Simon Stevens: Unrealistic, And Will Fall On Deaf Ears, by Clive Peedell

Simons Stevens's projected £22bn savings are unrealistic, and his call on political parties to fill an £8bn funding gap will fall on deaf ears.

Despite the swift declarations of political support for the principles of his plan for the next five years of the NHS, NHS England chief executive Simon Stevens is a long way from securing the £8 billion extra by 2020 that he admits is needed to make ends meet even after extraordinarily ambitious efficiency savings of £22 billion.

None of the three main political parties is committed to raise NHS spending by anything like as much as £8 billion: the Tories are sticking rigidly to their planned further five-year freeze to 2021, the Lib Dems have offered two related injections of £1 billion from 2017, and Labour has promised £2.5 billion also in 2017 – by which point the financial crisis already brewing in the NHS will be boiling over into cuts and closures.

The Tories keep banging on about needing a strong economy for a strong NHS.

But only this week George Osborne was shown to have missed his deficit target and their real terms cuts to NHS funding have led to rising waiting times, an A&E crisis and GP surgeries in meltdown.

Meanwhile Labour's plans for a Mansion Tax are already falling apart and won't raise sufficient funds.

The National Health Action Party is putting forward a genuine alternative plan that would break now from the spending freeze and start with an immediate injection of extra funding, if necessary raised through taxation, to be followed by efficiency savings based on stripping away the wasteful bureaucracy of the market​,​ coupled with measures to force the rich and big business to stop dodging £120 billion a year in taxes and pay their fair share towards the public services and health care we all need.

Simon Stevens has totally ignored the grotesque financial waste that is draining billions of pounds from frontline care in our NHS - 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.

We also need to consider the damaging physical and mental health impacts of austerity economics. Poverty and inequalities are the big issues that the government must tackle if good health is to be preserved.

Another striking thing about Stevens's plan, which many reports see as radical, is that few of the ideas are new: most have been at the centre of various attempts at reorganising the NHS over the last 20 years, during which time few of the promised new services outside hospital have taken shape, and far from reducing dependence on hospital services, attendances at A&E and GP referrals for hospital treatment of continued to rise stubbornly each year.

Many of Stevens's proposals to seek ways of reducing demand for hospital treatment by improving public health are quite sensible – even if they cannot be guaranteed to deliver any significant change in hospital caseload in the five-year period.

But it's less clear that some of the proposals for reorganising the delivery of services could generate anything like the scale of savings that are required, especially when some of the proposals in the Stevens plan involve substantial additional new investment:

• He proposes an end to the continued freeze on NHS pay, which has so far delivered at least a third of the "cost savings" since 2010.
• He proposes to "radically upgrade" prevention and public health.
• He proposes to give "resources and support" to the introduction of what he calls radical new care delivery options including establishing "multispecialty community providers" bringing together GPs, nurses, community health services, mental health and social workers, employing hospital consultants and running community hospitals.
• He promises more NHS support for frail older people living in nursing homes.
• He also promises to "invest in new options for our workforce, and raise our game on health technology".

None of the costs of these suggestions is discussed.

But the plan for example for "multispecialty community providers" appears to revive Lord Darzi’s controversial "polyclinics", and would inevitably mean capital investment in new, larger buildings, new equipment, possibly including MRI scanners, and the recruitment of professional support staff, some of whom are already in short supply.

It's not clear how scattering the services which are currently provided in specialist hospital centres across a wider network of smaller centres could possibly be more efficient in terms of the time of consultants and professional staff or save money.

Dr Clive Peedell is Co-Leader of the National Health Action Party.

To Speak The Truth To Those In Power, by Clive Peedell

This is a big opportunity for Simon Stevens to wake up the government to the realities of the crisis and meltdown that the NHS is facing.

He must make the point that flat funding of the NHS is a policy mistake in the context of health inflation running at 4% and an increasing population.

Hence per capita spend on the NHS has fallen under the coalition. Efficiency savings are effectively cuts, and they have gone too far. Patient care and patient safety are at risk.

The NHS clearly needs more investment, and that needs to be at least a 4% increase year on year. This could be funded by addressing the NHS elephant in the room. That is the internal market, which is estimated to cost the NHS at least £5bn per year.

