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New Statesman
30-04-2025
- Health
- New Statesman
The NHS will be paid to cut waiting lists – at great cost to patient safety
Imagine the furore if a Conservative government announced a scheme to shrink hospital waiting lists using financial incentives. First, they'd pay cash-strapped hospitals unlimited bonuses to kick patients off the lists. Then, they'd offer GPs cash to stop referring patients to hospital. I'm not sure anyone would hold back from calling it what it was: an overt attempt at using the profit motive to distort safe decision-making. There is no need to imagine this scenario. A Labour health secretary has decided to go where not even Andrew Lansley, Jeremy Hunt and Sajid Javid dared tread. Earlier this month, the Guardian revealed hospitals in England are being offered unlimited bonus payments to remove people they have decided do not need treatment from their waiting lists. Something like this was in place before, but with a payment cap of 5 per cent of the trust's total waiting list. Now the cap has been lifted. Trusts have been instructed to 'validate' their entire list. They will receive an 'incentive payment' for every patient they remove, with no limit to the amount awarded. Deficits at NHS trusts in England have more than doubled over the past year. Do we really expect hospital bosses not to be tempted to game their figures by taking a scythe to those waiting? Then, the BBC ran a story headlined: 'Plan for GPs to keep millions out of hospital.' The health minister Karin Smyth said the scheme would 'save time and stop masses of people having to head to hospital for unnecessary appointments'. This would be achieved, apparently, by linking 'GPs and hospital specialists before patients are referred on to waiting lists, so that tests and treatments can be offered in the most convenient place'. The piece cited the examples of earwax, IBS and menopause symptoms – as though hapless GPs routinely refer patients with earwax to specialists (they do not). Only mentioned at the end of the piece was that every time a GP decides not to refer a patient to hospital, they will be paid £20 for doing so. Is this a patient-safety scandal or simply common sense? Are waiting lists really clogged up with thousands of patients who don't need to be there? In theory, some patients – those whose symptoms have eased, or who have already resorted to paying for private care – could perhaps be taken off lists safely. But experienced GPs do not make referrals lightly. Indeed, part of the art of general practice lies in using one's judgement to decide who really needs to be referred and who can be safely managed in a community setting. More so, the danger of incentivising a particular behaviour is that providers become so fixated on the goal that they cease to notice, or choose to ignore, harm to patients. The NHS has a long and egregious record of doing precisely this. The Mid Staffordshire scandal, for example, was caused by the trust cutting staff to unsustainable levels to try to meet financial targets. Immeasurable harm to patients followed. No one can doubt Wes Streeting's zeal to tackle NHS waiting lists, or how vital doing so is after a succession of Conservative governments permitted them to double, from 2.3 million to 4.6 million cases from 2010 to 2019. Are some patients destined to become collateral damage, denied treatment to make the lists 'fall' faster? The words of Streeting's predecessor on this issue are worth quoting in full. When, in 2018, it was revealed some clinical commissioning groups had started trying to balance their books by offering GPs cash not to refer patients to hospital, Jonathan Ashworth, the then shadow health secretary, was unequivocal: 'The minister should step in and ban this practice immediately. Patients should be referred for treatment on the basis of their medical needs. These cash handouts – which some might even describe as 'bribes' – to block referrals are totally unacceptable and the latest pernicious effect of Tory underfunding of our NHS.' Subscribe to The New Statesman today from only £8.99 per month Subscribe With Labour now in power, the tables have turned. Phil Whitaker will return to Health Matters in the summer [See also: The nastiness and cowardice of Kneecap] Related
The Guardian
18-03-2025
- Health
- The Guardian
