Archive for the 'NHS' Category


Situation critical. How the NHS could affect the path of Brexit

Wednesday, October 26th, 2016


That £350m “commitment” could be damaging

The debate in Britain about health spending is fundamentally dishonest.  The left constantly press for large increases in spending.  The government constantly boasts about ever-increasing spending at or above inflation levels.  Voices on the right frequently argue for scaling back the health services that the public sector provides.  None of them address what Britain needs.

Britain’s health needs are growing at a rate far faster than inflation, even if one uses measures of healthcare inflation.  Those needs are not growing in line with prices but demography.  40% of NHS spending is devoted to those aged 65 and over, though that group comprises only 18% of the population, with this spending concentrated in the older age bands.  70% of NHS spending in England is directed towards just 25% of the population – those with incurable long term conditions.  As the nation’s population inexorably gets older and as those with incurable long term conditions can be supported more effectively, costs will inevitably rise.

Make no mistake, it is good news that we are living longer and that those with health needs can be supported more effectively.  But that good news comes with a cost and one that rises as we age.  By 2039 the Office for National Statistics estimates that those aged 75 or over will increase from 8% of the population to over 13% of the population.  (Besides being the most needy of resources, the over-75s are also the most violent.)    Healthcare costs, if no changes are made to NHS coverage, will rise far in excess of inflation for the next generation.  Increasing funds for the NHS is like throwing cakes at a bear.

There is no easy solution.  To make the books balance, either taxes will need to rise steeply, other government spending will need to be reduced significantly or NHS services will need to be cut sharply.  Probably we will need to see a combination of all three.  There is a crunch coming and it cannot be deferred indefinitely.

That crunch may be coming very soon indeed.  75% of acute hospitals are in deficit – only 8% of NHS providers were in deficit in 2009/10.  The NHS has managed to keep the show on the road in the last few years by spending more than it receives.  That is not a sustainable model in the long term and may not be sustainable in the short term.  Ambulance response rates are worsening, waiting times after referral are deteriorating (cancer treatment waiting time targets have not been met since 2014) and A&E waiting time targets are now routinely being missed, with the latest quarter showing the most patients delayed in a decade.  Pressures are building up in the system.  The sense of crisis building is palpable.

The government will be hoping for another quiet winter in the health service, as are we all.  Given the state of hospital finances and current performance, there is no particular reason to expect that hope to be met.  The media reporting on a crisis in the NHS this winter looks considerably more likely than not.

The public aren’t expecting this at all.  They’ve just voted in a referendum where they were told that £350 million a week could be saved for the NHS.  Reasonably enough they are going to ask why this has not happened.  They are unlikely to be impressed to be told that the money is not going to be available, that actually the £350 million was earmarked for other things as well, that Brexit has yet to happen, that the Leave camp are not the government and that it wouldn’t make all that much difference anyway.  Pointing at the small print will just leave the public feeling duped and angry.

If the public think that they have been had, this is probably going to do nothing to assuage concerns about how Brexit is developing.  Theresa May has pencilled in March for triggering Article 50 (subject to whatever the courts might rule about this).  Nothing much looks likely to happen before then and the vacuum about what Brexit means seems likely to continue till then, with increasing alarm among the public about the absence of a disclosed plan.  If Leave’s flagship policy comes to be seen as a con in the public’s eyes, public confidence in the whole idea is likely to dissipate at high speed. 

So Leavers should be thinking right now what they’re going to be telling the public if the NHS does go through a rough patch this winter.  The NHS’s problems could rapidly become their own.

Alastair Meeks



As doctors stage their 3rd strike Ipsos-MORI finds that they are still getting strong public support

Wednesday, March 9th, 2016


57% blame the Government 11% the doctors

With thousands of operations being cancelled because of the latest doctors strike public support for them is as high as it was for the first two strikes in January and February, according to new polling from Ipsos MORI.

The survey of adults in England finds the same proportion (65%) supporting junior doctors strikes as for the previous round of action in February (66%) – as long as emergency care is provided. Opposition to junior doctors striking has decreased by 5% to 17% compared to last month.

