Secretary Of State For Health But Social Care Victoria Atkins continued her arm-wrestle with Julian Patterson for the title of NHS Chief Satirist this week, with a splendid interview with ‘The Stylist’ magazine.

“It’s a system that was created by men for men”: Victoria Atkins on the NHS and women’s health

“I’m determined to build the NHS of the future.”

Now it is a good thing for politicians (one of which Mrs Atkins is) to sure a wide variety of means to connect with the voting public. I’m not being scornful about the venue: just the interview content. Because for this direct-to-elector strategy to work, it might be a good idea to have something of real substance that is well-researched to convey.

Mrs Atkins tells Stylist readers that she wants to see the NHS focus more on women’s health issues. This is a fine ambition, albeit that men have lower life expectancy and poorer health on a wide range of conditions. And maternity services in the NHS in England do feel like a bit of a killing field.

Mrs Atkins asserts that “I’ll be bringing forward GP health checks for new mums within six to eight weeks of giving birth so that mothers are asked ‘Are you OK? Is everything all right?’ as well as the focus on the baby.”

Which is obviously lovely, or would be if community midwifery and health visiting had not been mangled over the past fourteen years. The fall in health visitor numbers is catastrophic: published workforce data show a fall from 11,192 FTE in October 2015, to 6,688 FTE in April 2023.

Maternity home visits have declined (this comes from a survey of 1995-2014); maternity staff numbers risen only trivially; and the complexity of births (rises in both maternal age and obesity) has increased although numbers have declined.

That is from one minute’s internet searching: I am no expert in this area. Perhaps Mrs Atkins and team should take a shot at this approach, to ensure that her future interview comments are better-informed. Hello’s journalists may be sharper.

The Stylistics | Official Home Of The Stylistics

The Stylistics are a soul music vocal group. One of the best-known Philadelphia soul groups of the 1970s. Airrion Love, Herbert Murrell, Jason Sharp, Michael Muse.

stylistics-copy

Consultants graciously deign to accept more money

To the considerable surprise of absolutely nobody, the BMA consultants voted to accept the Government’s yet further increased pay offer. You will remember that it was rejected by a very slim margin.

This time around, eligible BMA consultant members voted 83% (turnout 62%) to accept the increased offer, which also makes commitments on reforms to the DDRB system of setting future pay deals.

What do you mean, you’re old enough to remember Rishi Sunak’s ‘final’ decision that “there will be no more talks on pay” last July?

SOS Atkins took to Kiss (formerly Twitter) to laud this breakthrough and the consultants’ acceptance “after weeks of negotiations of this fair and reasonable offer”.

Good old negotiation, eh? It‘s almost enough to make a person wonder whether SOS Atkins is in any form of negotiation with the junior doctors’ leaders.

Doctors Vote (no, they really do - mainly for strikes)

Junior doctors accused of smear campaign to seize control of BMA

Hard-left junior doctors face allegations of running a covert social media campaign aimed at taking over the British Medical Association

The TelegraphHenry Bodkin,

The Boris Johnson Fanzine has a frothing vibe to it presently. It couldn’t happen to a nicer former newspaper. In this appropriately camp piece on ‘Doctor’s Vote’ and the British Medical Association, a ‘senior reporter’ Henry Bodkin makes us ponder how bad the BJF’s junior reporters must be. The article cites zero named sources: it has obviously been briefed by people who think they are going to lose the upcoming votes about ARM representation.

‘There are Reds under the bed!’ Honestly, it’s about that good. This BJF worthy has spotted that a lot of young doctors are radicalised (whatever could have caused this? He does not wonder.) and are using democratic systems to achieve power within the BMA.

Oh, and some of them are mean on the internet to people whom they don’t like, or with whom they disagree.

Next up in the BJF: “Bears in ‘shit in woods’ shock”, presumably.

ONS data implies NHS waiting lists may be an undercount

Experiences of GP practice access and NHS waiting times - Office for National Statistics

Quality and Methodology Information (QMI) for the GP Access Survey, detailing the strengths and limitations of the data, methods used, and data uses.

Office for National Statistics

Might the waiting list be missing two million people?

Those perusing the recent ONS data on ‘Experiences Of GP Practice Access And NHS Waiting Times’ have concerns, as best expressed by Anna Gross’ good analysis for the Financial Times.

