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The Guardian view on the seven-day NHS: the figures don’t add up The Guardian view on the seven-day NHS: the figures don’t add up
(about 17 hours later)
At first reading, the words in the health department’s private internal briefing can seem measured and unsensational: “The current financial context means we need to demonstrate that 7DS [seven-day services in the NHS] is achievable and realistic.” Who could disagree with that? Lift the stone and peer beneath, however, and the Whitehall calm soon crumbles as the full implications sink in.At first reading, the words in the health department’s private internal briefing can seem measured and unsensational: “The current financial context means we need to demonstrate that 7DS [seven-day services in the NHS] is achievable and realistic.” Who could disagree with that? Lift the stone and peer beneath, however, and the Whitehall calm soon crumbles as the full implications sink in.
The reality underlying the studied words in the latest departmental document seen by the Guardian and Channel 4 News is that internal anxiety over the health secretary Jeremy Hunt’s flagship 7DS pledge for the NHS is still churning. Is 7DS achievable as the budget stands? Is it realistic? The answers to these apparently innocent questions are extremely uncertain. They signal huge economic and political problems for Theresa May’s government, which cannot afford to be seen as anti-NHS. The reality underlying the studied words in the latest departmental document seen by the Guardian and Channel 4 News is that internal anxiety over the health secretary Jeremy Hunt’s flagship 7DS pledge for the NHS is still churning. Is 7DS achievable as the budget stands? Is it realistic? The answers to these apparently innocent questions are extremely uncertain. They signal huge economic and political problems for Theresa May’s government, which cannot afford to be seen as anti-NHS.
The latest Department of Health document illuminates one particular part of the problem. The briefing is actually less worried by the financial context than by the terms in which Mr Hunt has framed the argument for 7DS. Mr Hunt has long put the supposed “weekend effect” of uneven hospital care at the core of his case for hospital rota and contract reorganisation. Solving that problem was the Conservative party’s headline pledge on health in the 2015 election. Mr Hunt’s promise to overhaul a system that he claimed was causing 6,000 deaths a year provided the emotional underpinning of David Cameron’s commitment to the NHS.The latest Department of Health document illuminates one particular part of the problem. The briefing is actually less worried by the financial context than by the terms in which Mr Hunt has framed the argument for 7DS. Mr Hunt has long put the supposed “weekend effect” of uneven hospital care at the core of his case for hospital rota and contract reorganisation. Solving that problem was the Conservative party’s headline pledge on health in the 2015 election. Mr Hunt’s promise to overhaul a system that he claimed was causing 6,000 deaths a year provided the emotional underpinning of David Cameron’s commitment to the NHS.
But the “weekend effect” claim was always hugely contentious. The issue became increasingly toxic as relations between Mr Hunt and the doctors deteriorated over contract reform. The Department of Health document now concedes that the claim, with its not-so-subtle subtext that doctors are allowing patients to die, “has not been helpful”. But it also implies that the focus on public safety, which was not at the top of the public’s list of concerns about the NHS, has allowed Mr Hunt to cast himself as the enemy of much-cherished doctors. As a result, the more he warns about deaths, the more he seems to lose standing in the dispute. But the “weekend effect” claim was always hugely contentious. The issue became increasingly toxic as relations between Mr Hunt and the doctors deteriorated over contract reform. The Department of Health document now concedes that the claim, with its not-so-subtle subtext that doctors are allowing patients to die, “has not been helpful”. But it also implies that the focus on public safety, which was not at the top of the public’s list of concerns about the NHS, has allowed Mr Hunt to cast himself as the enemy of much-cherished doctors. As a result, the more he warns about deaths, the more he seems to lose standing in the dispute.
Ordinarily, a skilled minister might be able to turn the tables with new offers to the doctors. But that is where the overriding constraint of the financial context kicks in. The documents that were leaked on Monday provide the wider context. Here the department itself identifies 13 major risks, five of them in the gravest category, that stand between Mr Hunt and delivery of the promised seven-days-a-week service.Ordinarily, a skilled minister might be able to turn the tables with new offers to the doctors. But that is where the overriding constraint of the financial context kicks in. The documents that were leaked on Monday provide the wider context. Here the department itself identifies 13 major risks, five of them in the gravest category, that stand between Mr Hunt and delivery of the promised seven-days-a-week service.
The department dubs the most serious of these risks “workforce overload”. This, it admits, would involve fundamental roles in the 7DS system – consultants, GPs and other health professionals – going unfilled by trained staff. But this is a euphemistic way of describing the issue. It is simply another way of saying that there may not in fact be enough money to deliver the health service the government says it wants. The department dubs the most serious of these risks “workforce overload”. This, it admits, would involve fundamental roles in the 7DS system – consultants, GPs and other health professionals – going unfilled by trained staff. But this is a euphemistic way of describing the issue. It is simply another way of saying that there may not in fact be enough money to deliver the health service the government says it wants.
This in turn gets to the much more fundamental issue, which is that the supply of extra funds for health in an expanding and ageing population will always struggle to keep up with demand, even in expansionary times. It will certainly fall behind if government prioritises the elimination of the deficit, as the Cameron government did for so long. That priority has now been abandoned in the wake of Brexit, though the chancellor, Philip Hammond, has yet to spell out the consequences. These could be good or bad at the margins for health. But the fact remains that, faced with 7DS reorganisation, the figures simply do not seem to add up.This in turn gets to the much more fundamental issue, which is that the supply of extra funds for health in an expanding and ageing population will always struggle to keep up with demand, even in expansionary times. It will certainly fall behind if government prioritises the elimination of the deficit, as the Cameron government did for so long. That priority has now been abandoned in the wake of Brexit, though the chancellor, Philip Hammond, has yet to spell out the consequences. These could be good or bad at the margins for health. But the fact remains that, faced with 7DS reorganisation, the figures simply do not seem to add up.
This is compounded by the sheer political damage that the government has done itself over the years, first in Andrew Lansley’s botched reorganisation after 2010 and now as a result of Mr Hunt’s failure to settle fairly with the doctors. Here again, the leaked internal documents resort to euphemism, calling this risk “negative publicity”. But the political reality is spelled out later on when the document admits that the NHS workforce “do not believe in the case for change”.This is compounded by the sheer political damage that the government has done itself over the years, first in Andrew Lansley’s botched reorganisation after 2010 and now as a result of Mr Hunt’s failure to settle fairly with the doctors. Here again, the leaked internal documents resort to euphemism, calling this risk “negative publicity”. But the political reality is spelled out later on when the document admits that the NHS workforce “do not believe in the case for change”.
Theresa May has not said much about the NHS since she became prime minister. But she cannot ignore what these documents expose. The Conservative party always struggles for trust on the NHS, even when Labour is in disarray. It is now paying the price for what a former Tory health minister, Dan Poulter, this week said is “putting soundbites ahead of properly costed and resourced plans for our NHS”. Mrs May has many big issues on her plate. She should not run away from this one.Theresa May has not said much about the NHS since she became prime minister. But she cannot ignore what these documents expose. The Conservative party always struggles for trust on the NHS, even when Labour is in disarray. It is now paying the price for what a former Tory health minister, Dan Poulter, this week said is “putting soundbites ahead of properly costed and resourced plans for our NHS”. Mrs May has many big issues on her plate. She should not run away from this one.