The new figures are published as doctors go on strike for a third time, and show that the government continues to bear much of the blame for the ongoing dispute. 57% say that the government is more at fault for the dispute continuing this long, down from 64% in February, and the number saying the junior doctors are more at fault is still low at 11% (13% in February).

However there has been a 10 point increase since last month in the number saying that the doctors and the government are both equally at fault (28%).

If it wasn’t for referendum this would be getting more attention than it is and create more problems for the Tories.

Mike Smithson


The latest Jeremy Hunt betting

Sunday, November 29th, 2015


Another story that hasn’t received the coverage it deserves is the problems Jeremy Hunt is having with junior doctors, but with the first junior doctors’ strike scheduled for this Tuesday, that will change.  But people like David Cameron and George Osborne are aware of how important the NHS is, a few days ago, The Spectator reported that

Another area where Osborne is determined to keep putting in extra resources is the health service. He believes it was Cameron’s NHS commitment that was the most important and electorally significant element of Tory modernisation. The tensions between 10 and 11 Downing Street and Jeremy Hunt in recent weeks have been borne out of frustration that, despite the cash that the Tories are pumping in, they are still regularly waking up to headlines about the NHS being in crisis.

William Hill have a market up on whether Jeremy Hunt will remain Health Secretary until 2017. I’d probably take the 5/2 because Cameron has form for moving a cabinet minister that manages to upset a profession that is respected and trusted by the public, especially if it undoes the Conservative modernisation and detoxification strategy.

Michael Gove was moved from the Department of Education and replaced with the more emollient Nicky Morgan, after Gove had antagonised the teaching profession with Lynton Crosby warning Cameron that Gove was toxic for the Tories. The omens are not good for Jeremy Hunt continuing as Health Secretary for much longer. As Alastair Meeks noted a few weeks ago ‘It seems to me that Jeremy Hunt can lose quickly or he can lose slowly.’



Why Jeremy Hunt might be onto a loser in his fight with the doctors

Monday, November 16th, 2015

Antifrank on  “picking your battles carefully”

The government is heading for a major confrontation with junior doctors over pay restructuring. Jeremy Hunt is looking to change their terms of employment to facilitate his vision of a seven day a week health service. Junior doctors feel that the revised terms pull the rug from under them. They feel that Jeremy Hunt is spoiling for a fight and that he is looking to impose his terms on them. As a result, they are due to strike for three days in December. How is this going to pan out?

This isn’t going to be a fancy article. It’s largely going to consist of one table, courtesy of Ipsos-MORI. 


It seems to me that Jeremy Hunt can lose quickly or he can lose slowly. Losing slowly will be more damaging and more humiliating. He should concede gracefully and enter into negotiations with no preconditions. This is a battle that he has very poor chances of winning.



The Tory Keogh report offensive appears to have had no impact on the “best party on NHS” ratings

Tuesday, July 30th, 2013

One of the big apparent “wins” for the Tories before they broke up for the summer recess was their response on the Keogh report on hospital failings which had happened on Labour’s watch. This it was hoped would help the party eat into the traditional LAB lead that they have on the NHS.

The CON attack was high octane and certainly LAB, with its less than convincing shadow health minister Andy Burnham, were put on the defensive.

The view, certainly from the right wing pundits, was that this was a win and a demonstration of what the Lynton Crosby approach could do.

Today we see the first YouGov best party on the NHS tracker since then and, as can be seen all parties move up 2 so the LAB 12% lead remains.

It doesn’t appear as though the blue message has got through.

As I’ve been arguing the NHS is one of those areas where the Tories are almost bound to come off second best. Far better to stick to areas of strength like the economy and immigration.

Mike Smithson


The NHS is to the Tories what immigration is to Labour – a policy area they can’t win. Better to move on

Wednesday, July 24th, 2013

The best strategy is to steer the debate on to areas of strength

A week, as Harold Wilson used to say, is a long in politics and just seven days ago the Tories felt they were on to a winner with the concerted attacks on a Labour’s custodianship of the NHS when they were in power.

Whether it was the right thing for the Tories to do is one thing but there’s little doubt that seeing the main opposition party on the defensive on a policy area that they’ve always made their own sent CON MPs off in good heart as they left for their summer recess.

    But was this politically the right thing to do and should this aggressive approach be repeated when hostilities resume in September?

