So the NHS faces another reorganisation … again. When doesn’t it? And, more than ever, it has all the hallmarks of a campaign to progressively cut the NHS.
Fresh from his high court defeat by health campaigners in south east London, health secretary Jeremy Hunt is now looking to have emergency care in north Wales reviewed.
Of course, when I say ‘review’, I mean ‘downgrade’ one of the three A&E units in question – at Ysbyty Gwynedd in Bangor, Glan Clwyd Hospital at Bodelwyddan, and at Wrexham Maelor.
Announcing the review on BBC Radio Cymru, health minister Mark Drakeford explained the rationale for making changes with the usual glib, politician-management speak.
“We are looking to see where we can improve things now, or in the future, but I can’t say exactly what that will mean,” he said. “But downgrading is one of the options.
“The important thing is that the system works together so that the people of Wales receive the treatment they need, where they need it.”
Drakeford went on to say that the NHS is constantly changing. Too bloody right it is!
Of course, healthcare provision is expensive and there are legitimate issues to be addressed over costs, how patients are accessing A&E services, and the performance of those services in the face of a long-term rise in ‘inappropriate attendances’.
According to an interim report by NHS medical director Prof Sir Bruce Keogh, published last month, 40% of A&E attendances resulted in discharge without treatment. There were also 1m avoidable admissions last year and half of 999 calls led to the dispatch of an ambulance when the condition could have been otherwise treated at the scene.
In response, Keogh recommends the wider promotion of ‘self-care’, better access to GP services and a hub-and-spoke network of A&E departments. This would consist of fewer, but better-equipped, specialised services fed by a series of smaller emergency units. Significantly, such a system would involve the closure of some of the smaller A&E departments.
Keogh argues that change is needed because the current system is under “intense, growing and unsustainable pressure” through rising demand from an ageing population trying to access a confusing and inconsistent array of services.
In other words, when push comes to shove, people are increasingly making A&E their first port of call because – compared with GP surgeries, for instance – they an always-open, highly-visible and understandable element of the widely-trusted A&E ‘brand’.
The problem, of course, is trusting Jeremy Hunt’s – and, by extension, the Conservative-led Coalition government’s – true intentions for the NHS. Because they have been pretty slippery on the future of the NHS since coming to power in 2010.
It all started with the monumental Health & Social Care Act 2012, which was pushed through Parliament without any electoral mandate. The legislation makes it easier for private service providers to bid for and run NHS services in what opponents describe as ‘creeping privatisation’.
More recently, we had the fiasco of Hunt attempting to close Lewisham Hospital’s financially-robust A&E unit – and downgrade its maternity services – as a result of the debt accumulated by a neighbouring healthcare trust.
As a result of his double defeat in court, Hunt quietly introduced provisions into the Care Bill going through Parliament, giving him powers to close A&E and other services with minimal public consultation.
And, to add to suspicions of skulduggery, Hunt’s department was briefing the press – but not Parliament – on the Keogh report, with coverage embargoed until its scheduled release on Wednesday November 13, the day Parliament went into recess. It was only because shadow health secretary Andy Burnham got wind of the report and requested a debate that Hunt was forced to set out his plans to MPs.
Hunt told the House that he would not duck the ‘difficult decisions’ over A&E services, adding to the sense of foreboding about the future of NHS services.
Cash and accountability
Hunt is keen to say that the rising cost of NHS services are unsustainable. But, given his government’s actions on this particular issue, it is difficult to see how improving cost-effectiveness is really the motivation.
The NHS that the Coalition inherited was judged by the World Health Organisation (WHO) as the second most cost-effective health service in the world – just behind Ireland’s. The Health & Social Care Act 2012 has been highlighted as an attempt to remodel the NHS more along US lines. The US ‘health service’ came seventeenth on the WHO efficiency league table.
Hunt’s current desire to discourage patients from attending hospital, combined with more distant A&E units, is fraught with dangers, not least because ‘self care’ may actually turn out as ‘no care’, the consequences of which are likely to cost a great deal more.
Indeed, Hunt’s focus on the cost of NHS services is interesting, particularly when you consider that £375bn has been created out of thin air over four years via quantitative easing and given to the banks to do with as they wish. The NHS budget for 2013/14 was £105.3bn.
Obviously, when it comes to rewarding a corrupt financial system with public money so that its players can speculate and give themselves staggering bonuses, affordability isn’t such an issue.
Surely, what this is really about is shrinking the state and moves to make us more dependant on the vagaries of the market – no matter how compromised by fixing scandals and manipulation the markets may be.
Because, if George Osborne’s Autumn Statement is anything to go by, Hunt’s actions are very much in line with the Conservative’s ambition of cutting back the state to pre-1948 levels – ie. before the NHS was established by the then Labour government – by the end of this decade.
And, judging by their approach, if Hunt and Osborne do manage to get their way, there will have been precious little public debate about that, either.
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