Dr Louise Irvine interview about the NHS Crisis on Talk Radio this morning (interview begins 9 mins in).
Dr Louise Irvine: Good Morning James (Max, Talk Radio)
Talk Radio: Is (Jeremy Hunt’s) “Sorry” enough (over NHS Winter crisis)?
Dr Louise Irvine: “Sorry” is not enough. Patients are really hurting. Staff are really hurting. This is a dreadful crisis but it is one that happens year on year, and each year worse than the year before. When I heard Jeremy Hunt say “Sorry”, it reminded me actually of some of my patients who have been subject to domestic violence where an abusive partner keeps hurting you and then keeps saying sorry. What are you supposed to do? Keep saying, oh that’s all right then? At what point do you have to stop accepting sorry and actually start saying you are responsible. You have to take that responsibility. You have actually failed. I actually think that Jeremy Hunt should resign.
Talk Radio: You think he should resign. There are others who would say, look, he’s got a very difficult job, and the difficult job is trying to juggle an organisation that is outmoded, it is outdated in how it is structured, it wastes a lot of money, and it is a bottomless pit. You can never spend too much money on health, and we’re going to have to ration it. He’s doing just that.
Dr Louise Irvine: Those things you have listed I would say are myths. The NHS is one of the most cost effective and efficient healthcare systems in the world. It has actually suffered because of meddling by not just this government but by the coalition government.
Talk Radio: So, why yesterday, when I was speaking to various health professionals who know far more than I do, did they all say the way it is structured, the way the NHS procures its drugs, for example, the way that the NHS procures its services across the country, the way that the NHS hires people (particularly when it comes to temporary staff), all of these things and management as well, are quite wasteful.
Dr Louise Irvine: Yes. In 2012, the coalition government led by the Tories brought in a very costly reorganisation – we call it a redisorganisation – (it was) the Health and Social Care Act which did exactly that. It actually split the NHS up further. It created chaos and fragmentation. It has been criticised by The King’s Fund for being bewildering in its complexity and actually wastes a whole lot of money on what we call “transaction costs” by trying to make the NHS into a market structure. Yes, there is waste in the system. That is because of consecutive recent policies since 2012. The basic structure of the NHS is actually very sound and effective.
Talk Radio: Well, that’s your view and opinion and I understand that. If we’ve got a system that needs to be organised in a different way, you can either continue and just throw money at it or you can try and reform it, can’t you?
Dr Louise Irvine: If you compare the spending in the UK on health and social care, it is about 10% of GDP. Other comparable economies, for example, France, Germany, The Netherlands, Sweden, Norway, spend much more. They spend 11% of GDP which is actually about £18bn a year more. Now, therefore, the way that we actually organise and spend on our healthcare is one based on a principle of austerity, of cutting back on the spend. Compared with other countries that we want to compare ourselves to, we are actually underfunding our NHS. It’s gone through its longest funding squeeze. It’s 7 and a half years into a 10 year funding squeeze which is unprecedented. At the same time, we have bad planning, very bad workflow planning, not enough nurses, we’ve been making major cuts to public health. As I said, we are wasting lots of money on endless reorganisations. These are the issues. This is the bad planning that has been going on for several years now, under Jeremy Hunt’s watch. And, that is why the NHS is in crisis. It is not about the fundamental structure or the nature of the NHS. It is about what this government and the previous government have been doing to the NHS.
Talk Radio: Well, that is one argument but never, certainly in my lifetime, has anyone looked at the NHS and said it is doing everything marvellously. Even when, for example, there were significant amounts of money being pumped into it, we then had different kinds of scales. We had issues where hospitals were killing people, we had situations where hospitals were losing data, we had situations where hospitals were bungling operations. We are always going to have problems with the NHS because of its size, the huge amount of work that it does and, in essence, no politician of any political colour is ever going to get it right, are they?
Dr Louise Irvine: Well, by 2008, 2009, 2010, the NHS had actually improved significantly. I’ve been a GP since Margaret Thatcher was Prime Minister so I’ve been doing this job for a long time. The NHS had definitely improved during the years of the 2,000s. It’s not perfect. I was a critic also of aspects of Labour policy. They did though start to invest properly in the NHS and we did see tangible results. The NHS had its highest score of popularity with the public by 2010. The bungling…People are unsafe now. There are people are lying in corridors. There are people who are seriously ill who are now at risk of dying. There is an increase in the dangers that they are facing. This is not something that is from the past this is happening now.
