Healthcare,  Journalism

NHS: the hard questions

…If the Today programme won’t ask the difficult questions about the NHS, I will

When David Cameron woke up this morning, surely he must have had a little tingle of nerves about his appearance on the Today show. On the NHS alone, his record as PM has left enough questions to fill the whole three hour show; surely a short sharp burst from Sarah Montague was going to be an excruciating experience.

Today’s researchers had plenty to choose from. For years, long before that insidious document, the Health and Social Care Act was enforced on the system, alarm bells have been ringing.

The BMA, the Royal College of GPs, the Royal College of Psychiatrists, the Royal College of Nursing, countless doctors, nurses, academics, public policy experts, unions, campaigners – in the interests of word count I’ll leave it there – have been warning, no pleading with the government to change course, and for the public to wake up to the ominous reality of what the Act means.

But to Hell with what they think. Without even acknowledging a word of it, the only person our Prime Minister chose to quote today was Simon Stevens – a private healthcare man charged with reforming the public NHS.

Of course, this is hardly a surprise. Cameron isn’t likely to quote the medical professionals who actually have to carry out the work (unlike me, see below). When you’re lead around by Oliver Letwin, the author of public-service destruction manual ‘Privatising the World‘, you’re not going to bother sullying your mind with the petty concerns of lowly professionals.

No, that wasn’t a surprise – just the PM acting on instinct. But what was surprising – I think – was what was so sickeningly absent from the questions. None of the really tough ones at all, and no real rebuttal on the spurious facts Cameron gave to support his case.

If the broadcasters aren’t going to ask the right questions, or quote the right people, I’m going to. Over the course of the last 18 months I’ve written extensively about the changes taking place in the NHS, for the New Statesman, Open Democracy and others. I’ve met with activists, healthcare assistants, academics, doctors, nurses, politicians, union members and concerned campaigners from the public.

I might not be in the elevated position of a Today programme researcher, not least a presenter who walks between the raindrops, miles behind from the frontline. But I’ve picked up a thing or two – and for what it’s worth, I’d like to offer my own set of questions on the NHS, and some startling quotes at the end.

Even if I’m just shouting into the empty corridors of social media here, at least someone’s asking these questions.

  • With the Public Accounts Committee reporting that four out of five NHS trusts providing acute care are running a deficit, do you accept that funding for these trusts has been below what is required?
  • Numerous medical professional bodies, individual doctors, nurses, academics and public policy experts – even one of your own ministers – (see below) have been scathing about the Health and Social Care Act 2012 – are they misguided?
  • The use of locum doctors has increased  significantly since 2010 – rising 22.9% in 2013/14 from the previous year alone. Why are hospitals being forced to resort to emergency relief staff and why are you allowing this false economy to continue?
  • The Royal College of Nursing has described a “payday loan” attitude to staffing in the nursing profession, which has seen the amount spent on temporary agency staff almost double in two years while permanent staff have been on a pay freeze for most of the last four years. Are you satisfied with your record on workforce planning in nursing?
  • You promised “no more pointless and disruptive reorganisations” of the NHS; given that the current reorganisation has cost £3bn and completely overhauled the way commissioning is carried out in England, do you accept that you have broken this promise?
  • Given that more than a half of all new contracts have gone to private healthcare companies since the Health and Social Care Act came into being, is a piecemeal privatisation of the NHS underway?
  • Estimates for the cost of administering the internal market that the Health and Social Care Act has enabled run between £4bn-£10bn. Why have you enforced these new costs on NHS trusts?
  • NHS trusts are being forced to pump resources into expensive tendering processes, often just to lose out to private providers anyway. Is this a valuable use of funds which could be spent on frontline care?
  • A&E wards up and down the country are declaring crisis status, compounded by poor emergency staff retention and cuts to training – should accident and emergency wards be given more funds to cope? And do you accept that major cuts to local authorities’ budgets are exacerbating problems and delays in frontline medical care?
  • Dozens of trusts are currently crippled by PFI repayments, paying up to 20% of their annual budgets on interest payments alone. Why have you done nothing to ease their burdens in the last five years, and why do you endorse the Simon Stevens plan when it doesn’t mention this blight on the service, even once?