The human cost of yet another NHS reorganisation
As the Labour party plans yet another costly NHS reorganisation, we should reflect on the former health secretary Andrew Lansley's disastrous and expensive reforms in 2012 (Keir Starmer scraps NHS England to put health service 'into democratic control', 13 March). I worked as an NHS GP and hospital specialist for 25 years. Those of us working in the service could see where many of the major problems lay, but rather than listening to those working at the coalface, David Cameron seemed to be seduced by Lansley's ideas. The disastrous effects of the reorganisation were seen most clearly when the Covid pandemic struck, with respect to provision of personal protective equipment and the test-and-trace debacle. Effective public health pathways had been changed and there was no joined-up thinking whatsoever. Now we have elderly patients fit for discharge lying in hospital beds as plans for social care reform are again kicked down the road. Patients awaiting hospital admission lie in corridors, where care is clearly substandard despite the heroic efforts of doctors and nurses. It is scandalous. What happens if we have a new administration in four years, another reorganisation? We must stop the NHS becoming a political football and have some cohesive and effective forward planning before it really is too Michael Cohen Bristol The cuts to integrated care boards are yet another example of short-term cost-saving measures that will weaken our economy, public services and workforce (30,000 jobs could go in Labour's radical overhaul of NHS, 14 March). Good jobs are not just expenses; they are investments in a stable, productive society. Beyond the numbers, there is a deep human cost. Many of those losing their jobs are the very people who worked tirelessly to keep the NHS from collapsing after years of underfunding. To reward them with redundancy rather than support is an insult. What's even more troubling is that a Labour government, supposedly the party of workers and vulnerable people, is making these cuts instead of pursuing fairer ways to raise revenue. Rather than increasing taxes on those who can afford it, they are targeting NHS staff while ignoring the system's deeper issues. The NHS is inefficient, but not because of its workforce. The real causes are years of deliberate underinvestment and the unchecked power of NHS trusts, which act as bureaucratic fiefdoms obstructing modernisation. Frontline staff today are less efficient than their predecessors, not due to lack of skill but because they are trapped in an outdated, fragmented system. If Labour is serious about fixing the NHS, it must invest properly, break down power imbalances, and implement long-term change. Instead, it is choosing the same failed austerity playbook. The UK cannot afford to dismantle its skilled workforce under the guise of fiscal WainmanPontefract, West Yorkshire When I joined the NHS as a manager nearly 35 years ago, my boss explained to me that there was a fundamental rhythm to the reorganisation of the NHS. Incoming governments, he said, centralised things, believing that they could 'fix the NHS', and then, when they discovered that they couldn't, they decentralised again to avoid the blame. Here we go again…Nigel TurnerLondon Matthew Weaver (How did Andrew Lansley reorganise health and create NHS England?, 14 March) misses one change that had a big impact on communities: the transfer of the ownership of many health service buildings to a company, NHS Property Services (NHSPS), charged with obtaining national market value from them. In Devon, community hospitals paid for by local donations became the property of NHSPS without anyone being informed, and wards were closed with the intention of selling sites for housebuilding. In Seaton, more than a third of the hospital – a wing funded entirely by local people – has been empty for nearly eight years, partly because NHSPS won't vary its rental charges to allow for new uses, despite a huge local outcry and lengthy discussions. Wes Streeting should look into NHSPS, and would be welcome in Devon to see the problems for ShawSeaton, Devon Do you have a photograph you'd like to share with Guardian readers? If so, please click here to upload it. A selection will be published in our Readers' best photographs galleries and in the print edition on Saturdays.