Gross writes that “about one in five adults in England is waiting for hospital appointments or treatments, according to a study that underscores the severe care backlogs in the NHS ahead of the general election expected this year. Delays were starkest among 16 to 24-year-olds, with 22 per cent reporting wait times of more than 12 months … for those aged 70 and over the proportion stood at 8.5 per cent.

“One in seven people in need of treatment said they had been waiting for at least a year, with about 12 per cent of respondents noting wait times of more than 18 months.”

Gross adds that the results “also pointed to large regional discrepancies in delays to care. About 18 per cent of adults in the North West said they had been waiting 12 months or longer, the highest of any region, compared with 9 per cent in Yorkshire and the Humber … (it) also looked at people’s access to GP surgeries. It showed 50 per cent of respondents found it very easy or easy to contact their practice, while more than 30 per cent found it difficult or very difficult. Nearly one in 10 people said they were unable to reach their GP practice when they had last tried to contact them”.

There are important caveats: this research is the first of its kind by the ONS to assess the experiences of adults awaiting hospital appointments, tests or medical treatments. It has been weighted to take account of sample size, and thus suggests that about 9.7 million people aged over 16 — equating to roughly 20 per cent of the population — are waiting for hospital care.

More on waits and measures

The Times reported on House of Commons Library data commissioned by the Liberal Democrats, which shows that millions more patients are experiencing four-week waits to see their GPs.

The Thunderer’s write-up notes that “nationally, the number of four-week waits rose by more than a third from 12.8 million to 17.6 million. This meant that one in 20 GP appointments last year — or 5.1 per cent — involved a wait of four weeks or more. 

“In some parts of the country the proportion of patients waiting a month to see their GP is more than double the national average.”

‘The system has to change’ as A&E staff and patients continue to suffer due to overcrowding - RCEM

Overcrowding and ambulance delays continue to pose “extreme challenges” for A&E staff and patients, says RCEM

RCEMSid Draper

And if that didn’t cheer you up enough, the Royal College of Emergency Medicine got a big media hit with its commentary on the final dose of Winter Sitrep data: “overcrowding and ambulance delays continue to pose “extreme challenges” for A&E staff and patients … the final weekly winter ‘situation report’ figures released by NHS England today (5 April 2024) which cover 25 – 31 March 2024 and show that major hospitals are dangerously full”.

The RCEM says that “average bed occupancy across the week was 93.3%, which far exceeds the level considered to be “safe” (85%). The figure peaked on 27 March 2024 when almost 19 out of every 20 beds across the country were occupied – many taken up by people who were well enough to go home but unable to because of the lack of appropriate support.”

Reform report: decentralise power and abolish NHS England

Close Enough To Care: A New Structure For The English Health And Care System is the new report from centre-right think-tank Reform. It’s thoughtful, and proposes some radical regional and local decentralisation of powers and responsibilities, which should in time be accompanied by the abolition of NHS England.

Cut readers know that I am no fan of the current version of NHS England, nor of its leadership. I have indeed referred to it as ‘abolition-prone’ quite often. Its Borg-like absorption of so many other bodies (Monitor/NHS Improvement; the Trust Development Authority; HEE; NHS Kiss …) to some extent reflected Simon Stevens’ willingness to brook no ‘number two’ in the power stakes; and later reflected Alan’s increasing irritation that Simon had successfully kept stuff like responsibility for NHS workforce at, well, arms length (which was, let’s be fair, a decent trick for an arms length body CE).

I am slightly sceptical about the idea of abolishing NHSE, though. I’d cut it down to size considerably, but I just have this instinct that under saner political leadership, there may on balance be a case for the operational leadership of the NHS in England to be at arms length.

From a slightly abstract perspective, I think it is also worth seeing whether further evidence confirms that an independent NHS QUANGO can only be run by a politically very skilled leader. The NHS Commissioning Board’s first leader David Nicholson has been a bit under-rated in this regard by history, partly because the Mid-Staffs scandal emerged on his watch, and mainly because of the widespread Messiah-fication of Nicholson’s successor Simon Stevens.

‘He’s not the Messiah but...’: HSJ’s Christmas cover

This year’s HSJ “Christmas cover” is lovingly ripped off from an idea by HSJ comment editor Andy Cowper, who himself ripped off Monty Python’s Life of Brian.

Health Service JournalHealth Service Journal

NHSE’s current chief executive provides food for thought on this hypothesis. Amanda Pritchard has resisted similar Messiah-fixation and indeed any shows of unwelcome political acumen with aplomb: possibly with several plombs. Her leadership is plumbing the depths, with its current segue from ‘recruit like mad!’ into ‘fire, fire, fire!’.

