Last week, in a speech at the NHS Providers conference, Simon Stevens - chief executive of NHS England - broke ranks from his political masters and laid bare the full extent of the crisis in the health service.
Far from the ‘we’re spending more than ever in the NHS’ rhetoric, or the illusory mantra of politicians promising world-class convenience on second-class funding, Mr Stevens was unequivocal that the NHS was broken, declaring that the current budget ‘…is well short of what is currently needed to look after our patients and their families at their time of greatest need.’
He was openly critical of the impact of austerity on the NHS, describing it as ‘the exceptional choking back of funding growth of the past seven years.’
He mirrored the BMA’s own analysis of the NHS being woefully underfunded compared to European counterparts, arguing: ‘If instead you think modern Britain should look more like Germany, France or Sweden then we are underfunding our health services by £20bn to £30bn a year.’
Indeed I felt a sense of ‘at last’ in hearing language that could have been lifted from the BMA’s own NHS at breaking point campaign.
And as Mr Stevens made patently clear, we are not arguing simply about a number here but about the impact on the health of millions of lives, including explicit government priorities, saying that ’on the current funding outlook it is going to be increasingly hard to expand mental health services or improve cancer care’.
He went further to state it was a ‘duty of candour’ – relating to speaking up when patients were at risk - to ‘explain the consequences’ of this starvation of funds to the NHS.
He also spoke of the impact of inadequate resources on workforce: ‘On the current budget, far from growing the number of nurses and other frontline staff, in many parts of the country next year hospitals, community health services and GPs are more likely to be retrenching and retreating.’
And instead of the usual DH pronouncement of a wishful 5,000 more GPs he was candid: ‘GP numbers over the last seven years have actually fallen but their workload has risen’ - exactly what the BMA GPs committee have been warning of repeatedly.
Mr Stevens also argued for the ‘clinical and the financial logic for integrated care rather than fragmented competition’ – in doing so he reflected 25 years of BMA lobbying opposing the market-driven purchaser provider split.
I hope that he will now go one step further and unequivocally call for an end to competition law enshrined in the Health and Social Care Act - only that will put an end to fragmented care and the billions wasted in the transaction costs of competition.
It is these procurement rules that allow private companies to provide cherry-picked services in the NHS, and also mean that the future proposed accountable care organisations could be sold off to multinationals.
Mr Stevens speech crucially reinforced what the BMA has always argued - that with the UK being a leading health economy globally, the level of funding of the NHS is a political choice by Government. He said: ‘No-one disputes that these are choices that a chancellor could make.’
More specifically he claimed that next year’s funding gap is likely to be £4 billion, citing the analysis of three leading think tanks (the King’s Fund, NHS Providers and Health Foundation).
He asserted this should not be a challenge for the politicians, since it would only bring the NHS back to historic norms. ‘[The independent analysts] show there’s nothing out of the ordinary about needing such a sum. In their words, it would just be a return to the average increases of the first 63 years of the NHS’ history.’
Mr Stevens also rightly reminded government of the promise to the nation of an extra £350m per week paid into the NHS to leave the EU - at a time when indications show the antithesis that Brexit is likely to act as a further drain on NHS resources.
He called on the Government to meet this funding pledge on the fundamental matter of not undermining public trust: ‘You voted Brexit, partly for a better funded health service. But precisely because of Brexit, you now can’t have one.’
It is probably no accident that Mr Stevens’ comments came ahead of next week’s budget; so it’s over to the chancellor, health secretary Jeremy Hunt and the prime minister. The case for investment is overwhelming, as is the daily experience of an NHS that is failing patients, doctors and other NHS staff.
The Government has a choice, of whether to acknowledge the evidence it faces and whether to heed the clear message from the boss it appointed to run the NHS. And a choice between punishing patients or belatedly properly funding the health service this country needs, deserves and which the government itself has promised.
Chaand Nagpaul is BMA council chair
Find out more about the BMA’s work on NHS funding
But he then went and gave a contract to GP Babylon to promote and endorse taking worried well, low risk patients away from their practices leaving the jobbing GP principles to look after all the chronic load whilst others cherry picked the easy stuff. And all the young newly trained GP's will much prefer to do this work so who sits at the coalface seeing the really chronically ill?
He had me at hello and up to the point he mentioned Brexit, which is irrelevant here. The much hyped £350m per week in extra funding was never going to materialise before the final divorce bill was agreed and Brexit actually happened. Whether that estimate was correct remains to be seen - and I won't be surprised if it wasn't, as the economy will take a hit anyway. But then, I think a lot of people realised that no one had a crystal ball, yet voted for Brexit anyway on grounds other than funding promises.
Firstly, I support the plea "to save the National Health Service" by Dr Chand Nagpal, Chairman of the BMA Council. When I read Simon Stevens, Chief Executive of NHS England's speech, I had to check that he has not become the CEO of the BMA. Then penny dropped; I can foresee that Rt Hon Mr Hammond, Chancellor of the Exchequer, would announce more funding for the NHS in the imminent budget and Mr Steven's speech is likely to be his peg to hang his hat. It is a principle in Politics, to play cards close to the chest; go really hard first and then gradually soften it, so that the opposite party may think that you are doing a favour and they calmed down. I know that this has been a British play from the Colonial times. It is wonderful how the games many people play.
Secondly, "Privatisation" is a right wing policy to pay money according to a person's hard work; as this creates competition for working harder and the nation becomes rich. This custom is practised since the foundation of "Financial world". "Nationalisation" is the left wing policy to pay money, housing and food to everyone equally; no rich or poor and no need to have to compete. This concept was founded by late Carl Marks, who is buried in Highgate cemetery London, which I have visited. The Nationalisation policy was firmly adopted by Russia and the Communist countries, they joined together as the Soviet Union. Stalin jumped up and down to support this policy. Then they found that "it is possible to make everyone poor and equal but not at all possible to make everyone rich ans equal". The Soviet Union collapsed and Putin is walking up and down the world with Privatisation. I suggest that our BMA should follow the British traditional policy of Privatisation, while caring for the poor by Social Services and the NHS.
Finally, all people working for the British Government, Politicians, Academics and the rest are patients. Nobody is becoming unfair in dealing with others. However, I have noted that only in Britain, the Academics and Politicians do not like each other. Funny enough, I like all of them and get the most from them. Furthermore, the "Brexit" means becoming a free Great Britain again instead of current position as one state of 28 states in European Union. I must warn that freedom brings poverty for a short term and then the Nation becomes rich again due to competition for work. I observed that is what happened in India in 1947. Nevertheless, Independence is better that dependence.
Dr Bashir Qureshi MBBS, FRCGP, FRCPCH, AFOM-RCP, Hon FFSRH-RCOG, Hon FRSPH, Hon MAPHA-USA. Life Member of the BMA and its supporter since 1964.
Spare is the simplistic history and economics lecture. Who is Carl Marks anyway? Karl Marx. however was a left wing thinker.
The BMA will not let up on the politics, so why should Drs be censured?
Powerful messages... Why is this not front page /headline news.(or is everything hidden underneath a "Brexit" headline agenda?)...
but the pay gap for many nhs workers/other public health workers is such too that it will take some time to see any impact on services if the recruitment crisis/working conditions are to be tackled 1st - what are the figures 1% pay rise=6bn and there've been no pay rises for 10 yrs.. It is a mountainously tricky endeavour now to improve services and equalize investment.
And it is not just the NHS who are at crisis point but Social Services too. Community Hospitals closing and other community services being run down