    In essence is the Lynton Crosby strategy right?

The polling at the weekend on the aftermath of the Keogh report found barely one in five blaming Labour for what had gone on which must have been a disappointment to the blues but not really surprising given how well as Labour continues to be regarded.

To my mind the NHS is to the Tories like immigration is to Labour – a policy area where whatever they do or say they can’t win. Better to move the debate onto areas of strength which I believe is what they’ll now do.

Mike Smithson


Corporeal on David Cameron and the NHS

Thursday, February 14th, 2013

The Three letters of David Cameron

When David Cameron won the Conservative party leadership contest he said he could state his priorities in three letters: NHS. More than any other issue, from the Big Society to hugging huskies in hoodies, he’s tried to connect himself to the state of healthcare in this country.

While prescribing declaring cuts had to take place in almost every other department he declared he would protect the NHS by ring-fencing its budget. It is a personal crusade (he has talked about how his experiences with his son made the issue so important to him), it is central to his campaign to de-toxify the Conservative party, with the Stafford hospital report published it is very much on the agenda.

From a polling standpoint on YouGov’s issues tracker it ranks as the 2nd most important issue facing ‘you and your family’ (behind the economy) and 3rd facing the country (behind economy and immigration).

But has Cameron’s focus on the issue been successful?

Or at least has it been popular (in politics the two are so entwined with each other). Below are graphs tracking the Conservative score, and Conservative lead (either positive or negative) over Labour, I’ve drawn them from YouGov’s recent tracker (which since early 2010 has regularly been tracking issue ratings, and infrequently in between 2005 and 2010) and Ipsos Mori’s unparalleled historical data which covers a much longer time span but always infrequently.

Firstly the YouGov data:

What we can see here is just how badly the Conservatives have rated on the NHS, since 2005 and including 75 polls taken since the start of 2010, they have one instance of being level with Labour, and three of leading them (with leads of 1, 1, and 3). The other 71 polls have them behind (even while they were leading in voting intention polls).

Cameron’s time as Leader of the Opposition up to the early years of his premiership show some sustained improvement in the Conservative ratings (and that helping to drive a similar level of improvement in the gap to Labour) with the caveat that given how the polls since 2010 jump around the infrequency of the polling 05-10 casts a bit of doubt on reading too much into it.

From the start of 2010 we have much more frequent data that places them mildly behind Labour up until the election and improving after the election through to that autumn, but then turns downwards and heads below even the 2005 ratings.

(The separate lines indicate a change of methodology, before 1988 the question was about the National Health Service, from the start of 1988 the question referred to “Health Care”).

What the longer historical perspective offers is a suggestion that Cameron is still performing relatively well even after his decline, remaining higher than all the ratings apart from Major’s stretch before the 1992 election and his peak the highest Conservative rating of the past 25 years (and comes outside of election time, while the other Conservative high points cluster around elections).

The leads (fairly unsurprisingly) tell a broadly similar story, that Cameron’s worst result (or conversely Miliband’s biggest lead) is better than any other since the 1980s.

That is certainly the most positive way of interpreting this data (it also depends on how much you think the change in wording has changed the results) but for all Cameron’s efforts on what in many ways has been his flagship project, I think he’ll view these figures (and hello to Dave if he’s reading, or Samantha for that matter) with some disappointment.



Maybe, just maybe, voters are starting to believe that the NHS is safe in Tory hands

Thursday, December 20th, 2012

Concern about the service drops to lowest level since election

Last night the Ipsos-MORI Issues Index for December was published and one of the highlights was the decline in the numbers of those saying that the NHS was an important issue facing the country.

The Index operates in a totally different manner from any other regular poll and has done for the past 37 years. For rather than ask how respondents feel about specific issues it seeks to test the salience.

All the interviews are carried out face to face and those questioned are asked to name as many important issues as they like which they think are facing the UK at the moment. It is important to note that this is totally unprompted.

    This month the proportion including the NHS dropped to 15% – the lowest level since the general election and, as can be seen from the chart, in line with the long-term trend.

If these figures are in any way accurate then, I’d suggest, it’s good news for the Tories. An issue on which they are almost always seen as doing worse than Labour has lost a lot of its salience.

Mike Smithson

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