Thus, instead of employing accountants and lawyers to deal with the market bureaucracy, the money could be spent on frontline care where it is needed.

We also need to hear about the wasteful PFI, and a call for it to be abolished, with existing schemes bought out or refinanced at better value for the taxpayer.

If Simon Stevens wants to save the NHS then he needs to engage with NHS staff to get them onside with his vision and plans.

This can only happen if he is open and honest with them. He therefore needs to follow the lead of the cabinet minister who admitted the NHS reforms were a mistake.

The enormous financial cost and associated upheaval of this undemocratic top-down reorganisation has been hugely damaging and must be acknowledged.

In order to address demand on the NHS, we must also see a focus on the social determinants of health such as poverty and deprivation.

Austerity policies are unsustainable and incompatible with a healthy welfare system and the NHS won't survive as as free at the point of service system much longer.

Public health must also be top of the agenda with a call to back plain cigarette packing and a minimum price on alcohol.

We must also hear the arguments that healthcare spending actually helps to stimulate economic growth and investment in the NHS will help fuel the economy and address wealth and health inequality.

I hope Simon Stevens takes this opportunity to speak the truth to those in power.

The solutions are actually there, but he should listen to NHS staff and the public, not to overhyped management consultants and to politicians with vested interests.

What the NHA Party is calling for:

Finance:

• Guarantee a minimum 4% annual rise in NHS spending to keep pace with healthcare inflation. This should be funded from​ general​ taxation including a 1​ ​​penny temporary rise to address the NHS spending gap until ​NHA ​policy ​initiatives ​(remove the market, halt privatisation, end PFI) ​bring ​billions of pounds of ​savings.
• Aim to increase NHS funding to at least 10% of GDP to bring us closer to the levels of healthcare spending in other G7 countries.
• End the costly Private Finance Initiative.
• Use the purchasing power of the NHS to get the best value in procurement.

Organisation:

• Repeal the Health and Social Care Act in the least disruptive way possible.
• Remove the competitive market by abolishing the purchaser provider split.
• Halt and reverse NHS privatisation Integrate health and social care.
• Bring back national and regional planning structures into ​the ​NHS.
• Involve public health and representative clinical leaders in the policy-making process.
• Keep public health improvement teams in Local Authorities and re-establish public health teams in the NHS.

Patient care:

• Abolish prescription charges and resist imposition of charges for NHS services currently free at the point of use.
• Improve the patients' complaints process and protect whistle-blowers within the NHS Prioritise prevention of illness and the social determinants of health in all policy-making​, including minimum alcohol pricing, plain cigarette packaging and a sugar tax.
• Ensure safe staffing levels throughout the NHS with an increased number of GPs, nurses and midwives. 
• Create a sustainable workforce by improving training places, recruitment and retention​, fair pay, reducing burn-out and losing staff outside the NHS.
• Establish parity of esteem between mental and physical healthcare​ and invest in crisis care teams for mental health patients.
• Ensure women are able to give birth locally and safely whether at home or in hospital, and improve continuity of care by midwives.

Dr Clive Peedell is Co-Leader of the National Health Action Party.

On Mistakes and Strikes, by Clive Peedell

This and ​this are a huge embarrassment for the Tories, but also a depressing revelation.

It's no surprise to us that these reforms have been a disaster as this is exactly what we predicted - a huge mistake from start to finish. The NHA Party was launched precisely because of, and in direct opposition to, these reforms.

Within months of taking office, the Tories broke their promises of no top down reorganisation of the NHS and no privatisation. They ignored widespread professional opposition and forced through their disastrous Health and Social Care Act.

It's totally reckless of David Cameron to have backed the​ reforms without even understanding them. And his decision to make the protection of the NHS a central part of his conference speech is now shown to be disingenuous and inept, as behind the scenes he was regretting his own reforms as a huge strategic error.

The Prime Minister seems to care only about the dreadful impact they've had on the Tory party rather than on millions of NHS patients and staff.

This damaging reorganisation wasted billions of pounds at a time of unprecedented NHS austerity, has accelerated privatisation, worsened patient care and  left the NHS facing a £30bn funding gap by 2020.