And in case any researchers are short on resources, here are 50 quotes about the NHS to be getting on with. I’ve even included links to twitter accounts for them…

If the Today programme’s performance this morning is anything to go by, none of the above questions, or the below quotes, will be put to David Cameron. But this is out there now – one thing the researchers can’t say is that they haven’t been told…..


NHS ‘reforms’ in quotes

“In future, the NHS will be a state insurance provider not a state deliverer. In future ‘any willing provider’ from the private sector will be able to sell goods and services to the system. The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years”. Mark Britnell, KPMG global head of health [speaking at a conference run by APAX in 2010].

“Section 75 is the legislation that was dropped in [to the Health and Social Care Act] that means that all the GPs working their butts off in the CCGs have to put all the new work out to competitive tender. That basically gives carte blanche for all the big private healthcare companies and private sector to come in and bid for the market. It’s all a smokescreen for this. It’s not a big-bang privatisation of the NHS but bit by little bit they’re picking it off. Trouble with the private sector is they always need to make a profit; if they can’t make a profit they piss off again, so they’ll take over these services, they’ll find they can’t make a 5% profit and they’ll just go again..or they cherry-pick the easy cases”. Dr Philip Hammond, GP and Private Eye’s ‘M.D.’

“What is occurring is an accelerating erosion, and increasingly a reversal, of what the NHS was created to achieve: making health care a right, and no longer something that could be bought or sold”. Dr Allyson Pollock, Professor of public health research and policy

“Historians will not be kind in their assessment of the coalition government’s record on NHS reform. The first three years were wasted on major organisational changes when the NHS should have been concentrating on growing financial and services pressures. This was a strategic error.” Prof Chris Ham, the King’s Fund’s chief executive

“There is mounting evidence – such as the doubling of the number of patients having to be sent out-of-area for care between 2011/12-2013/14 – that there are simply not enough mental health beds available in some areas. This is a system at breaking point, and patients are being put at serious risk as a result. The college’s position is very clear – everyone who requires an acute mental health bed should be able to access one in their local NHS trust area.” Simon Wesseley, president of the Royal College of Psychiatrists.

“We’re here for the young, the old and the in-betweeners. We need to speak out; our NHS is in dire straits. It’s in a critical condition”. Jill Mountford, Save Lewisham Hospital campaigner

“We must retain this critical public service, and prevent the establishment of a two-tier system, with the best medicine for the wealthy, and an inferior service for the rest.” Stephen Hawking

“My God how they built, and what they built. Every bit as much a wonder of the world as any architectural marvel or any natural miracle…the National Health Service. A truly monumental vision – the result of true representation, of real advocacy; a symbol of equality, of fairness and compassion….What sort of society do we want to be? It is a choice. Do we want to be a society that is fractured, divided, disconnected, mistrustful of its own people – a society that is exploitative, that sees people as commodities, instruments of profit. Or do we want to be a society where all are equal in value, and that value is not purely a monetary one?” Michael Sheen

“Our NHS is being dismantled piece by piece. A fragmented, market-based structure isn’t the ‘national’ service that so many people fought for so courageously. It mustn’t be reduced to a set of transactions, contracts and bidding wars that hollow it into little more than a logo – and waste resources that could be spent on front-line patient care.” Caroline Lucas

“People feel a very emotional commitment to the NHS; but much of the media is just a tool for the powerful. If you talk about the NHS in the media you risk being considered outside the frame of what’s permitted. Propaganda is becoming easier to propagate”. Alan Taman, freelance health journalist and campaigner

