Rescue services require urgent reform 20 December 2022 Fire and rescue services are under unprecedented pressure. The Manchester Arena bombing and the Grenfell Tower fire exposed failings in leadership, communications and collaboration with other emergency services; climate change raises the spectre of simultaneous major emergencies across the country; and domination by white men makes fire and rescue look like a service from the 1970s. Are government reform plans up to the task? Phase one of the Grenfell Tower Inquiry, which investigated events on the night of the fire in June 2017, called for improvements in leadership, training, communications and coordination between emergency services. Lord Kerslake’s inquiry into the Manchester bombing the previous month highlighted the need for improvements in the same areas and laid bare cultural failings in Greater Manchester Fire and Rescue Service that impeded collaboration with ambulances and police. Justin Partridge, who has held senior positions in police and fire and is now a researcher at the University of Leeds, says that while the response of the emergency services to an incident is generally good, the weaknesses in collaboration occur at a strategic level, where they are unclear how they can support each other in improving community safety: “That strategic level is badly fragmented, and for every example of good collaboration, you have instances where it has fallen apart.” Read the full article at Public Finance __________________________________________________ What Rishi Sunak’s covid record reveals 16 November 2022 Rishi Sunak’s actions during the covid-19 pandemic tell us a great deal about his attitudes towards healthcare and science—and therefore how these may fare under his tenure as UK prime minister. As chancellor of the exchequer and one of the government’s key decision makers, Sunak had much influence on the course of the pandemic and its economic and other consequences. Boris Johnson appointed Sunak chancellor on 13 February 2020 after Sajid Javid quit. Sunak had been chief secretary to the Treasury for the previous seven months. Two weeks before his promotion the first covid cases had been confirmed in the UK. Sunak was one of the quartet of key decision makers during the pandemic, alongside Johnson, the health and social care secretary for England, Matt Hancock, and the Cabinet Office minister, Michael Gove. Sunak had to rewrite his first budget hastily to respond to the rapidly escalating crisis before he delivered it on 11 March. He unveiled £12bn of pandemic spending, including at least £5bn for the NHS in England and other public services, alongside £7bn for businesses and workers across the UK. Promising to do “whatever it takes” to support people and businesses through the emergency, he added, “Whatever resources the NHS needs to deal with coronavirus, it will get.” Read the full article at BMJ __________________________________________________ NHS in jeopardy as Hunt looks for cuts 19 October 2022 The longest serving health secretary is now the chancellor of the exchequer in search of cuts. The health service looks exposed, but could Jeremy Hunt end up delivering a workforce plan? Hunt was explicit on the public spending consequences of needing to get debt falling as a share of the economy: “All departments will need to redouble their efforts to find savings, and some areas of spending will need to be cut.” But he claimed every decision to be announced in the Medium Term Fiscal Plan on 31 October will “prioritise the needs of the most vulnerable.” One part of the prime minister Liz Truss’s growth plan that survived the Hunt cull was the abolition of the health and social care levy, which the Office for Budget Responsibility (OBR) had estimated would raise £12.4 billion a year. Abolition does not hit the spending plans for those services, but it kills off an experiment with an element of hypothecation for NHS and social care funding. Hunt needs to find around £60 billion (the Institute for Fiscal Studies estimate) to £72 billion (the OBR’s figure). The £32 billion from scrapping Truss’s plans barely gets halfway there. Read the full article at BMJ __________________________________________________ Turning around the crisis in democracy 14 October 2022 Even before the polarising and divisive impact of the Covid-19 pandemic, growing numbers of people across the world believed they were being lied to by their leaders. This created a void, into which poured misinformation, destabilising public sentiment even further. However, faced with this erosion of democratic legitimacy, many institutions of government are finding ways to rebuild and sustain trust through openness, integrity and innovation. Adrian Brown, executive director of the Centre for Public Impact, says: “Governments are facing twin crises of legitimacy and effectiveness. The health of democracies is built on the extent to which people believe that, while government may not do everything they want, it is able to act broadly in society’s interests and make headway on many of the challenges we see. The trust ratings in a whole range of governments, particularly in Western liberal democracies, are either at or very near to all-time lows.” The Edelman Trust Barometer, run by the Edelman Trust Institute in the US, has been surveying global trust in institutions such as governments, businesses, the media and non-governmental organisations for 22 years. Its 2022 report reveals that just 52% of respondents across 27 leading countries trusted their government. Read the full article at Public Finance __________________________________________________ Coffey’s NHS plan fails to tackle crisis 23 September 2022 The government’s plan to get the NHS through this winter offers virtually nothing of substance and shows that ministers are in denial about the scale of the crisis. In her first big announcement as England’s health and social care secretary, Thérèse Coffey unveiled Our Plan for Patients. Having promised in the opening lines of the document that “we will not paper over the problems that we face,” she spends much of the following 4000 words doing precisely that. The overwhelming pressures on services such as ambulances, emergency departments, and primary care are presented as the unfortunate side effects of poor performance and bureaucratic barriers such as too few phone lines for GP surgeries and too little data sharing between ambulance trusts. At no point does Coffey reference the fundamental problem that there are too few staff to meet the high and growing demand from an ageing population. One of the few solid commitments is £500m to restart support for discharging