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You can find the current article at its original source at http://www.theguardian.com/commentisfree/2016/apr/07/jeremy-hunt-in-trouble-ids-moment
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| Jeremy Hunt is in trouble. This is his IDS moment | Jeremy Hunt is in trouble. This is his IDS moment |
| (35 minutes later) | |
| The NHS in England is facing the biggest crisis in its history. Hospitals are running up large and growing financial deficits, missing targets for waiting times, and under pressure from rising demand at a time of constrained resources. | The NHS in England is facing the biggest crisis in its history. Hospitals are running up large and growing financial deficits, missing targets for waiting times, and under pressure from rising demand at a time of constrained resources. |
| The government’s immediate priority is to restore stability to finances and performance. A large part of the additional funding announced in last autumn’s spending review will be used to reduce deficits in hospitals and support hard-pressed NHS providers trying to hit patient-care targets. | The government’s immediate priority is to restore stability to finances and performance. A large part of the additional funding announced in last autumn’s spending review will be used to reduce deficits in hospitals and support hard-pressed NHS providers trying to hit patient-care targets. |
| Related: Health chief tears into Jeremy Hunt's NHS policies | |
| I talk to NHS leaders every day, and they argue in private that the demands on them cannot be met – because the financial position is worse than official figures suggest and does not allow for the cost of new commitments such as seven-day working or increases in pension contributions for staff. | I talk to NHS leaders every day, and they argue in private that the demands on them cannot be met – because the financial position is worse than official figures suggest and does not allow for the cost of new commitments such as seven-day working or increases in pension contributions for staff. |
| As one asked me only this week: are ministers in denial or simply unaware of the impact of their actions on the ground? | As one asked me only this week: are ministers in denial or simply unaware of the impact of their actions on the ground? |
| With about two-thirds of spending going on pay, national bodies are now scrutinising staffing costs to reduce headcount. This will be a personal challenge for Jeremy Hunt, the health secretary, who has led a drive to ensure safe staffing levels as part of his mission to shift attention away from Andrew Lansley’s damaging structural reforms. | With about two-thirds of spending going on pay, national bodies are now scrutinising staffing costs to reduce headcount. This will be a personal challenge for Jeremy Hunt, the health secretary, who has led a drive to ensure safe staffing levels as part of his mission to shift attention away from Andrew Lansley’s damaging structural reforms. |
| Hunt now faces unpalatable choices about the direction of health policy, akin to the dilemmas that led Iain Duncan Smith to resign as work and pensions secretary. Just as Duncan Smith felt his mission to reform welfare was undermined by budget cuts, so Hunt’s ambition to improve quality of care is at risk from financial constraints. He will have to examine his conscience if funding pressures mean a reversal of policies to improve patient care that he was instrumental in developing. | Hunt now faces unpalatable choices about the direction of health policy, akin to the dilemmas that led Iain Duncan Smith to resign as work and pensions secretary. Just as Duncan Smith felt his mission to reform welfare was undermined by budget cuts, so Hunt’s ambition to improve quality of care is at risk from financial constraints. He will have to examine his conscience if funding pressures mean a reversal of policies to improve patient care that he was instrumental in developing. |
| What should be done to secure the future of the NHS? A good start would be greater political honesty about the state of health and social care. If restoring financial balance is the government’s overriding priority, then ministers may be forced to relax waiting time targets, difficult as this may be. | What should be done to secure the future of the NHS? A good start would be greater political honesty about the state of health and social care. If restoring financial balance is the government’s overriding priority, then ministers may be forced to relax waiting time targets, difficult as this may be. |
| Honesty should extend to new commitments like seven-day services, a laudable aspiration with a hefty price tag. There needs to be greater realism too about the time it will take to realise improvements in productivity. | Honesty should extend to new commitments like seven-day services, a laudable aspiration with a hefty price tag. There needs to be greater realism too about the time it will take to realise improvements in productivity. |
| While it is certainly possible to deliver better value for the £120bn spent on the English NHS, it will fall short of the £22bn in productivity improvements on which Simon Stevens’ Five Year Forward View – and the government’s funding calculations – are based. There is now no prospect that efficiencies on this scale can be achieved by 2020/21. | While it is certainly possible to deliver better value for the £120bn spent on the English NHS, it will fall short of the £22bn in productivity improvements on which Simon Stevens’ Five Year Forward View – and the government’s funding calculations – are based. There is now no prospect that efficiencies on this scale can be achieved by 2020/21. |
| The unwillingness to recognise publicly what is well understood privately is storing up much bigger problems | The unwillingness to recognise publicly what is well understood privately is storing up much bigger problems |
| NHS leaders have never felt this target was credible and are now wondering when the emperor will be seen to have no clothes. Many feel as if they are living in a parallel universe in which they are striving to sustain existing services in conditions of adversity while politicians promise improvements in care that cannot be delivered with available resources. | NHS leaders have never felt this target was credible and are now wondering when the emperor will be seen to have no clothes. Many feel as if they are living in a parallel universe in which they are striving to sustain existing services in conditions of adversity while politicians promise improvements in care that cannot be delivered with available resources. |
| Underlying these immediate challenges are fundamental questions about how to fund health and social care on a sustainable basis. With average funding increases of less than 1% a year over the current parliament, NHS spending as a proportion of GDP will, at the end of this decade, be almost as low as when Tony Blair made his famous pledge to increase health spending in 2000. With a growing and ageing population, it is not credible to expect the NHS to survive in its present form under these financial pressures. | Underlying these immediate challenges are fundamental questions about how to fund health and social care on a sustainable basis. With average funding increases of less than 1% a year over the current parliament, NHS spending as a proportion of GDP will, at the end of this decade, be almost as low as when Tony Blair made his famous pledge to increase health spending in 2000. With a growing and ageing population, it is not credible to expect the NHS to survive in its present form under these financial pressures. |
| There needs to be an honest debate about the level of funding required to sustain services and improve care. The independent Barker Commission set up by the King’s Fund to examine these issues has done the groundwork, putting forward the case for a single health and care system in which entitlements to social care are aligned with those in health care. The commission argued this was best done largely, through increases in public funding implemented over a decade. | There needs to be an honest debate about the level of funding required to sustain services and improve care. The independent Barker Commission set up by the King’s Fund to examine these issues has done the groundwork, putting forward the case for a single health and care system in which entitlements to social care are aligned with those in health care. The commission argued this was best done largely, through increases in public funding implemented over a decade. |
| The government has shown no interest in exploring these issues, or in lending support to the proposal championed by some MPs for a cross-party review. The risk this creates is that there will be a continuing decline in NHS performance, with cuts in staff, compromises to the quality of care, and patients waiting longer for treatment. The unwillingness to recognise publicly what is well understood privately is storing up much bigger problems for the future. | The government has shown no interest in exploring these issues, or in lending support to the proposal championed by some MPs for a cross-party review. The risk this creates is that there will be a continuing decline in NHS performance, with cuts in staff, compromises to the quality of care, and patients waiting longer for treatment. The unwillingness to recognise publicly what is well understood privately is storing up much bigger problems for the future. |
| Observing the NHS today is like watching a car crash about to happen. A collision can be avoided but only the driver and navigator have power to act. Those of us observing can issue warnings and advice, but it will take political will to prevent damage that may be impossible to repair. | Observing the NHS today is like watching a car crash about to happen. A collision can be avoided but only the driver and navigator have power to act. Those of us observing can issue warnings and advice, but it will take political will to prevent damage that may be impossible to repair. |
| • Read more at http://www.kingsfund.org.uk/publications/articles/nhsagendaforaction |