Talk Radio: So, what Jeremy Hunt has proposed then is non-essential operations are being put off in order to ease the crisis. That’s quite a sensible thing to do, isn’t it?
Dr Louise Irvine: When you say non-essential operations, what do you mean? Do you mean ones that are not immediately life threatening? All operations are essential ultimately. Nobody goes in for an operation just for fun. So, we’re talking about what we call elective or planned operations. That might be a hip replacement. It may be somebody who is in severe pain or has been severely disabled by arthritis in the hip. Their having to wait longer and longer for that necessary intervention is actually going to cause longer suffering. So, you’re going to see real chaos. Putting off operations for a month or maybe longer is actually going to cause a huge backlog.
Talk Radio: OK. I understand that. So, if the solution is whether that Jeremy Hunt has to go or more money has to go into it, or all of these solutions that people come up with, where is the money going to come from to pump into the NHS that you would like to see clearly?
Dr Louise Irvine: Austerity is a deliberate policy of our government. It is not a policy shared by other similar Western countries who have not actually….
Talk Radio (interrupting): Well, it’s necessary because we’ve spent too much money and we’ve borrowed too much money.
Dr Louise Irvine: It’s a choice. Austerity is a choice and …
Talk Radio (interrupting): OK, where does the money come from?
Dr Louise Irvine: The money comes from taxation. That’s one way…
Talk Radio (interrupting): So, you wanna put up tax?
Dr Louise Irvine: That’s one way we could do it. We could actually start collecting some of the tax that is not being collected from tax avoidance. We could start reversing …
Talk Radio (interrupting): We can’t do that unilaterally. If somebody decides to move their money overseas and offshore. Guess what? You can’t get it.
Dr Louise Irvine: Most of the private healthcare companies that are providing healthcare in the UK are actually based in offshore tax havens. All the Private Finance Initiatives companies are….
Talk Radio (interrupting): So, what do you do? You just say, right, you can’t come to this country as you’re based offshore?
Dr Louise Irvine: You deal with it on an international level. I think the UK should have been all along…
Talk Radio (interrupting): But, that’s not gonna be done by next week.
Dr Louise Irvine: Well, no because this issue should have been planned long ago. As I was saying….
Talk Radio (interrupting): It’s very easy to say we’re gonna fix this just by taxing people more.
Dr Louise Irvine: We were saying this 3, 4 5, years ago. We could have been saying this when it was clear the NHS was heading off a cliff edge. This is a predictable …
Talk Radio (interrupting): But, the NHS has not had any less money.
Dr Louise Irvine: It has had effective flat line funding of 0.1% per capita real terms increase since 2010 at a time when real healthcare costs are going up by about 3% to 4% each year. And, that is international. That’s not the UK being inefficient. That is the cost of modern healthcare for a…
Talk Radio (interrupting): So, in essence, tax more and then we can have the NHS. What about asking people to pay something towards that? You mentioned France. In France they pay various aspects of their healthcare and you go into Europe and they have these hybrid models. Is that a good idea?
Dr Louise Irvine: Most of those European countries are spending more on health altogether. The evidence is that if you ask people to pay, it is the poor and more worse off that suffer most – the people who are the most sick. Actually, it increases inequalities. A tax funded system where everybody receives what healthcare they need at the point of use is actually the most efficient way of organising equitable healthcare.
In his Telegraph article attacking Stephen Hawking’s 19 August speech on the NHS at the Royal Society of Medicine Jeremy Hunt made a series of statements that exhibited his trademark use of weasel words, distortions and omissions. But there was one outright lie that really bothered me as it exemplified the very thing he was being accused of by Hawking – shameless abuse of statistics. In the Telegraph article Hunt produced the following bar chart of the different parties’ manifesto promises on NHS spend by 2022-23.
