Six answers for Jeremy Hunt – and six questions

27th September, 2014 8:00 am

Today Labour activists will be out in force across the country to campaign on the NHS.

They’ll have the wind in their sails after Conference, buoyed by the fact that the Tories are rattled and now on the back foot.

You can always tell when Jeremy Hunt is rattled. He starts sending out dodgy tweets.

When most people might reasonably have expected the Health Secretary to be focused on sorting out the A&E crisis, he instead took to Twitter this week to provide a running commentary on Labour Conference.

On Tuesday, responding to Ed Miliband’s pledge of an extra £2.5 billion extra for the NHS, Jeremy tried to claim that the Coalition had provided a large spending increase.

This was not a good idea. Embarrassingly, a Professor of Health Economics replied moments later to tell him he was talking nonsense.

Undeterred, Jeremy was back online on Wednesday. Responding to my claim that NHS services are being forced out to tender, Jeremy tweeted that privatisation of the NHS “isn’t happening”.

Try telling that, Jeremy, to the group of mums from Darlington who just walked 300 miles to protest about it. Or to the GP surgery who tweeted this in reply: “@HonitonSurgery: privatisation isn’t happening? Really? Our school nurses & health visitors now work for Virgin & not the NHS!”.

Now, most people in this situation might have entered a period of online silence. But not our Jeremy. He was back at his computer again yesterday writing a blog listing “six questions for Labour”.

This is classic Hunt. When in a corner, quickly point at someone else.

Jeremy_Hunt_visiting_the_Kaiser_Permanente_Center_for_Total_Health,_700_Second_St,_Washington,_USA-3June2013

When people say it’s getting harder to get a GP appointment, it’s the fault of those lazy GPs. When people say there aren’t enough nurses, he says  these modern nurses just don’t care any more. And when people point out that hospital A&Es have not hit his A&E target for over a year, it’s all the fault of NHS England.

But when he’s in a really big hole, Jeremy’s failsafe is to blame the last Labour Government.Anticipating a tough week of questioning at Tory Conference, it was no surprise when Thursday’s blog appeared. So that he’s got no excuses, I am sending Jeremy an early reply and setting him six questions of my own. He really shouldn’t be allowed to leave Birmingham until he has answered them all – in full.

Hunt’s six questions for Labour

1. How can people trust them to increase the NHS budget?

The last Labour Government proudly corrected the chronic under-funding of the NHS in the Thatcher-Major years. We were able to do this because of the strength of the Labour economy in the ten years before the worldwide financial crash. We have now reaffirmed the NHS as our No1 funding priority and people will trust us because of our track record.

Trust on NHS finance is, in fact, a bigger issue for the Tories. The last Tory manifesto promised “real-terms increases” for the NHS but they actually delivered a real-terms cut early in the Parliament. It must always be remembered that, from within this flat budget, over £3 billion has been diverted from the front-line to pay for back-office reorganisation. This helps explain the growing financial problems in the NHS.

2. Where would £2.5 billion really come from?

The new money for the NHS will come from a new Mansion Tax, measures to end tax avoidance and a new levy on tobacco companies. Labour has conservatively pitched the proceeds of the Mansion Tax at £1.2 billion – half a billion pounds less than the Lib Dem estimated at the last Election. If the Tories want to clear up any questions about our spending plans, then they should let the independent Office of Budget Responsibility audit them as we have requested.

3. Is Andy Burnham proposing an NHS reorganisation?

No. Unlike Andrew Lansley, I will work with the organisations I inherit. There will be no structural reorganisation. But the way we provide services will need to change. Hospital trusts are already looking to provide more and more services out of hospital and we will encourage that.

4. Why no apology for Mid Staffs?

Gordon Brown and Alan Johnson both issued full apologies to the people of Stafford when the care failings were first revealed. I repeated that apology when I received the first Francis report in February 2010 and Ed Miliband did so again when the second Francis report was published in February 2013.