The Guardian
16-03-2025
- Health
- The Guardian
The Observer view: NHS job cuts may exacerbate health service's challenges
On Thursday, Keir Starmer pledged to streamline the 'flabby state' and take on a 'cottage industry of blockers and checkers' to deliver better outcomes for citizens. The centrepiece of the prime minister's intervention was an announcement that he would be abolishing NHS England, merging it into the Department of Health. NHS England was created in 2012 by the then Conservative health secretary, Andrew Lansley, as part of his ill-judged, expensive structural 'reform' of the NHS. Its purpose was to put the day-to-day operational management of the NHS at arm's length from ministers, supposedly insulating it from the short-termism that afflicts governments of all colours. Since 2012, it has swelled through multiple mergers, and today oversees a huge range of functions for the English NHS, including allocating funding, sharing good practice, coordinating national programmes such as vaccination and screening, planning around future staffing, and negotiating contracts such as the price the NHS pays for medicines. In practice, research suggests that since 2012 ministers have retained a significant degree of political control over the NHS, and rightly so. Sign up to Observed Analysis and opinion on the week's news and culture brought to you by the best Observer writers after newsletter promotion In principle, there is nothing wrong with abolishing NHS England and merging its functions with the Department of Health; this should generate some savings, albeit marginal. However, the government appears to want to make much more radical cuts to the managerial headcount of the NHS: to cut the number of jobs not just within the central structure of the service by half – 10,000 roles – but also to cut running costs of regional integrated care boards (ICBs) by half, and to reduce the number of roles in HR, finance and communications at the NHS trusts that are directly responsible for running hospitals. This could amount to a total of between 20,000 and 30,000 fewer jobs. ICBs have already had to make 20% cuts; some leaders say this further round would compromise their ability to offer services such as vaccination programmes and blood pressure checks. These cuts could represent a medium-term incremental saving for the NHS in the grand scheme of things – perhaps at most £1bn a year from an annual budget of close to £200bn – but, as health policy thinktanks such as the King's Fund and the Health Foundation have warned, such a significant and rapid structural reorganisation could jeopardise the NHS's focus on improving health. Large-scale reorganisations come with short-term costs – including making so many staff redundant – and the impact of a high degree of uncertainty on managers whose energy would be better focused elsewhere. It is also a huge number of people for ministers to decide to lay off during a cost of living crisis, underpinned by stagnating living standards: barely discernible in the macho government briefing about radical cuts is that there are real people doing these jobs, with real lives. What cutting these jobs absolutely will not do is tackle the long-term challenges facing the NHS: namely, that we spend significantly less per capita on healthcare than countries such as Germany, the Netherlands, Austria and France. This is despite having an ageing population with rising health and care needs, underpinned by relatively poor levels of public health, with higher-than-average obesity levels and sharp health inequalities. Nor will they fix the NHS's frontline staffing shortages. There is a risk that, if poorly executed, a structural reorganisation could make those challenges even harder to confront. Ministers need to be clear what it will help them achieve: more devolution? More integration of health and social care? More focus on prevention? At the moment that is not at all clear; this feels more like a bid to try to mitigate the multibillion-pound overspend NHS trusts are collectively forecasting for next year.
Yahoo
13-03-2025
- Health
- Yahoo
A welcome first step to fixing the NHS
NHS England came into being with Andrew Lansley's botched reforms in 2012. The ambition was to depoliticise the health service. The result instead was to strip the last vestiges of accountability from its structures. Rather than shielding politicians from criticism for the health service's performance behind the operational independence of NHS England, the effect was to shield the health service from criticism while politicians were held accountable for a system they were seemingly unable to influence. Sir Keir Starmer's decision to abolish this ludicrous structure is therefore most welcome. A situation where an unelected bureaucracy was handed an annual budget of £169 billion to spend with minimal oversight from Parliament was never going to last, and its rectification is a symbolic move towards sanity. The challenge now is to make sure that it is more than that. Having made the right decision to abolish the world's largest quango, the task facing the Labour Government is to come up with a replacement system that addresses the health service's flaws. There should be no understating the scale of this task: fixing the NHS has defeated politicians practically since its inception. However, it is heartening that Sir Keir and Health Secretary Wes Streeting appear willing to take it on. The fundamental problem with the NHS remains as it has always been: the lack of any incentives for performance. Competitors in a private system face the discipline of the market, and the knowledge that patients will shun poor performance or high prices generated by waste. There are few, if any, such mechanisms through which patient dissatisfaction can act to discipline the NHS. Abolishing NHS England will not address this failure if it simply results in a command economy with ministers at the top of the chain. While it will still be an improvement, providing some means for public pressure to influence the health service, we must surely hope more radical reforms will follow. Having made this first step, Sir Keir should now set out how he intends to see this change in governance translate into improvements in the NHS. Reforms intended to scrap bureaucracy and red tape are welcome, and could potentially lay the groundwork for the Government to make bold interventions of the sort needed. Whether it will do so, and whether it will succeed, is another question entirely. The proof, as the saying goes, will be in the pudding. Broaden your horizons with award-winning British journalism. Try The Telegraph free for 1 month with unlimited access to our award-winning website, exclusive app, money-saving offers and more.