I knew immediately there was something wrong with that graph because I had read the Nuffield Trust’s report on the different parties’ manifesto pledges on NHS funding and recalled that Labour had promised to increase funding by more than the Conservatives. I looked at the Nuffield report again and discovered that what Hunt had done was truly sneaky. He had used two different baselines from which to measure the different parties’ funding pledges, thus artificially deflating the Labour and Lib Dem NHS funding pledges by several £billion relative to the Conservatives.
For the Conservatives his baseline was current 2017/18 NHS spend (£123.7bn a year), and for Labour and the Lib Dems his baseline was the projected NHS spend in 2022/23 if existing government spending plans continued (£128.4bn a year).
To make a true comparison Hunt should have used the same baseline for all parties – either current or projected spending levels. That’s what the Nuffield report did.
It analysed the different parties’ manifesto spending pledges and estimated the promised NHS funding increase of each party by 2022/23 compared with spending this year.
The graph below from the Nuffield Trust shows the true picture. It also shows that all three parties’ spending pledges will mean a reduction in NHS spend as a percentage of GDP and will fall well short of various reliable predictions of NHS funding requirements.
Conservatives spending proposals would bring total health spending in England to £131.7 billion by 2022/23, an increase of £8 billion over spending this year.
Labour’s spending commitments would bring total health spending in England to £135.3 billion in 2022/23; an increase of £11.6 billion over spending this year.
The Lib Dems promised to increase NHS spending to around £132.2 billion in 2022/23; an increase of £8.5 billion over spending this year.
Jeremy Hunt’s bar chart should have looked like this:
Labour promised to spend nearly £4 billion more on the NHS than the Tories. The Lib Dems also promised to spend more than the Tories.
Hunt’s trick of using two different baselines tells the opposite of the truth. This isn’t “cherry picking”. It is a deliberately deceptive use of statistics. The real data was there, already analysed and easy to find. Hunt has a team of people working for him. He can’t pretend he didn’t know.
Recent figures show that NHS staff shortages have got worse but statistics don’t convey the dreadful reality of how this affects NHS staff and patient care. To understand the real impact we have to read the accounts of brave doctors, nurses and other health care staff describing the daily stresses of their work – stresses that are leading many to breaking point and to leave the NHS.
There are now more nurses leaving the profession than joining.
Those that remain struggle to provide safe effective care. In the recent NHS staff survey, 47% said current staffing levels were insufficient to allow them to do their job properly and 59% reported working unpaid overtime each week.
Staffing levels in some places are so poor that not only can quality care not be guaranteed, but safe and humane care is also at grave risk. Doctors and nurses are warning that this is creating another “Mid Staffs” across the country.
Recruitment from overseas to fill the gaps is now at risk too. Since the Brexit referendum applications from EU nurses have dropped 96%. This is having a serious impact on nursing numbers.
But the shortage of 30,000 nurses is not caused by the Brexit threat alone. The chronic shortage of nurses is the result of years of short-term planning, cuts to training places, underfunding of the NHS workforce and pay restraint – amounting to a real terms pay cut of 14% since 2010.
The government’s response is to try to minimise the scale of the staff shortages while announcing new initiatives that are inadequate to the problem.
For example Jeremy Hunt recently tweeted there were now 12,000 more nurses than in 2010.
But this is untrue. In May 2010 there were 280,950 nurses in England and in March 2017 (the most up to date stats we have from NHS Digital) there were 285,893. This is an increase of 4,943 or 1.6%. Yet over that period the population rose by 5% which means that there are now fewer nurses per person than in 2010. Key areas of nursing have suffered actual reductions in numbers: mental health being a prime example. See this excellent blog by David Munday for detailed analysis.
David Munday cites figures showing that between 2010 and 2017, the number of mental health nurses reduced by 4,942 (from 40,630 to 35,688) or 12.2%. It means a change from 1,296 people/mental health nurse to 1,549 people/mental health nurse.
This is scandalous given years of Government rhetoric about “parity of esteem” between mental and physical health.
There has also been a decline in numbers of community based nurses. One in seven district nursing posts were lost between 2014 and 2016. The government’s decision to hand over responsibility for children’s community nursing to local authorities while simultaneously cutting their funding has led to cuts in health visitor and school nurse numbers. Health visitors have declined from a peak of 10,309 in October 2015 to 9087 in March 2017.
