Posted by: Nigel Praities Editor's Blog11 July 2016
So, we are to have a new Prime Minister tomorrow. And she is probably thinking more about squaring off with Jean-Claude Juncker rather than the NHS right now.
It is time to work out a sustainable plan for the health service
Of course Teresa May’s Brexit negotiations are absolutely crucial to get right, but I hope she is aware that another part of her predecessor David Cameron’s legacy is a health service in probably its most perilous place since 1948.
Ms May has said little to date about the NHS apart from that she would ‘cherish’ this unique institution, but unless the new PM is not careful, the whole house of cards that the Conservatives have built may come tumbling down on her watch.
A mixture of mismanagement, neglect and bloody mindedness have meant that systemic problems in the health service are now beginning to burst through the wallpaper, like long-hidden rising damp. Ms May has promised to build a country that ‘works for everyone and not just the privileged few’. This must include urgent action on the health service, the greatest post-war vehicle of social justice that is rapidly running out of steam.
I doubt that Ms May reads this column, but if anyone close to her does, then here are five areas that I believe need urgent action within her first few months of office.
One, stabilising the NHS finances. A King’s Fund report published today makes grim reading: a record deficit of £1.85bn, doubt that £22bn in ‘efficiency savings’ can be made by 2020 and an admission that ‘new models of care’ are unlikely to deliver any savings in the short term. Both sides of the EU referendum agreed that the NHS needed more cash, it is time to work out a sustainable plan for the health service to plan against.
Two, deliver on the promises in the GP Forward View. I would be asking NHS England some awkward questions about this. Have we seen an extra penny invested in general practice since the GP Forward View was announced in April? No. Where is the £16m practice resilience funding? The £30m fund to ‘release time for patients’? The much-trumpeted indemnity support scheme for GPs? These are all very nice ideas, but mean nothing if they are not acted upon. (Also, she should start making ugly noises about the lack of a similar commitment to general practice in the devolved nations, which will help quiten that pesky Nicola Sturgeon)
Three, forget seven-day GP services. This is a good time to take stock. Mr Cameron’s personal project to extend GP practice hours is unaffordable to pursue this while waiting times for appointments in core-hours are lengthening. Existing pilot schemes under the Prime Minister’s Challenge Fund are being propped up by NHS England as CCGs do not want to pay for them. Listen to your advisers and shelve the whole idea quietly.
Four, mental health. It is encouraging to hear the new PM speak about the ‘burning injustice’ of the current lack of mental health services. The Mental Health Taskforce earlier this year promised a £1bn of money for mental health, but this was contingent on CCGs raiding existing budgets (slim chance of that). With care and some attention Ms May could leave a good legacy here, but there is much to do (see here).
Five, appoint a new health secretary. It cannot have escaped Ms May’s attention that Jeremy Hunt is looking a bit tired of his brief. He has burnt all his bridges with the medical profession over the junior doctors’ contract and has no personal capital left to make any meaningful changes. I hear that the Department of Energy and Climate Change has a vacancy that you could reshuffle him to.
Nigel Praities is editor of Pulse