Yahoo
13-03-2025
- Health
- Yahoo
Why is NHS England being axed – and will it save the government money?
NHS England will be abolished with the loss of 9,000 jobs to divert more money to frontline services and bring management 'back into democratic control'. Sir Keir Starmer said an 'arms-length' body should not make decisions about the more than £150bn annual NHS England budget as he promised the move would allow the government to deliver better care. The prime minister warned the state was 'weaker than ever' while the health service is operated by an independent body and said the NHS is 'overstretched, unfocused, trying to do too much, doing it badly'. Bringing it back under the department for health and social care would put an 'end to the duplication resulting from two organisations doing the same job in a system currently holding staff back from delivering for patients'. But how exactly does NHS England spend taxpayers' money, and how much has the government claimed it would save? NHS England is a quango - Quasi-Autonomous Non-Governmental Organisation - an arm's-length body that oversees the budget, planning, delivery and day-to-day operation of the health service in England. It employs more than 15,000 staff and was set up in 2013 by then-Conservative health secretary Andrew Lansley to give the NHS greater autonomy. It is funded by taxpayers and is not controlled directly by central government. Sir Keir said the move would free up cash for doctors, nurses and frontline services, and cut red tape to help speed up improvements in the health service amid frustrations about the pace of change. He added the cuts, which will see the workforce more than halved, will 'refocus' the NHS on cutting waiting times across the board. Public funding for health services in England comes from the department of health and social care's budget. The Department of Health and Social Care (DHSC) is a ministerial department which is responsible for developing policies on health and social care in England. In October, Chancellor Rachel Reeves announced the health and social care budget will increase to £200.5 billion in 2025/26 and its sub-budget for NHS England will increase to £192 billion. Around 95 per cent of this spending is on daily costs such as staff salaries and medicines. The remainder is allocated to central budgets of the DHSC and its other arms-length bodies. The NHS spends around £70 billion on salaries each year. According to NHS guidance, the 2024/25 pay grades range from £23,615 in Band 1, up to £121,271 at the highest end of Band 9. It is unclear what distribution of salaries on the NHS England administrative staff are set to be cut; but even on the lowest end, slashing 9,300 jobs could save at least £219 million in staff pay each year. In the short-term, the government will likely face redundancy costs from letting staff go and reorganising the health departments. Health Secretary Wes Streeting told the Commons on Thursday he wanted the transition of moving NHS England into the department of health to be completed within two years. 'Today we're abolishing the biggest quango in the world,' Mr Streeting told MPs. Mr Streeting said that half of the 15,300 jobs in NHS England's administrative arm would be cut, alongside half of the 3,300 DHSC positions which work on the NHS. The NHS is the largest employer in the UK, and the sixth largest worldwide, with 1.5 million staff as of November 2024. The cuts – estimated to be around 9,300 positions – make up a minuscule fraction of the total NHS workforce, representing just 0.6 per cent of all employees. Cutting staff 'will deliver hundreds of millions of pounds worth of savings', but the exact figures will depend on how the service is reorganised, Mr Streeting said. Across the NHS, over 13,400 senior managers are employed as part of infrastructure support, according to NHS workforce statistics. These workers are likely part of the administrative staff at risk of losing their jobs. The number of senior managers has risen substantially in the past decade, increasing by 51 per cent from 8,876 in November 2014, while the overall NHS workforce only grew by a third. The government said work would begin 'immediately' to return many of NHS England's functions to the Department of Health and Social Care. But the process will not be a quick one and is expected to take two years, Mr Streeting told the Commons. A new leadership team, Sir Jim Mackey and Dr Penny Dash, will oversee the transition, while 'reasserting financial discipline and continuing to deliver on the government's priority of cutting waiting times'., the government said. Mr Streeting said the abolition of NHS England will generate £100m in savings. The prime minister's official spokesperson said: 'A more efficient, leaner centre will free up capacity to help deliver significant savings of hundreds of millions of pounds a year, which will be reinvested into frontline services to cut waiting times for the government's change.' However, Sir Keir's spokesperson admitted it may need to make 'one off capital investments or upgrades in order to release savings in the budget'.