The Government’s response to this is to say they will increase nurse training places. It has just announced some £16 million for 10,000 extra clinical placements for nurses, midwives and allied health professionals by 2020. It seems the government was only moved to act on funding because universities protested that they had been given no extra funding for the clinical placements. This is yet another example of a reactive decision to avoid bad headlines rather than sensible pro-active planning for the future – because extra nurse training places should have been funded years ago when people began warning about the impending crisis.
Latest data shows the number of nursing degree applications has fallen by 23 per cent this year compared with 2016. This is in large part due to the abolition of the NHS student bursary. Even though there are still more applicants than places there has been a reduction in applications from mature students with children – a group that has always been a key demographic for nurse recruitment, and more likely to stay on in nursing once trained.
But even if there is to be an increase in nurse training places, those new students will not qualify for several years, so will not help the current staff shortage. And increasing training places won’t help if high numbers of nurses still continue to leave the profession. The only way to ensure adequate staffing levels is to stem the flow of nurses and other health workers leaving the NHS and this means reversing the decline in pay and conditions. Pleas to the government to address this by nurses’ unions such as the Royal College of Nursing have fallen on deaf ears.
Nurses have reached their limit. In 2016 we saw unprecedented industrial action by junior doctors. Now it looks like the nurses are prepared to consider taking industrial action to defend their pay and conditions. The main nurses’ union, the Royal College of Nursing, recently surveyed its members to gain their views on industrial action and a majority indicated their support. As with the junior doctors this is not just about pay but about ensuring we have the necessary nursing workforce to provide safe high quality patient care.
Those of us who care about the NHS and its future can show support for our nurses and other health care professionals in their struggle for decent pay and conditions by joining them at their Scrap the Cap rally in London on 6 September. Let’s show them how much we value our nurses and make it a day to remember!
Today, 15 different organisations representing NHS employees (including the Royal College of Nursing and the British Medical Association) have written to the Prime Minister urging her to scrap the draconian pay cap on our NHS staff. (1)
“The public sector pay cap has forced professionals out of jobs they love…
Those who stay are overstretched and under pressure to do ever more with less…
The longstanding cap stands in the way of recruiting and retaining the best in healthcare.”
The pay cap has meant that there has been a 14% fall in real-term nursing pay since 2014 (2). This is just one of the factors that is leading us towards a crisis in staffing.
Not only is it unfair, it is incredibly short-sighted. Along with the removal of the bursary that enables people from all backgrounds to train to become a nurse (3), the ever more stressful conditions leading to 50% of nurses considering leaving the profession (4), 1 in 10 posts already vacant and Brexit threatening to stop us recruiting the additional staff we need (5), this pay cap is simply making things worse – for nurses and, ultimately for us. And remember, it is not only nurses but other health care workers too, for example physiotherapists and OTs, that are affected by the loss of the student bursary and by the pay cap.
I have been so touched by the support I have had recently for standing up for nurses and other health workers – both in the election campaign and since then when you saw how Jeremy Hunt used his victory speech to personally attack me and accuse me of spreading falsehoods (6). I know that what I wrote in response, where I provided evidence about the extent of the NHS staffing crisis, resonated with so many people because of the respect and gratitude you feel for our NHS staff and your awareness of how vital it is to have adequate and sustainable staffing levels.
It’s time to remove this pay cap, to pay our nurses a fair wage and to start to take the steps to move the NHS back from the brink of a staffing crisis.
Thank you for reading
Dr Louise Irvine
Dear Mr Hunt
On Thursday night, in your acceptance speech, you accused me of “falsehoods”.
In your words, you accuse me of lying about “both our record with the NHS and also our motives”. You were clearly rattled that over 12,000 people in South West Surrey showed their concern for the NHS and voted for someone who questioned your record, but that is what democracy is all about – holding the government to account.
The truth is that I haven’t lied for the simple reason that I haven’t needed to. The facts speak for themselves.
