As local NHS teams across the country prepare for the traditional winter onslaught on their underfunded, under-resourced front line and social care services, Jeremy Hunt oozed on to a stage to give a speech about what he still laughingly refers to as ‘our’ NHS.

The US based Commonwealth Fund has rated NHS performance as the best and the safest in the world for the second year running, and of course Hunt was keen to take as much credit as possible.  As usual the Health Secretary chose to include himself amongst the ranks of all the amazing NHS staff working not with, but in spite of his efforts to destroy our health service and it didn’t go down too well them.

Wearing his customary NHS lapel pin – something that irritates the hell out of every NHS worker I know – he went on to explain his “mixed feelings” about the top rating for patient safety in the NHS and his concern about the amount of “avoidable harm” that may still be present in the system.  It’s clear he thought he was making an inspirational speech, but it had undertones of the usual agenda of undermining the service and damning it with faint praise.

Seemingly painfully unaware that the majority of the NHS workforce regard him as about as inspirational as a bout of the norovirus, he went on to tweet a video of the portion of his speech that dealt with these concerns for which he received understandable anger from many NHS staff.

One respondent told him in no uncertain terms :

You don’t speak for us; don’t claim to. There is no ‘we’ here. The NHS functions in spite of you. We work daily around the huge obstacles you place in our way and I don’t know a single NHS staff member who doesn’t absolutely despise you. Not one

Every year since the Tories took power – first under the coalition and now as part of their dodgy minority government – we’ve seen the NHS get worse and worse, and winter time is always when fresh cracks start to show.  This year is no exception with hospitals already denouncing targets as “barking mad”.  Last year these fissures developed into chasms with A&E departments overwhelmed to the point where the International Red Cross declared the situation a “humanitarian crisis” – something that was at that point unprecedented in any developed country during peacetime, outside of a natural catastrophe.

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This is the culture within which ministers like Hunt feel it’s appropriate to pat themselves on the back and accept awards for a service that without the selflessness and dedication of the people he routinely sabotages, would have collapsed years ago.  The fact that we still have an NHS is testament to these people, and it’s an achievement that the likes of Hunt praises openly, whilst seeking to disrupt in private.

He and the rest of the government are of course keen to see the end of a universally free health service, and each near collapse must be a small private victory for him, justifying the usual mantra that the private sector would do a much better job – something that has already been disproved on numerous occasions.

In that sense the nurses, doctors and support staff that prop it up must be a source of constant annoyance to him.  But it’s also useful propaganda.  Rather than seeing the situation for what it is, he regards the fact that NHS workers will always go beyond what could be reasonably be expected of them as just another selling point along the road towards privatisation. “Roll-up, Roll-up!  Not only do we have a nice juicy monopoly for you buy into, we also have a workforce that’s open to exploitation by virtue of their own dedication and vocation!”

Another plank in the Tory final solution is to avoid any blame for the collapse of health service they need to see fail to further their ends.  That could of course have toxic political consequences for them, and they’ve worked hard since the much criticised Health and Social Care Act 2012 to construct a framework of credible denial.  To that end the formation of foundation trusts and in particular the Clinical Commissioning Groups (CCGs) were not only a part of their privatisation by stealth programme, they were also an essential mechanism for them to dismantle the NHS at arms length.

In the CCGs they have created convenient whipping boys who eventually have no choice but to cut services as real terms funding is decreased.  Then MPs and ministers wring their hands and cry about the impact of these cuts as if they had nothing to do with them. 

It’s a great little ruse, and this year Theresa May took it one step further during a private meeting with NHS boss Simon Stevens, reportedly making him “personally responsible” for any repeat of last year’s near meltdown over the winter period.

Relations between May and Stevens have been strained at best since she took over the big seat from David Cameron who originally appointed him.  Around this time last year, news leaked of another secret meeting between Stevens, Hunt and May where he claimed that the NHS needed an extra £16bn just to stay afloat.

These claims were dismissed by Hunt as “mad” and he was effectively told by the PM that there would be no more money for the NHS beyond that already proposed in the budget.  Stevens later told the public accounts committee that the government were not being entirely forthright in the way that different departments recorded and reported health spending so that it looked as if they were spending more than they were.  This view has also been supported by the King’s Fund.