“And let’s state, loudly, clearly and simply, that the profit motive has no place in health care. Think of a fragile, prematurely born neonate, struggling for breath, in need of high cost, careful, considered treatment – do you want an accountant standing over the nurse’s shoulder, counting the costs, taking would could be treatment resources for private profit? Think of an old person at the end of their life, seeking a peaceful end, a good death, with care, compassion, human attention – services that can’t be – or certainly shouldn’t be rationed, subject to efficiency drives and cost-cutting”. Natalie Bennett, Green Party leader

“The Trans Atlantic Trade and Investment Partnership is not really about trade; it’s about giving transnational corporations rights and getting rid of the regulations that protect us”. Linda Kaucher, international trade treaty specialist

“Where will all of this end? What will be given the greatest priority in a new health care system that sends every service, from blood work to chemotherapy, out to the lowest bid tender? It ends where I began my life – in a Britain that believed health care depended on your social status. So if you were rich and insured you received timely medical treatment, while the rest of the country got the drippings.

“Sometimes I try to think how I might explain to Marion how we built these beautiful structures in our society – which protected the poor, which kept them safe at work, healthy in their lives, supported them when they were down on their luck – only to watch them be destroyed within a few short generations. But I cannot find the words”. Harry Leslie Smith, writer and anti-austerity campaigner – whose sister [Marion] died of tuberculosis in 1926 in a workhouse infirmary

“The NHS is one of the single greatest achievements of any civilisation. [Jeremy Hunt] is killing the NHS so that his owners can bleed you dry. Big, rich, private healthcare companies have donated millions to the Conservative party and now they’re calling in the debt”. Rufus Hound

“If we allow market forces to continue to take hold they will eventually break the NHS apart. Our destination is integration. Markets deliver fragmentation. They bring more providers onto the pitch, increasing the cost and complexity of care”. Andy Burnham

“Cameron’s right. Employers should give workers a pay rise. If only he was in charge of something like the NHS, then he could lead by example”. David Schneider

“NHS reorganisation was our worst mistake in government. [Lansley] kept saying his grand plans had the backing of the medical establishment and we trusted him. In retrospect it was a mistake….Lansley talked unintelligible gobbledygook for half an hour. When he sat down, David Cameron and George Osborne turned to Oliver Letwin and said: ‘Are we sure that this makes sense?’. The Tories’ policy guru nodded sagely, telling his colleagues that it was a brilliant idea to hand the commissioning of healthcare to GPs. And that was that”. Senior Conservative cabinet member MP

“Some £60bn of the NHS budget is now in the hands of clinical commissioning groups, supposedly run by GPs. This is a sham, though one which turns local doctors into human shields for the privatisers. In reality, the vast majority of GPs will keep on doing what they do already – looking after patients – while commissioning will be managed by private companies.

“It is with huge regret that I must say that – however much faith we have – we did not fight to save it. The NHS has been killed, murdered, assassinated by a Tory government. The question now is – do we have enough faith to bring it back to life?” Owen Jones

[Speaking in 2013] “The health service is being restructured onto an insurance compatible footing and the CCGs are technically state-owned insurance schemes. They’re going to take on around 80% of the NHS budget and they’re going to be parcelling it out to private providers. What’s going to happen on the 1st of April…is finishing the transition away from the original form of funding the NHS and moving into a market system which is going to be full-on market. The public sector will shrink away and the private sector will grow”. Dr Lucy Reynolds

“Like others, I heard David Cameron say ‘no top-down reorganisation of the NHS’. I was so relieved, because I had lived through 15 reorganisations . . . [But this reform] isn’t so much putting GPs in charge of commissioning, but about dismantling the systems and the architecture of the NHS”. Dr Clare Gerada, former Chair of the Council of the Royal College of GPs

“Private companies are just in it for a quick buck; they don’t care what happens to a hospital long term. They see the NHS budget as an enormous opportunity. We have to put pressure on the Labour Party and make them stand by what they’ve said about reversing privatisation and getting rid of the expensive tendering process which is all in favour of the private companies”. Ursula Holdsworth, retired doctor and NHS campaigner