When I talked about your record, I drew out many facts:
- The number of people lying on trolleys waiting more than 4 hours to be admitted to a hospital bed increased from 387,737 in 2015/16 to 560,108 in 2016/17 – that’s a 45% increase in one year. I’m sure I don’t need to remind you that a trolley is one of the least safe places to be in the health care system or of the three patients who died in Worcestershire hospital on trolleys during last winter’s crisis?[i] The British Red Cross described it as a “humanitarian crisis.”
- Ambulance response times, especially for the most urgent calls, are the worst since records began. The national target of reaching 75% of Category A calls within eight minutes has not been met for 32 consecutive months. [ii]
- Mental health services are struggling. Suicide is the commonest cause of death in boys age 5-16 yet children’s mental health services can’t cope with the volume of referrals and often there is not a single mental health bed anywhere in the country due to cuts to mental health provision. [iii]
- Performance against the 6-week cancer treatment target and the 18-week elective treatment target are deteriorating. [iv]
- Infant mortality is rising for the first time in years, having been rising for poorer children for a decade. [v]
- The Royal Society of Medicine attributed the 30,000 excess deaths in the winter of 2015 to cuts to health and social care. [vi]
- The NHS has fallen further down international league tables of mortality due to treatable causes. [vii]
None of these is a lie.
I also talked about the increasing privatisation for the NHS and your quote that “I am not privatising the NHS”. Was it a lie when I pointed out that the percentage of Dept of Health budget spent on for-profit providers rose by 25% in two years? [viii]
Perhaps it was my comments about funding that you felt were untrue. I said that the NHS had been underfunded and that future plans in the manifesto were insufficient. In fact, it was your government that was rebuked by the health select committee (including two Conservative MPs) for claiming that you’d be spending an extra £10 billion a year on NHS by 2020.[ix] They pointed out that a large proportion of this was taken from public health and doctor and nurse training budgets. Moving money around within a service to appear more generous than you actually are is fundamentally dishonest. [x]
In fact, your claim that you will be spending an extra £10bn per annum by 2020 compared with 2015 turns out to be only a £4.5 bn increase. This amounts to a 1.1% annual rise each year in the decade from 2010 -2020[xi], the biggest funding squeeze in NHS history and not even half of the 2.7% per annum forecast growth in need over that period, according to the NHS chief executive.[xii] As for the future, Prof Anita Charlesworth of the Health Foundation says that the promised extra funding for the NHS in the Conservative manifesto is far less than the NHS needs.[xiii]
Maybe you are accusing me of lying when I draw attention to NHS staff shortages and the disgraceful way you treat NHS staff:
- In 2015, Health Education England calculated that the NHS had 30,000 fewer full-time equivalent nurses than needed – equivalent to nearly one in 10 positions.[xiv]
- You have imposed a draconian pay cap on nurses meaning their pay will have been cut by 12% by 2020[xv]
- You have removed the bursary for student nurses, meaning many people who want to train to become a nurse can’t afford to do so[xvi]
- You have treated nurses and junior doctors with contempt. Record numbers are taking time off with stress because they fear that patients aren’t receiving the care they need[xvii] and 50% of nurses are considering leaving the profession because of this[xviii]
- In the recent NHS staff survey, 47% said current staffing levels were insufficient to allow them to do their job properly and 59% reported working unpaid overtime each week.[xix]
- Since your announcement in 2015 of 5,000 more GPs by 2020 we actually have fewer GPs now than two years ago! [xx]
In the election campaign I stated that your performance as Health Secretary is destroying the NHS, demoralising staff and risking patient safety. As you can see from the above, this is absolutely true.
Finally, you accused me of lying about your motives. I have no idea what your motives are for destroying our NHS, but I have tried to give you the benefit of the doubt.
I have assumed that you are doing it deliberately – in order to run it down and provide an excuse for privatisation.
If I were you I’d accept that interpretation, because the alternative is that this has all been caused by your sheer incompetence.
Patients and NHS staff deserve better than this. The NHS is a great organisation and provides excellent care to most people most of the time, thanks to its dedicated and hardworking staff. But it is cracking at the seams and sometimes failing, due to the many pressures it is under. I am motivated by the desire to defend the NHS and raise the alarm about the dangers it faces from a continuation of Conservative policies. And as long as you are health secretary I will continue to hold you to account for what you are doing to the NHS.
Dr Louise Irvine