Robert Francis concluded that the principal cause of the appalling care was the failure of the trust board to ensure adequate staffing levels. It is now time for the Conservative Party to stop trying to politicise this tragic failing and commit to increasing nurse numbers like Labour has done this week.

5. Where is the detail to support Labour’s health and social care integration policy?

On Wednesday, we issued a number of detailed steps that we would take to put the NHS on a path towards full integration. We will start by repealing the Health & Social Care Act which is fragmenting services, by forcing doctors to tender them, and wasting millions on competition lawyers. We will reinstate the NHS as our preferred provider. We will ensure a single commissioning plan for those with complex needs, bringing together budgets at local level, with a year of care budget to create a powerful incentive to provide better care outside hospital. These proposals are based on the recommendations of Sir John Oldham’s Commission for Whole Person Care which sets out even more detail on how our plans for integration will work in practice.

6. What is Labour’s justification for saying the NHS is on its knees?

Wherever you look, there are signs of an NHS in serious distress:

  • Hospital A&Es have missed the Government’s lowered A&E target for over a year;
  • NHS waiting lists are now at a six-year high, with the number of people waiting topping three million;
  • The NHS recently missed the National Cancer Target for the first time;
  • The Government’s own GP taskforce says “there is a GP workforce crisis” and people are waiting longer and longer to get appointments.

Given the above, Jeremy Hunt’s claims that the NHS is in fact doing well may well strike people as dangerously complacent.

Six questions for Jeremy Hunt

  1. Will you match Labour’s plan to raise an £2.5bn extra for the NHS and, if so, how will you pay for it?
  2. Will you match Labour’s plans to recruit 20,000 more nurses, 8,000 more GPs, 5,000 care workers and 3,000 more midwives?
  3. Do you deny the huge decline in A&E, cancer & GP services on your watch? Will you now repair the damage you’ve done, and do you support giving patients the right to an appointment within 48 hours?
  4. If you claim that NHS privatisation “isn’t happening”, how do you explain the fact that almost £6 billion of NHS services are currently out to tender and will you commit to making the NHS the Preferred Provider?
  5. Do you support full integration of health and social care as a single service and, if so, how is that compatible with the competition regime of the Health & Social Care Act?
  6. Will you apologise to the NHS and to the public on behalf of the Tory Party for breaking the pledge in the Coalition Agreement of “no top-down reorganisation”?

Without a credible answer to these questions, you will understand why people simply do not trust the Tories with the NHS.

Andy Burnham is the Shadow Health Secretary

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  • Dave Postles

    Hinchingbrooke and CQC?

    • Ian Robathan

      you will not get too many on the Tory side mention their failings eh ? Shame Burnham could not mention it either. The only reason the Tories say they are not privatising is by saying still free treatment. However what has happened is many treatments used to be available are now withdrawn ….

      • jaime taurosangastre candelas

        You make a good point; if I may broaden it?

        Since the inception of the NHS, the range of treatments made available has not so much mushroomed but exploded, due to advances in medicine, technology, pharmacology, and not least, public expectation. That is of course a good thing for us all, but in a completely non-political manner, I would observe that the costs bear no relation to national inflation rates, and perhaps we need a national conversation about what should or should not be paid for by the NHS. It does not take much mathematics to work out that increasing the range and cost of services, and paying ever larger social care bills as a result of increasing longevity, will result in the NHS and social care budgets ballooning to beyond that that taxpayers are willing to bear. I believe that is a purely factual observation: I intend no politics by it.

        I also have one technical point: the number of GPs has recently been increasing by about 1,300 a year, according to the GMC. It is unclear to me if the promise of 8,000 additional GPs by 2020 is on top of that, or simply extrapolating 2014s number of about 65,000, in which case it is not really a promise of an increase on the current trend.

        • Ian Robathan

          yes as technology advances it costs more so we should pledge to bring the spending up over a parliament to 10% of GDP. The money can be found if tough decisions in other areas are made, defence and trident for one is an obvious one.

          • jaime taurosangastre candelas

            I agree on Trident, but you are looking for £9.3 billion to achieve your 10% of GDP, per World Bank figures. Is Trident that expensive, every year? I do not think so, as the whole defence budget is only about 4 times bigger.