“This government’s disastrous and wasteful NHS reorganisation has enabled management consultants to cash in on our NHS and siphon off millions that should be spent on patients while hiding behind a cloak of unaccountability”. National Health Action Party statement 

“This underlines what the government is actually about, it’s nothing at all to do with restoring the economy, it’s about smashing the public sector…” John Lister co-founder of Keep Our NHS Public

“This [Hinchingbrooke] is exactly what we warned and predicted would happen and illustrates the folly of private sector involvement in our NHS. When the going gets tough, the private sector gets going – and dumps NHS patients. The privatisation experiment has lamentably failed”. Dr Louise Irvine

“[If I were Prime Minister] I would look for every privatised corner of the NHS and take it back into public ownership at once, with no compensation”. Philip Pullman

“Wasteful internal markets, commissioning support units, management consultancy fees, the cost of procurement of clinical services, profit-taking by private providers, the cost of fragmenting pathways due to outsourcing components to private contractors, and PFI deals bankrupting our hospitals; they are draining billions from frontline care in our NHS”. Dr Clive Peedell, NHA Party co-founder

“You can’t run the NHS and expect it to perform if you flush the money out of the system, it just doesn’t work. We see this every day and it’s getting worse”. Kathryn Anderson, nurse at the Royal Free Hospital

“The principles of the NHS aren’t intact. We felt it was our civic duty to bring people’s attention to what’s happening to the NHS. The final straw for us was Clause 119 and the battle for Lewisham before that. If it can happen to one hospital then it can happen to any hospital”. Rehana Azam, organiser of People’s March for the NHS 

“I’m on a zero-hours contract. Sometimes I get 40 hours a week, sometimes it’s 15. There’s never any guarantee”. Anonymous health care assistant at privately run hospital

“Clause 119 means no hospital in England is safe. It allows the closure of hospitals if it suits the higher powers and the main reasons may well be financial when it should be a clinically based decision. It’s effectively a hospital closure clause; it’s an affront to democracy.” Dr David Wrigley, GP and BMA GP Committee member

“We would be mad to enforce [the competition regulations] in a way that leaves commissioners spending all their time running competitive processes because they’re terrified they’re going to get into trouble if they don’t”. David Bennett, chief executive of Monitor

“Our department wouldn’t operate without locums; there have been night shifts where I am the only doctor working in A&E who isn’t a locum”. Anonymous A&E doctor

“Chronic underfunding puts massive pressure on A&E, which becomes a hellish place to work. Therefore trainees don’t apply into training programmes, leading to chronic understaffing, further putting pressure on the department so other staff leave”. Tim Crocker-Buque, speciality registrar

“All of this has been aggravated by all the so-called efficiency savings; with £1bn coming out of the primary care budget and the effects of the Health and Social Care Act, the profession has been totally demoralised. The government worships markets. They can’t have it both ways. If they want a market, this is what they get”. Dr Paul Hobday, retired GP and NHA Party PPC

Jeremy Hunt strives to airbrush out the past three Andrew Lansley years and the £3bn cost of the Health and Social Care Act. He tries to blame any fault on Andy Burnham’s previous era, a ruse unlikely to see him through the unfolding turmoil. Wriggling in front of the Commons health committee, he hinted the act might be revisited to soften the disastrous section 75. But the government has privately ruled it out as too politically embarrassing to reopen the floodgates of that controversy”. Polly Toynbee

“The Government claims that the reforms have the backing of the health professions. They do not. Neither do they have the public’s support. The Health and Social Care Bill will erode the NHS’s ethical and cooperative foundations and will not deliver efficiency, quality, fairness or choice. We ask the House of Lords to reject passage of the Health and Social Care Bill”. Open letter by over 400 health professionals and experts ahead of the Health and Social Care Bill