Trusts told to justify workforce increases, as NHSE warns the service must ‘consolidate’

NHS England has told trusts to review and justify their staffing increases over the last four years, saying there must now be a drive to “consolidate” services and workforce.

Health Service JournalHenry Anderson

The length of arm, as in NHSE independence, will be very short at times, as an incoming Labour Government tries to get to grips (literally) with the multiplicity of crises. There will be a big temptation to grip everything: it is going to require sophistication and good taste on the part of whoever becomes the next Health Secretary and their advisors to work out which leaders and organisations can be trusted with greater autonomy. Doing this will be like riding two differently-paced horses at the same time, and about as comfortable for all involved.

So while abolishing NHSE looks as tempting as hell, given its performance over recent years - and a leadership that is, in one of my favourite Lancashireisms, “neither use nor ornament”, sometimes you have to stop and properly think about things.

This is one of those times. Primary legislation takes political time and effort, and is needed if you want to abolish NHS England, and opportunity cost is A Thing.

So if you want to change NHS England for the better, then you ought to pay attention to the work of a subtle subversive.

Editorial Thursday 23 October 2014: A subtle subversion – NHS England’s Five-Year Forward View

‘Where there is no vision, the people perish: but he that keepeth the law, happy is he.’ – Proverbs 29:18 [”https://www.biblegateway.com/passage/?search=Proverbs+29%3A18&version=KJV] Simon Stevens is a subtle subversive: a highly effective character type. NHS England’s Five-Year Forward View [”http://www.

Health Policy InsightMr Andy Cowper

The subtle subversive in question is called Simon Stevens. He used to be the chief executive of NHS England, and he was quite good at politics.

Simon was hired by a scared, scarred Conservative And Unionist Party leadership of David Cameron and George Osborne, who’d realised just how catastrophically the Lansley NHS reforms had wasted their political capital, without delivering anything that could make things better.

Lansley’s reforms bet the farm on choice, competition and clinical commissioning to drive a self-perfecting NHS system.

And if there is anybody out there who thinks that those things drove any NHS reform whatsoever since 2012, then I’ll have a few ounces of what you’re smoking.

Simon Stevens simply subverted the shit out of the Lansley NHS reforms. It was blatant. He wrote down what he was going to do in the Five-Year Forward View (euthanise competition in favour of integration), and then he did it. And yes, I was one of one people who spotted it and wrote about it.

It worked. Simon spotted a vacuum where some form of potentially effective policy should be, and he filled it.

The difference between Simon Stevens Mark One and Mark Two is important, too.

The key point to learn from subtle subversive Simon Stevens is that you don’t necessarily need primary legislation to effect big change. You just need to be driving things, and to be good at politics - oh, and to have a Government that hasn’t a clue what it’s doing on NHS issues.

But the temptation to abolish NHS England is huge.

Editorial Friday 5 February 2021: Exclusive - Key points and analysis of the Government’s new Health White Paper

“The Health and Social Care Act 2012 put a regime in place which put competition as the organising principle for improvement in NHS care. This has in some cases hindered integration between providers. In practice, the NHS has not operated as the market intended by the 2012 Act … “The NHS

Health Policy InsightMr Andy Cowper

It is a badly-led and friendless organisation: nor is it meaningfully independent, as of the 2022 Act that enshrined the ‘more Matt Hancock’ reforms.

They’re nationalising the private sector! MTW buy Spire private hospital

Trust takes over private hospital

A successful acute trust has bought a private hospital for just under £10m to increase elective capacity.

Health Service JournalAlison Moore

HSJ reports on Maidstone and Tunbridge Wells NHS Trust’ acquisition of Spire’s 28-bedded private hospital for £10 million. The hospital has two theatres; MRI, CT, X-ray and endoscopy equipment; and several consulting rooms, with its beds used for both inpatient and day cases.

The purchase has been funded by NHS capital.

[clears throat] “THEY’RE NATIONALISING THE HEALTHCARE PRIVATE SECTOR! BUY MY MERCH! DONATE YOUR MONEY HERE!”

That’s how it’s done, right?

Recommended and required reading

Kevin Fong and colleagues in the BMJ on the oddness of the attempt to claim that the NHS was “not overwhelmed” by the Covid19 pandemic.

John Appleby and colleagues’ piece for the BMJ Commission on NHS funding.

FT long read on the next pandemic.

Prostate cancer screening still isn’t sufficiently accurate.