Tom Smith on today’s health policy debate.
Following on from an interview with the Guardian newspaper today, Alan Johnson gave the keynote speech on the first day of the NHS Confederation conference – the biggest they have ever held in terms of numbers registered. The Secretary of State said he could not reveal the contents of Darzi’s Next Steps review, but could show “a bit of leg”. He talked about the importance of “compassion” and said efforts would be made to measure it, as nurses had encouraged him to. Like most days, his speech may get the evening headlines, but the morning papers were concerned with new figures on cancer mortality, suggesting wide health inequalities – a subject Johnson touched upon. The papers also contained reaction to Alan Johnson’s statement yesterday that the ban on co-payments will be reviewed. But before getting to those things, this review starts with the front page of the Times, which was very concerned about the implications for rising inflation on the costs ofthe NHS.

The implications of rising inflation for the NHS

Inflation is in the news – now up to 3.3% and said to rise to 4% by the end of the year. Last night Newsnight convened its shadow monetary committee and its three members agreed that rising inflation was being imported into the economy – food is up 60% over the last year while oil has doubled in prince. The panellists were worried though that imported inflation will catch on to the domestic economy, causing a “wage-price spiral”.
What is the risk that will happen? According to the Times today, it is quite strong. They says that ‘hundreds of thousands of public sector workers are threatening to tear up agreements and demand higher pay, as the cost of living surges’.
Unison has called for their recently agreed pay deal for 500,000 workers to be re-examined. The head of the union, Dave Prentis, said he would ballot for industrial action amongst its NHS members if the government refused. The union is keen to ‘revisit a clause in the deal which recognises that members need to be “protected” if inflation rises’. While it is too late to include the inflation rise this year, the union would like to look at years two and three of the 3-year deal.
The Prime Minister will be worried. Just yesterday, he emphasised “the importance of pay restraint at a time of economic uncertainty” as he announced plans to hold back a recommended pay increase for MPs. The risk for the government is that inflation will spill over into the NHS, through inflation-based adjustments to pay awards and because of increased costs in food and energy.

Reaction to the announcement that the ban on co-payments will be reviewed

The Times, FT and Independent covered the announcement that Alan Johnson has asked Mike Richards to review the co-payment situation. Nigel Hawkes wrote that while ‘Mr Johnson denied that the review presaged a change in policy, it reflects a growing conviction among ministers that the government’s policy would be shredded in any court hearing’. He also notes the universal condemnation of the newspapers.
One dissenting voice is Ian Beaumont of Bowel Cancer UK who believes a change of policy would be a backward step because it may lead to a two-tier system.

“Co-payments will force more people to go private and give the Government, NICE and PCTs and excuse to deny patients access to effective treatments on the NHS” – Ian Beumont, Bowel Cancer UK.

Nigel Edwards, however, told the Independent, “this is a complex issue with each side of the argument largely incompatible. We need to find a solution that recognises an individual’s wish to spend money as they see fit while safeguarding the principles of the NHS”.

Figures from the National Cancer Intelligence Network reveals widespread inequalities

The National Cancer Intelligence Network, founded last year to collate information on 20 forms of cancer, released its first report today. It showed that people in the north have a 20% higher chance of dying from cancer ‘underlying stark divides in the nation’s health’. More people die of lung cancer in the north than south. The only measure on which the south does worst is in relation to breast cancer.
Mike Richards – the government’s cancer tsar and the man who will review the co-payment situation – offered his analysis of the differences in mortality. “In the north of the country, even though breast cancer rates of women are high, more women die of lung cancer. That’s a reflection of higher levels of smoking in more deprived areas. It goes in an opposite direction with breast cancer. Affluent women often tend to delay childbirth, and having children older may slightly increase the risk of the disease”.
The main response of the government so far has been to talk about how improving access will change the statistics. The Times’ Nigel Hawkes, however, suggests that the figures are compounded by differences in behaviour between groups – the middle-class tend to know how to use the health system better than working class people. Hawkes says ‘health inequalities start in the womb’ and the causes are social, suggesting that new forms of intervention are needed to reduce inequalities.

In an interview published today, Alan Johnson tells the Guardian of plans to rate the ‘compassion’ of nurses in the NHS

As well as doctors, nurses will be ranked ‘on how compassionate they are towards patients’. The Guardian said the move will be part of a plan to improve quality that will be unveiled before the NHS 60th anniversary on July 5th. Alan Johnson told the newspaper he would like the results to be compiled on a website. He said, “Trusts might want to reward the best team, but that’s a local concern”.
Speaking to the NHS Confederation, Johnson said he couldn’t reveal all of the Next Steps review but he could “show a bit of leg”. He confirmed the plan to gauge compassion and said the precise approach would be explored with the RCN and Unison.
Peter Carter, the general secretary of the RCN, said the plan could “open nurses’ performance up to real scrutiny, instead of relying on anecdote”.

Alan Johnson speaks to the NHS Confederation annual conference for the first time

Alan Johnson noted the news reports on health inequalities in relation to cancer (see above). He said the government’s great achievement is that “the level of the poor now is where the average was 10 years ago”. The situation has improved, but the health status of the more affluent has improved faster. He said there is much to do to improve inequalities, but also wanted to say that much had been done.
The NHS in 1997, he said, was “sick” and “needed resuscitation”. He talked about the successes of cutting waiting lists and said mortality had improved. He then made a claim which will sound to some like revisionism: “every structural reform of the last 11 years has been difficult, but necessary”. Furthermore, “every reform has really been a prelude to the Next Steps Review”, in which he promised there would be “no new national targets, “no structural change”.
By saying all reforms were a prelude to the Darzi review, Johnson means that it has taken a series of efforts to centrally drive improvements, set in place PCT structures and so on, but now it was time to give precedence to locally led reform.
As an example of change where no new structures are needed, he said it made sense for PCTs not to have long complicated names, but to be called Trafford NHS, for example. This would make it clear what responsibilities these bodies have. And it would overcome the widespread lack of awareness over what PCTs are and what they do.

Conservatives continue their pressure on the closure of GP surgeries

Writing in the Times, Alice Miles reminds us of what a political issue health policy is – and whatever the health services delivers, we will want more. She says, for example, ‘the fate of the local hospital or GP surgery will still account for more votes than any esoteric arguments about 42 days’ detention’.
For precisely this reason, perhaps, the Conservatives continue to voice fears about the impact of polyclinics: the possible closure of GP practices – something that Alan Johnson denies. In his interview with the Guardian, Alan Johnson seemed dumbfounded by the continuing criticism about polyclinics. “All the government is seeking is to expand capacity in primary care...Nye Bevan said in 1946 how important health centres should be”. He reiterated that no practice would close.
The debate over polyclinics involves a lot of semantics and this was added today. The Conservatives have named 608 practices in areas where polyclinics will be built, practices that are ‘at risk’. It is not that they will necessarily close, say the Conservatives, but that any new centre will threaten the viability of others. ‘It is inevitable that they will lose resources because of the new development even if they are not actually dragged into it’.
The Daily Telegraph publishes the full list of ‘at risk’ practices named by the Conservatives.