Earlier this month Stevens warned of continued underfunding of health services by £20bn-£30bn a year and called out the claims made by prominent government Brexiteers that the NHS should receive the extra £350m a week promised as a result of leaving the EU.  None of this has assured his continued inclusion on Theresa May’s Christmas card list.

Colleagues of Stevens have already come to his defence saying that it is unfair and unrealistic of May to expect the head of the service to be responsible for its entire performance, especially given its tight budget and under-staffing.  But it’s apparent that he’s being set up as her fall guy for when, as is very likely, the NHS hits another crisis point early in the New Year. 

Presumably the plan is to divert attention from the underfunding by dramatically sacking Stevens and installing someone more sympathetic to the government’s aims for the NHS.  In one neat move Hunt and May will remove a thorn in their sides and dodge the blame for another winter of discontent.

And it’s clear that the NHS is already braced for a re-run of last winter’s horrific scenes after the closure of yet more services, continued pressure on hospital and GP services, and the impact of staff shortages and bed closures caused by the double whammy of Brexit and the latest Sustainability and Transformation plans.  It’s likely that things could get much worse in the coming months.

A&E services in particular have laid contingency plans to try head off the mayhem, but without proper support from the government they’re probably only going to be of limited help.

In Oxfordshire the CCG have already downgraded several local services such as regional maternity units and A&E is now expected to be in the firing line.

Plans in Oxford include increasing pharmacist’s presence in care homes to prevent people being taken to hospital, creating additional GP appointments on particularly busy days and placing GPs in emergency departments to help decide who needs to be seen by hospital doctors.  But if you’ll excuse an obvious metaphor, these are really just sticking plasters.

But a note of pessimism has been sounded by Larry Sanders, the Green Party’s Health Spokesperson and the brother of last year’s US presidential runner Bernie.

He warned :

I respect the enormous effort that has gone into these plans to try and tackle the problems we face.  But if we read between the lines, we simply do not have the resources to make it work.  These excellent reports do not show what can be done but rather what cannot be done.

Chief operating officer at Oxfordshire CCG Diane Hedges said there were significant challenges the health system would have to overcome :

I am not going to sit here and tell you all it is going to be easy, we are aware of the challenges we have got in the system.  We have a massive workforce challenge, which has forced bed closures that none of us wanted to happen”  She added “We want to do further risk assessments to see if we can safety re-open beds

Comments on an article in local paper included insights from someone calling themselves ‘OxfordNurse’ : He or she paints a bleak picture of last year’s situation :

It is unfortunately fiddling whilst Rome burns. Last year was hellish, I saw patient safety compromised countless times and a lady die in horrible pain [of] totally preventably of sepsis, she was meant to have 1 on 1 care but because of short staffing the CSW [Clinical Support Worker] was asked to look after five “1 to 1” patients. Many more patients coming to serious harm or in avoidable pain.

 

Of course they have closed beds for “safety” but there is constant pressure to reopen the beds which defeats the point in them being closed for safety.  This year quite simply will be far worse.

Without enough doctors and nurses you can shuffle the deckchairs around but you aren’t going to make any serious difference to patient safety”

In view of Hunt’s own comments on patient safety within the NHS, these sorts of insider comments are particularly chilling.  It would seem that health bosses and front-line workers realise the huge danger we are all now facing as a result of the damage already done to the health service.  Taken in context, I can see another group being set up to take a fall here – every single person that works in and uses the NHS.

We’ve already seen how weak, indecisive and lacking in leadership May is, but her behaviour now is positively murderous, at least for anyone who is likely to need health care before the spring.  And let’s face it that could be any of us.

Instead of giving Simon Stevens the money and the resources he and the NHS need to function effectively, May is just using him as a patsy for her own inadequacy.  Along with Hunt, she appears to be looking forward to another disaster in the NHS as  the final nail in its coffin.

The Conservatives are essentially playing games with all our lives and it looks fairly certain that people are going to suffer and die as a result.  But rather than make things better, Theresa May’s and Jeremy Hunt’s overriding priority is simply to make damn sure they have someone else to blame.

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