            It is my belief that our DFID budget should not be ring-fenced. Would we rather pay for health here in the UK or abroad? Of course, we could pay for lots of things if we were not servicing national debt by about £50 billion a year.

          • Whatever Trident does cost, and according to Wiki its about £2 billion pa, there is going to be a higher proportion of that spending lost to the government than a similar amount spend on the NHS.

            Spending on the NHS largely comes back as increased tax receipts by way the normal process of deductions )income tax and NI) from staff pay. Then when they spend that money in the shops there’s VAT recovered on what they spend. That provides the wages of the shop staff and money is recouped again by the same process.

            So whenever Govt is calculating the true cost of increased spending it needs to also consider how much of the increased spending will quickly come back as taxes. For some reason they seem quite oblivious to all that.

            Having said all that, the notion that the NHS can be properly funded by scrapping Trident doesn’t make any sense either. The numbers don’t stack up. They are two separate issues.

          • jaime taurosangastre candelas

            Interest rates are not whatever the Government want them to be. Ask Greece, recently, or further back in time Zimbabwe, Argentina, or the Weimar Republic. Three of those four were sovereign currency issuers, before you go into an EU straw man.

            I understand your conceptual argument that a sovereign currency issuer can never run out of “money”, but you are completely foolish to ignore the effect of global market sentiment. And you do, in nearly every self-satisfied post that you make, written in language that may lead a casual reader to think that you know what on earth you are talking about. You do not, you are a foolish evangelist for idiocy.

          • Greece doesn’t control its own interest rates because it doesn’t control the Euro. Argentina had a problem with interest rates because it was trying to peg the Peso to the US dollar. It did not have to do that. Again that was something they chose to do. They chose to have higher interest rates, than was probably wise, to increase the value of their currency. The hyperinflations of Zimabwe and the Weimar republic were caused by special circumstances due to breakdown of government and their inability to effectively collect taxes.

            These are simple facts. They can be easily checked. Saying them is not evangelising for what should be, its just that is the way things are. You seem to be concerned that Government should not “just print money” but that’s exactly what they do. Even the Euro is just a printed currency. Or its created digitally in a computer. It is a simple statement of fact.

          • jaime taurosangastre candelas

            You manage to completely ignore the point, which is not that Governments can simply print money, but that if they print too much for the market’s sentiment, they get punished by currency deflation.

          • Leon Wolfeson

            So you’re completely unaware of how the gas market works, Jackster. Well.

          • Yes I’ve always said that spending too much can generate inflation levels which were higher than acceptable. But, if governments go too far the other way, spend too little and/or overtax they end up with recession. Business failures and unemployment. Have you acknowledged that?

          • Leon Wolfeson

            No surprise you’re ignoring the very low borrowing costs we have in Britain, which would have to rise massively – and the rise is both predictable and controllable with the amount of borrowing – before it was even moderately an issue.

            We are not Argentina. But we could easily be if the ongoing wage/productivity spiral is utterly ignored for a few years, as your right are, Jackster.

          • Leon, The conventional wisdom is that increased government borrowing increases the levels of interest rates, with the assumption of the laws of supply and demand applying. Yet, the evidence from the last few years is that governments can have close to zero levels of interest rates and yet their borrowing has been high. Japan has been pulling this trick for the last 20 years or more.
            So what’s going on? The reality is that governments don’t borrow. They just issue currency when they spend. When they tax they destroy it. The greater the difference the more money sloshes around in the banking system. So there’s a glut of money which naturally depresses interest rates. In other words everything works the other way around to what is generally perceived. Government effectively sets a floor under the level of interest rates , via the overnight rate, which stops them falling to zero.

          • Leon Wolfeson

            Japan managed to stagnate for years, before fresh borrowing actually kicked it out of that.

            But…that’s an interesting view, but I’m far from convinced. Moreover, I’m not sure it models the behavior of interest rates better than the conventional model.

