There was news this week that Health Secretary Jeremy Hunt faces an ‘unauthorised’ progressive alliance in his Surrey constituency that will attempt (against Labour Party policy) to unseat him in the forthcoming general election. The proposal is that local Labour Party and Green Party supporters stand aside and swing behind a ‘single progressive’ Liberal Democrat Party candidate. But far from generating optimism, this news filled me more with trepidation as it might signal most clearly all that is wrong or deficient in our system of parliamentary democracy.
The reason for this local, progressive alliance, is not because there is a feeling in the foothills of Surrey that Hunt has been neglecting the need of his constituents. No, rather it is in reaction to Hunt’s actions as Secretary of State for Health, in a period, (following the 2012 Health and Social Care Act) which has seen an unprecedented rise in the scale of private providers operating in the English NHS. Many commentators have written that these developments mark the creeping (or not so creeping!) privatisation of the English NHS, as more and more contracts are handed over to companies such as Virgin, Capita and Optum. As the three links demonstrate, these private sectors contracts are typically not without controversy.
This period has also been marked by an unprecedented series of strikes by junior doctors, objecting to the imposition of a new contract. Much of this struggle became embroiled in discussion about the need for a 7 day NHS. Hunt claimed that available evidence demonstrated that there was a higher chance of dying for patients admitted to hospital at a weekend, and that this was due to lower levels of staffing at weekends. Part of the dispute around the new Junior Doctors contract were changes to what counted as unsociable hours, and reduced rates of remuneration for working on weekends. Hunts claims about the excess mortality data were roundly rejected.
Similarly, in September 2016, the Royal College of Physicians issued a report which described the NHS as Underfunded, Under-doctored and Overstretched. Pulling no punches, the RCP stated that ‘patients and communities face a stark choice – “increase funding or cut care”. They call for an increase in NHS funding that i) meets the demand for health services, ii) sets realistic targets for efficiency savings (by implication, current targets are unrealistic), iii) protects funds for transformation (which currently are only guaranteed by adherence to STP plans) and iv) invests in the long term sustainability of the NHS (so by implication, there is currently insufficient investment).
These claims are not unsubstantiated. They point to the fact that waiting times are at their longest since 2007, that patients spent a claimed 1.8 million extra days in hospital because of delays in their discharge, that Clinical Commissioning Groups are rationing access to non-urgent operations, and that such is the pressure on beds and staff that many hospitals are temporarily closing their doors. The litany continues, seven out of 10 trainee physicians have reported working on a rota with a permanent gap. Hospitals are struggling to fill 2 out of every 5 advertised posts, and 96% of trainee doctors have reported gaps in nursing rotas. On the basis of this evidence, the issue of understaffing does not appear to be explained by staff refusing to work at the weekend!
In detailing some of the issues regarding overstretched staff, the report outlines how:
NHS staff feel caught between rising demand and squeezed budgets. Four-fifths of trainees say their job causes them excessive stress; three-quarters go through at least one shift a month without water; and, on average, they work an extra 5 weeks a year on top of their normal hours. 95% of trainees warn that poor staff morale harms patient safety.
On top of this, consider the fact that hospitals have dropping the mandatory requirement for patients to be seen within 4 hours of presenting at A&E. All of this paints a picture of an NHS on its knees.
Which brings me back to Surrey and Jeremy Hunt. In the face of all of this evidence, where he has been accused of misrepresenting the data, of underfunding a national service, of privatising it by the back door, why is the political response one of an almost underhanded subversion. Proper Parliamentary scrutiny should have held the Executive to account and opposition parties (mainly Labour) have spectacularly failed to do this. So it has fallen to local political parties to try and do this by going against national party policy. Granted, whilst there is a long history of local alliances to deprive politicians of their seat, (Martin Bell, the ‘man in the white seat’ who stood against Neil Hamilton is the most notable relatively recent example), this tactic points to a fundamental flaw in our democratic model. Serious issues of accountability are trivialised in a way that would not be possible under a different (more European) system of proportional representation. If we cannot hold Jeremy Hunt to account for the litany of problems outlined by the Royal College of Physicians and others, and instead are reliant on the will of local politicians defying their party lines, then our democracy is indeed in a parlous state. In this regard, I cannot help but think, but for Brexit, the current state of the NHS would be the political issue of the day. The fact that it is not shows how Brexit itself is undermining our political system of accountability.
Postscript: Right on cue, the same morning as this post was published, Jeremy Hunt appeared on British TV, where he deflected 4 separate questions about the NHS by talking about Brexit. His response to questions about the crisis in the NHS was “if we have a strong leader doing those negotiations, doing the best deal for Britain, we will have more money for our public services and that will be good for the NHS.” The political usefulness of Brexit in this election campaign is apparent for all to see.