“[The Health and Social Care Bill] means opening up the private sector to the market by making everything provided to the NHS subject to competition. There are a large number of sharks circling around the NHS. For some people the NHS is an unopened oyster capable of generating high income streams and profits.” Dr David McCoy, Medact Director, speaking in 2011

“Competitive tendering absorbs time and money; tenders do not write themselves. NHS commissioners now have a legal duty to use it for all care delivery… Strategic plans and tactical approaches will be the topic of countless away days, asking: Which contracts should we bid for? How far afield geographically should we chase new work? How will we manage the new contracts if we win them? And which tendering partnerships will strengthen our bids, nobble the competition or both? Already the burden of any qualified provider is stretching NHS provider managers. That workload is about to expand exponentially”. Noel Plumridge, independent consultant and former NHS finance director

“We are seeing people demonstrate their anger in different ways. The dermatology consultants were willing to forfeit their careers to protect care in Nottingham”. Rachael Maskell, head of health, Unite the Union

“People need to challenge media messages using social media. Challenge organisations, such as the Care Quality Commission (CQC) which may be generating ‘bad press’ for political reasons. Encourage opposition politicians to spell out how their policies will protect against specific concerns”. Neil Chadborn, Research Fellow, School of Medicine, University of Nottingham

“The NHS is being turned into a corporate structure modelled on the private sector all across the country. A&E is not profitable, it’s very high risk. A&E units are being shut across the country to focus on the profitable services”. Dr Bob Gill, GP and NHS campaigner

“Our NHS is special the values that inspire are enduring and the public service ethos that underpins it are unique.” Frances O’Grady, chair of the TUC

“I don’t blame the business people for being business people I blame Cameron for allowing them to occupy a position where they can be exerting undue influence to their commercial advantage” Dr Jacky Davis , co-founder of Keep Our NHS Public

“The NHS is really under threat right now, and the public scarcely realise. It’s happening by stealth and piecemeal. Private providers are allowed to hide behind the NHS logo. It’s all going on with absolutely no mandate from electors. In fact we were promised “no top down re-organisation”. It’s one of the biggest deceptions of our time”. Ben Clements, community health nurse

“In Britain they wouldn’t accept the deterioration or the destruction of the health service”.

“If you can find money to kill people, you can find money to help people”. Tony Benn

“It is not a charity; you are paying for it mainly as taxpayers and it will relieve your money worries in times of illness”. Leaflet published on introduction of the NHS

“So much time goes into creating business models now. We’re seeing services competing with each other, services pitted against each other. I’m spending more and more time and taxpayer money dealing with bureaucracy; it’s not what I wanted to do”. Dr Arun Chopra, psychiatrist and health campaigner

“People should be angry, very angry, about what is happening, but they just haven’t been hearing about it. This needs to change. The National Health Action Party and campaign groups like Keep Our NHS Public are doing a great job, but more people need to be reached. The only conclusion that can be drawn is that if we lose the NHS, my patients will suffer the consequences. I cannot stand by and watch that happen without protesting”. Sarah Hallett, junior doctor

“It was anger and fear that got me involved with campaigning. I was thinking about my children and grandchildren. My grandson is three and a half; he needs hospital treatment but already we’re seeing waiting lists go up. The NHS was created around the time I was born as a public service not a way for private companies to run a profit; I fear that it will not be there for my grandson”. Rosemary Muge, Nottingham KONP chair

“Patients and healthcare workers alike do not want to resist all change. But how do we tell when a change oversteps the mark and becomes a threat to the NHS values that we want to preserve? We think the answer is to set out the principles that make the NHS what it is – the enduring values that we want to see upheld. Then we intend to keep an eagle eye on the Government to spot when those principles are in danger.” UNISON

“We dragged the National Health Service in 1997 to 2010 from the depths of degradation that the Tories left it in and hoisted it back to the pinnacles of achievement. The Conservatives fought it then [in 1947]’s time that they understood that throughout the whole thing since 1947 people on millionaire’s row have opposed the very essence of the health service” Dennis Skinner





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