patients into the community through improved social care, including more staff. But this too is far from adequate for the size of the task, with 165 000 vacancies in England’s social care workforce. It also repeats the mistake—often made by the NHS itself—of treating social care as a hospital discharge service rather than a community care service. HSJ has reported that the £500m will come from existing budgets, so it is not new money. Read the full article at BMJ __________________________________________________ The verdict on Brexit’s healthcare impact 3 August 2022 The battle over Brexit triggered extreme claims about its likely impact on UK healthcare, ranging from a collapse in staffing and drug supplies to a big funding increase and a bonfire of red tape. Then came the covid pandemic, which all but obscured any Brexit effect. But, six years after the vote and 19 months after the UK finally separated from the EU, it’s possible to judge which predictions were accurate, which ones were not—and the things we didn’t see coming. Predictions that came true European nurse recruitment collapsed, but medical recruitment didn’t The European supply of nurses plummeted, but it’s been made up by immigration from outside the European Economic Area (EEA). Mark Dayan, policy analyst and head of public affairs at the Nuffield Trust, says, “Before the vote to leave, there was heavy recruitment of nurses from the EEA—more than 10 000 a year at one point—and that was a fairly crucial way in which the health service was trying to fill the shortage of nurses.” The migration of nurses from Europe “fell off a cliff in 2016, partly as a result of Brexit and partly as a result of a new language test that the Nursing and Midwifery Council imposed,” says Dayan. “Since then you see quite a rapid pick-up in non- EU nursing migration, especially after the liberalisation of migration rules in 2019. That’s gone back to delivering several thousand additional nurses recruited abroad every year.” Read the full article at BMJ __________________________________________________ High court opens pandemic blame game 29 April 2022 The High Court judgement that the policy of discharging untested hospital patients into care homes as Covid-19 erupted in the UK was unlawful sheds light on the respective roles of advisers and ministers as they grappled with the evolving science, while Matt Hancock’s response shows his determination to blame officials for mistakes. The first wave of the virus killed more than 20,000 care home residents. The judgement – Gardner & Harris v secretary of state for health and social care – is a significant staging post for the public inquiry, which will be led by Baroness Heather Hallett. It reveals how evidence for asymptomatic transmission gathered pace and the extent to which officials and ministers were aware of it and reflected it in public statements and policy. On 28 January 2020, just under a month after China notified the World Health Organization of what we now know as Covid- 19, the Scientific Advisory Group for Emergencies – SAGE – concluded “there is limited evidence of asymptomatic transmission, but early indications imply some is occurring”. In February and early March, scientific papers around the world gave increasing indications that asymptomatic transmission was occurring. Ministers knew there was growing evidence for it – health minister Lord Bethell told the Lords on 9 March that “large numbers of people are infectious or infected but are completely asymptomatic and never go near a test kit”. Read the full article at Civil Service World __________________________________________________ Ockenden exposes typical NHS failures 31 March 2022 Donna Ockenden’s final report on maternity failings at Shrewsbury and Telford Hospital NHS Trust once again exposes common problems underlying health service scandals: failures in leadership and teamwork, failure to follow clinical guidelines, failure to learn and improve, and a failure to listen to patients. The inquiry identified “significant or major concerns” in the care involved in nine maternal deaths, 131 stillbirths, 29 cases of hypoxic ischaemic encephalopathy (HIE), and 70 neonatal deaths, as well as around 65 cases of brain damage which were often diagnosed years later. Failures identified by Ockenden include poor antenatal care for vulnerable women, repeated failures to correctly assess fetal growth, reluctance to refer women to tertiary centres to address fetal abnormalities, poor management of multiple pregnancies, poor management of gestational hypertension, failure to recognise sick or deteriorating women, failure to act on abnormal fetal heart patterns and failure to escalate concerns. Shortcomings in leadership and teamwork—important factors identified in Bill Kirkup’s investigation into failings at the maternity unit in Furness General Hospital, Morecambe Bay—included a culture of bullying and a failure by the board to face up to problems. One staff member who tried to raise concerns “was referred straight to occupational health. It seemed that as I dared to raise a concern I must obviously be mentally unwell… This whole conversation was held in public.” Read the full article at BMJ __________________________________________________ Javid plan will unleash new NHS chaos 2 February 2022 The reported plan by health and social care secretary Sajid Javid to introduce “academy” style hospitals risks triggering organisational chaos in the NHS while failing to address any of its underlying problems. According to the Times, barely six months after returning to the cabinet Javid is planning to force failing hospitals to become “reform trusts,” similar to academy schools, to address wide variations in performance across the health service. It is possible that chains of hospitals will be run by leading NHS managers, or even outside sponsors. Everything about this plan is flawed. It shows that a decade after Andrew Lansley’s disastrous attempt to use market mechanisms to drive improvement in the NHS, this government has forgotten all the painful lessons of the cost, political damage and impact on services of ill-conceived top-down NHS reorganisations driven by ministerial whim rather than evidence. The reform trust plan is being stitched together just as parliament is considering the Health and Care Bill, which aims to dismantle the worst excesses of the Lansley reforms and provide the legal foundations for the local integration of services. Javid’s new plan risks unleashing yet another major reorganisation of the health service before the current one is even bedded in. Read the full article at BMJ __________________________________________________