No wonder Andrew Lansley vetoed publication the NHS Risk Register at the time, which predicted the current problems now facing the NHS would occur in relation to the changes.

It just goes to show that the Tories can never be trusted with the NHS, and that the NHS is electorally toxic for them.

We can’t run the NHS without suitable staff, we can’t improve the NHS without more staff, and we can’t recruit staff if pay keeps falling behind inflation and comparable jobs.

The nationally agreed pay system established in the last decade is now under sustained attack.

It’s outrageous that Jeremy Hunt has refused even a meagre 1% pay rise for 60% of NHS staff and 70% of nurses. One in five NHS workers are now forced to take on second jobs just to get by.

It’s also disingenuous to claim there has to be a choice between paying staff at agreed rates and inflicting savage cuts when it is this government that has wasted and continues to waste billions of pounds every year on an NHS reorganisation that no one wanted, on a market system and accelerated privatisation that  mean worse patient care, and on PFI loans that are bankrupting hospital trusts.

Why is Mr Hunt able to dismiss the 1% pay rise for NHS staff that was recommended by the Independent Pay Review Body, and yet David Cameron is unable to dismiss a 10% pay rise for MPs recommended by the Independent Parliamentary Standards Authority. It appears there is one set of rules for hardworking NHS staff and another set of rules for MPs.

The fact that NHS staff have been driven to take strike action speaks volumes for the damaging, morale-sapping policies this government has inflicted on them.

For these reasons, we support this strike action. NHS staff deserve fair pay.

Dr Clive Peedell is Co-Leader of the National Health Action Party.

"An Empty Populist Pledge", by Clive Peedell and Louise Irvine

Reaction to David Cameron's pledge of 7 day a week GP access from National Health Action Party co-leader Dr Clive Peedell and London GP, Dr Louise Irvine.

NHA co-leader, Dr Clive Peedell said:

"This announcement illustrates the chaos within the Coalition. The PM says he wants to tackle the causes of ill health yet his Chancellor announces cuts to the incomes of the working poor creating greater poverty the leading cause for ill health.

The PM supported the Health & Social Care Act which divested the Secretary of State for Health the responsibility for providing a health service yet here we have politicians deciding where scarce resources are best spent without any economic analysis in the public domain.

The announcement he should have made was to abolish the NHS market and reinvest the billions currently wasted on bureaucracy in frontline services whilst simultaneously tackling the determinants of ill health."

NHA's Dr Louise Irvine, London GP and prospective parliamentary candidate for SW Surrey, the seat of Jeremy Hunt said:

"This is utter nonsense. It is an empty populist pledge. Many of the pilot schemes that he claims have been a success haven't even got off the ground, so where's the evidence that they are effective?​

£100 million cannot even begin to make up for the loss of funding to maintain existing GP services never mind extending them to 7 days.

£100 million is about £2/person/year. For an average GP practice of 6000 patients that means an extra £12000 a year. For that the practice would have to be open 60% longer than currently (from 52.5 hours to 84 hours a week) and pay doctors, nurses and admin staff to be there. That would be approximately 1500 extra hours a year - £8 for every extra hour opened. That would not even pay for a receptionist for the surgery never mind the medical staff to provide the service.

This is a bad joke and shows how disdainful the Tories are of ordinary people and their health services. Instead of recognising and tackling the real crisis in general practice - not enough GPs, £1 billion of funding cuts to GP services over past 5 years and a recruitment crisis where young doctors are not choosing general practice and older ones are retiring early - Cameron is pretending that if you give a measly £100 million that will somehow sort the problems in general practice.

The real issues that people are concerned about are not 7 day opening but actually being able to see a GP in a reasonable time, and for the GP to have long enough to really deal with their problems properly.

Indeed, with the rate of practice closures and threatened closures, for What is needed is a reversal of the decline in percentage of NHS funding spent on general practice, bringing it back up to 11%, and the resources should be invested in more GPs with smaller patient lists so they have more time with their patients. Increasing average appointment time from 10 to 15 minutes would make a great improvement to the patient experience and quality of care.

That is the kind of proposal that would make a real difference, not Cameron's populist posturing. But that would take real money - and Cameron would rather give tax cuts to the rich than invest in our NHS."