          • Leon,

            You might be interested in a series of about 10 short videos on youtube by Profs Bill Mitchell and Randall Wray who explain the basics of the workings of the economic system better than I’ve ever seen anywhere else. They certainly turned upside down many of my previous assumptions!

            Google {you tube Wray Mitchell}

          • Leon Wolfeson

            No, I am not interested in wasting my time with videos, especially youtube ones which are of completely unknown providence, when I am in interested in serious studies with academic credentials, of well known ideological background so I know their bias up-front.

            This is the answer I always give to that, don’t take it personally.

          • I know there’s a lot of crap on youtube but there is some good stuff too. Both Prof Mitchell and Prof Wray have the highest of ‘academic credentials’ so there’s no reason to ignore them.

            Having said that, guys like Mises, Friedman and Hayek have or had, well established academic credentials too. Nobel prize winners were, just before the events of 2008, confidently proclaiming that the economic system was now so well understood that any repetition of the situation of the 30’s was impossible. Really?

            So in economics, academic credentials don’t count for very much at all I’m afraid. It’s necessary to listen to what people like Wray and Mitchell are saying and decide if they’ve got it right. OK. Start with their academic papers if you like.

          • Leon Wolfeson

            That’s why I insist on knowing people’s positions before I start reading them.

            People don’t read Smith and Ricardo, and they need to, and they need to understand the very limited positions from which the right’s favoured economists were really arguing, and how restricted the situations they work within. (Which is also true for a lot of economists generally, of course). They’re not Smith, and don’t have his scope.

            Also, I can generally read a good sized chunk of a paper in the time the introductory youtube video to their ideas has bored me away from it. Video’s a low-density information medium, which is fine for some things, but..

          • I’d say Bill Mitchell was Marxian rather than Marxist whereas Randall Wray was leftish Democrat by US standards.

            Mitchell writes on “billy blog”
            Wray on “New Economic perspectives.”

          • Leon Wolfeson

            Oh absolutely including Marx (Who I don’t think highly of). They were addressing market conditions, rather than as Smith and Ricardo did of the structure of markets themselves, which changes far less with the nature of the tokens exchanged!

          • Leon Wolfeson

            “So whenever Govt is calculating the true cost of increased spending it needs to also consider how much of the increased spending will quickly come back as taxes. For some reason they seem quite oblivious to all
            that”

            I’d just like to say I completely agree. In some cases, spending even *generates* money. It certainly also makes i.e. much of basic welfare spending considerably *less* expensive than the headline rate, and the government also does not properly consider the knock-on effects.

            If, (as an pure example, since it is one of the clearest and this point has been made, strongly), the government terminated winter fuel payments, it would mark that as a net positive, when in fact the additional NHS usage alone would be a net negative.

          • Ian Robathan

            We can afford 0.75% if targeted corrected on others less fortunate. Of course 10% has to be achieved over a number of years but it is possible if you are willing to look at all expenditure and as a country stop trying to be ‘relevant’ on the world stage.

          • Guest

            Bear in mind that means we also have to deal with being a far smaller power in all ways, including trade, so the overall pool is going to be a lot smaller, and we’ll need higher military spending in other areas without NATO, and…

          • gunnerbear

            Nah….Trident stays….chop the £11bn on Foreign Aid. The recipient countries have had billions of Pounds over the years…..enough is enough. Keep £1bn for emergency aid and split the rest between Trident, the NHS and the Emergency Services.

        • Leon Wolfeson

          We spend, of course, Jackster, far less as a % of GDP on healthcare than comparable nations. But it’s never low enough for you.

          I’m sure you want to slash basic services from the NHS – and that would in practice be decided by the government, without any significant external input.

          And we have a rapidly aging population of GP’s and a recruitment crisis looming, too.

          • jaime taurosangastre candelas

            Firstly, we spend a rough comparability with peer nations. Look it up.

            Secondly, as 100% of my income is from the NHS, it would be surprising if I wanted less to be spent upon it.

