s been a tough month. Dani’s been handed around from person to person, with vague explanations given, such as her partner being in ‘full time work’ now (it’s an apprenticeship and he’s on £3.25/hour) and a so-called administrative error in which a ‘change of circumstance’ application Dani had to fill out didn’t have a due date on it. By the time she had gathered the masses of personal medical information the DWP required, only five days later, it was too late. No benefits for a month. At the next ‘infringement’ the sanction will be for 13 weeks. – Dani is one of […]

We tried

I won’t lie, I felt pretty abject on May 8th. So many hopes shattered, so many people now entering frightening unknowns, feeling insecure, threatened, battle-weary; so much disappointment, so many careers dashed and prospects ruined. This is the reality which a whole nation of healthcare workers woke up to the day after the election. Because we the Left could not persuade you the voting public what was at stake yesterday. I’m sorry. I’m sorry we could not speak over the volume of a right-wing press complicit in the dismantling of our greatest public service. We could not persuade the BBC to give you the facts, or ask the government the right questions on your behalf. Lacking all conviction, we tried. We tried to spell it out. Four years ago 400 health professionals and experts publically condemned the Health and Social Care Act, hoping to get your attention, saying the Bill would “erode the NHS’s ethical and cooperative foundations, and [would] not deliver efficiency, quality, fairness or choice”. You ignored them. Since then countless experts not driven by political ambition – the BMA, the Royal College of GPs, the Royal College of Psychiatrists, the Royal College of Nursing– have pleaded with the government to think again. They have all been dismissed by the government, which knew better. And those professionals who pleaded for mercy have since seen their budgets squeezed, pay frozen, wards shut and services fragmented. The “moral economy” which once gave NHS hospitals “almost a family atmosphere”, to quote a nurse […]

I’m voting to save the NHS

I’m embarrassed to admit, that I used to dismiss talk of the ways the NHS was changing. I’d read a few things, but never really understood what it all meant.  I never really grasped the true nature of the health service, its history and the way it is being altered today. I shrugged off talk about private companies taking over, and counter-argued with the fact that the population was growing, ageing, and as a result the way we funded its care needed to change. But for the past 18 months I’ve covered medical politics for a number of titles, including the New Statesman, Open Democracy, and others. It’s been a fascinating, often painful education. I have met with nurses, doctors, academics, politicians, campaigners, patients and concerned members of the public, who have spelled out what is happening to our NHS. The other day I had a particularly sad conversation, with a nurse I was interviewing for a feature. He described the death of what he called a “moral economy” among NHS workers. He said: “There was almost a family environment in hospitals before. That’s been taken away; the market has ripped the heart and soul out of the service”. In 2015 we face a lot of big issues as a country – low productivity, public expenditure which well outstrips our national income, environmental challenges, the need to find a fair balance on immigration and so on. They’re all important, but I’m not expert enough to make any big statements on them […]