            You are an angry, inchoate and foolish person, as evidenced by your posts.

          • Leon Wolfeson

            I did. We spend significantly less. Per the Nuffield Trust, NHS spending will be 6.2% of GDP in 2015-2016.

            France – 11.7%
            Spain – 9.6%
            Italy – 9.2%
            Germany – 11.3%

            Canada- 10.9%

            Australia – 9.1%

            (I am deliberately ignoring America, of course)

            I have looked at the statistics, the average age is rising, stop looking at the 2009 stats.

            You scream I must be like you, as you roost in NHS outsourcing. You are what you supposedly despise, as you scream that facts are “howling to the wind” and everyone has your alcohol abuse problem and tendency to scream about Jenkem and that people are *insert your own issues here*.

            You will, of course, scream and howl and show that producing the evidence was mistake (and I will then remove it), as you keep on with the same Jihad as before, jackster.

          • jaime taurosangastre candelas

            You are a bit tiresome. Why use the Nuffield Trust, when you have the ONS to look at Government spending? 9.4% this year, 9.4% next year.

            The figures for GPS are from the GMC, updated monthly, this month of September 2014 quoted. Go and have a Google using “LRMP Statistics GMC September 2014”, as LL does not allow links.

          • Leon Wolfeson

            Right, it was a mistake to use reliable figures, to provide data, since you’ll just whine it’s a “bit tiresome”. You keep using figures for i.e. all spending rather than state spending to hide things which don’t suit your ideology.

          • jaime taurosangastre candelas

            You are really odd. You post figures (assertions) that are provably wrong, then delete them when proven to be wrong, while trying to assert that somehow my ideology is the cause of you deleting them. I don’t have an ideology as far as facts are concerned: the facts are what they are.

          • Leon Wolfeson

            Right right, you say that the official US etc. figures are “provable wrong”. To you, facts are “really odd”. This is no surprise, on top of your saying that facts are a “bit tiresome”.

            I deleted them because you are a vicious troll, who was screaming last nught about mythic drugs etc. – providing you with facts is just silly when you’ll reject them, and replace them with your nasty ideology entirely, jackster,

            Or, wait, as you have *actually done* – you’ll abuse incompatible statistics (total health spending vs government health spending) to “prove” your “case” that your job selling off choice bits of the NHS is so wonderful!

            You’re the worst sort of bureaucrat as far as I’m concerned, the political appointee.

          • According to Wiki UK health spending is 9.4 % or 9.6% of GDP (depending on the source) whereas it is a couple of % higher than that in France and Germany.

            So £2.5 billion isn’t going to cut it. We need to be talking at least an order of magnitude more than that.

          • jaime taurosangastre candelas

            The ONS states 9.4% which seems authoritative. Not the 6.7% asserted by Leon, now withdrawn by him.

            A wider point: what do these percentages mean? Little really. For instance in France with a lower population density per square kilometre but slightly higher targets for critical treatment times, they spend a lot more per capita on ambulances (they need more to meet their targets). They also have a fully functional cross-border set of agreements that can see patients treated for some diseases in Germany or Switzerland, while France trains some Swiss and Italian nurses. It is difficult to compare with the UK, so a percent here or there means little unless you compare exact equivalence.

          • Leon Wolfeson

            You are, of course, using total spending rather than government spending. This is entirely and typically dishonest of you, jackster.

            What’s withdrawn is any form of rational argument on your part, you are arguing from ideology, pure and simple.

            You are frantically making excuses, one after another, as to why we spend so much less, then the answer is quite simply that the government chose to spend less, and there is a direct equivalent since government spending includes cross-border spending.

            Your argument is of course perfectly suited for spending £0 per year, because if you can’t fix everything in your world nothing should be fixed on the NHS, I get that argument, and it’s hence unaffordable.

            That you are arguing that considerably below-average spending is magically hitting “diminishing returns” is another example of this, you have no proof of this and indeed there are critical funding shortages threatening care, but care budgets are still too high for you.

            No doubt you’d “compensate” by charging or other measures to make sure that the poor don’t get any benefit from the increased spending, again in line with your expressed ideology, jackster, as you completely ignore the fact the NHS was set up to save money, and does indeed do so, and you are working very hard to chisel away at that.

          • There is always a problem when discussing finances with those who are incapable of escaping from their neo-liberal mindsets. We can look at things two ways. As you do by looking to see if there is enough money in the kitty. Incidentally, if those who were in charge in 1940 had looked at things this way the only possible course of action would have been to surrender on the grounds that there was just ‘not enough money’ available to fight a war.

            But as Tony Benn used to point out, there was always enough money to kill Germans! So why isn’t there enough money to properly run the NHS?

            Alternatively, and the correct way to look at these issues is in terms of resources. If there are enough people available to run the NHS then it can be afforded. If there are not then it can’t.

          • Leon Wolfeson

            That’s *total* health spending, Peter. Government health spending is considerably below that.

            (Private health insurance and spending is up very sharply in recent years)

          • Yes that’s a good point. It’s total health spending -including all the expensive doctors in Harley Street. So your 6.7% of GDP for NHS spending would seem about right.

          • Leon Wolfeson

            That’s the Nuffield Trust figure. And really, I trust them over the government on this one.

    • DaveAboard

      Of course Burnham won’t mention Hinchingbrooke – it was he who initiated the the bid in the first place, a process which eventually led to Circle being awarded the contract at the same time ensuring it was impossible for the NHS consortium based at Addenbrooks to compete thus guaranteeing a private sector company would win the contract.

      For some reason, Burnham refuses to answer any correspondence on this issue, nor will he answer any questions in person, dismissing them with “you must put your concerns in writing”……..and then doesn’t respond.

      Forget the CQC report, this is just the tip of the iceberg as many who have been subjected to this second rate medical facility will testify, not to mention the industrial scale numbers massaging that goes on to give the impression all is rosy.

      • Dave Postles

        The leaked CQC report is damning – and it is only part of the report so far. It castigates the conditions there.

        • DaveAboard

          Many of us who have had the misfortune to have to use this hospital have been calling out deficiencies at Hinchingbrooke for the last 18 months or so. They either fall on deaf ears or result in a threat of costly legal action landing on your doormat.

          Our issues have been ignored by Circle, by the DoH, by the media – the press have repeatedly printed Circle’s PR press releases as if they are “fact” – and by politicians of all colours. Including Burnham.

  • According to Wikipedia, the NHS budget for the financial year 2014-2014 was £110 billion.

    So, whilst an extra £2.5 billion wouldn’t go amiss, it’s not, in itself, going to make that much difference. It’s the sort of extra money that is going to have to be found every year just to offset the effects of inflation.

    So, if Andy Burnham wants to ask Jeremy Hunt how he’s going to pay for this £2.5 billion, I’d like to ask Andy Burnham how he’s going to pay for the £25 billion that is more like the figure needed to bring the NHS closer to European standards?

    • jaime taurosangastre candelas

      If your solution does not involve additional taxation, it is either paid for by additional cuts, or, in your case I suspect by merely printing the money. You often claim this to be the perfect solution, but never address the reality that the pound would be seen as riskier on the world markets, relative to other currencies, be sold off, and thus cause inflation as we are a net importer.

      If money printing is so easy, why does not every Government do it, rather than sell bonds?

  • Fragmenting Services

    In 2010 there was one commissioning organisation for my condition, type 1 diabetes, the PCT. Now there are three and they don’t talk to each other, instead, when I express my concerns they say “we don’t commission that service”. The three commissioners are:

    – Public Health England commission the retinopathy screening for my eyes
    – NHS England Area Team commission the GP services I use
    – Clinical Commissioning Group commission the hospital services I use.

    Just to complete the picture, the Lansley act created another commissioner of healthcare services: local authorities. Local authorities now commission public health, but this includes healthcare services like health visitors, school nurses and sexual health services.

    • treborc1

      It’s all about trust, do you trust labour, and to be honest the answer is no I do not.

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