{"id":45946,"date":"2019-10-25T15:21:20","date_gmt":"2019-10-25T14:21:20","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=45946"},"modified":"2019-10-29T14:01:19","modified_gmt":"2019-10-29T13:01:19","slug":"david-oliver-a-speech-to-be-proud-of","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/10\/25\/david-oliver-a-speech-to-be-proud-of\/","title":{"rendered":"David Oliver: A speech to be proud of?"},"content":{"rendered":"<p><span style=\"font-weight: 400\">A couple of weeks ago <\/span><span style=\"font-weight: 400\">Matt Hancock, the Secretary of State for Health and Social Care in England gave a speech at the annual NHS Providers\u2019 Conference.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Unexpectedly, he popped up on my twitter timeline, urging me and others to <a href=\"https:\/\/twitter.com\/MattHancock\/status\/1181958272745721857\">read the speech in full<\/a>.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Naturally, I did read the full text of the speech. <\/span><a href=\"https:\/\/www.gov.uk\/government\/speeches\/how-we-build-an-nhs-thats-there-for-every-member-of-society\"><span style=\"font-weight: 400\">It\u2019s freely available on the government website.<\/span><\/a><span style=\"font-weight: 400\"> This wasn\u2019t any old ministerial speech, but a major set piece designed to signal his intention and priorities for the NHS and only days before the Queen\u2019s Speech on the 14 October. The title \u201cHow we build an NHS that\u2019s there for every member of society\u201d speaks volumes, especially in the run-up to a possible general election.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Hancock was clearly proud of it and keen to promote and defend it. So let\u2019s look at what he did and did not say about the challenges facing the NHS and the big ticket solutions.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">By common consent the largest challenge facing the service right now is the clinical workforce without which service quality is bound to deteriorate. This he glossed over by referring to \u201cThe People Plan\u201d (delegated to NHS national arms-length bodies) \u201cwhich will be published later this year\u201d. He mouthed scripted platitudes about \u201cinspiring and engaging the workforce\u201d without saying how.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">He also claimed that \u201cMost of the additional \u00a333.9 billion will be spent on people\u201d. But this figure is highly contestable. <a href=\"https:\/\/www.bmj.com\/content\/366\/bmj.l5446\">The government has already been criticised<\/a> for claiming that additional funding from 2018\/19 to 2023\/24 is a \u201crecord funding increase\u201d when it is merely in line with average annual percentage increases up until 2012. But that figure took into account projected inflation which more accurately reflects additional spending power. It seems that Hancock had conveniently forgotten this inflation adjustment. <\/span><span style=\"font-weight: 400\">Boris Johnson then repeated the \u00a333.9bn figure in the commons during Prime Minister\u2019s Question Time.<\/span><\/p>\n<p><span style=\"font-weight: 400\">His speech only briefly mentioned public health and completely ignored public health funding and provision or policies to prevent ill-health or inequalities. It ducked the increasingly pressing challenge of social care funding and provision\u2014perhaps because this would be mentioned in the Queen\u2019s Speech. He discussed \u201c<\/span><span style=\"font-weight: 400\">wrap-around care and support we provide to elderly people and people with physical or learning disabilities\u201d with no detail on delivery.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Come the Queen\u2019s Speech, there was a re-announcement of the serially delayed <\/span><span style=\"font-weight: 400\">Social Care Green Paper<\/span><span style=\"font-weight: 400\"> with no timescale for publication, let alone a resulting white paper or bill and a re-announcement of a \u00a31.5bn injection for social care available to councils relying on councils raising more council tax from local residents. As <a href=\"https:\/\/www.bmj.com\/content\/361\/bmj.k2745\">I have argued here<\/a>, this is a regressive approach, entrenching inequalities and inverse care between affluent and poor areas<\/span><\/p>\n<p><span style=\"font-weight: 400\">Hancock did, in his speech promise a \u201cLong Term Plan Bill\u201d with legislative changes to support the NHS Long Term Plan. This focussed on a statutory footing for new structures such as integrated care systems and new permissions to move towards more integrated locality working, risk sharing, organisational mergers, removal of enforced competition and a move away from a purchaser provider split and traditional payment models.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">As <a href=\"https:\/\/www.hsj.co.uk\/policy-and-regulation\/stevens-calls-for-legislation-to-accelerate-long-term-plan\/7023542.article\">NHS England leaders<\/a> have called for this<\/span><span style=\"font-weight: 400\"> and critics of the long term plan <a href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/04\/17\/integrating-health-and-social-care-in-england-when-the-sum-is-not-greater-than-its-parts\/\">have criticised reorganisation without legislation or public scrutiny<\/a>, <\/span><span style=\"font-weight: 400\">I can accept this\u2014although the devil is in the detail and it\u2019s not the kind of announcement to inspire anyway outside the NHS senior management cadre.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Hancock went on to renew his repeated commitment to better technology in the NHS, citing his creation of the new arm\u2019s length body NHSX and a focus on \u201cshared standards on governance, procurement and contracts, so that you can buy whatever you want, from whoever you want, as long as it\u2019s safe, inter-operable and does the job\u201d.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The jury is very much still out on these approaches. The <\/span><a href=\"https:\/\/www.bmj.com\/content\/365\/bmj.l1297\"><span style=\"font-weight: 400\">revolving door<\/span><\/a> <a href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/07\/16\/paul-tiffin-can-we-tame-big-techs-big-influence\/\"><span style=\"font-weight: 400\">between NHS Digital <\/span><\/a><span style=\"font-weight: 400\">and NHSX senior posts and the health tech sector keen to do business with the NHS has <\/span><a href=\"https:\/\/www.bmj.com\/content\/365\/bmj.l1297\"><span style=\"font-weight: 400\">raised questions<\/span><\/a><span style=\"font-weight: 400\">. The premature over-promoting of still unproven technology, and relationships with organisations like Babylon Health,<\/span><span style=\"font-weight: 400\">\u00a0<a href=\"https:\/\/www.bmj.com\/content\/365\/bmj.l2387\">have raised eyebrows<\/a>. We need more transparency, scrutiny, and far better evidence rather than blind faith and assumptions about the effectiveness of health technology innovations.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Alongside legislation for reform and technology, the third element of Hancock\u2019s speech involved commitments to capital expenditure on NHS buildings and facilities\u2014which is certainly long overdue.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">However, his speech focussed on acute hospitals rather than other vital facilities in community and primary care, promising: <\/span><span style=\"font-weight: 400\">\u201c6 new hospitals, ready-to-go now, will start immediately, and another 34 new hospitals, in the pipeline, have been given the green-light, and seed funding, to develop their plans.\u201d\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">This is some way off the \u201c<\/span><a href=\"https:\/\/www.channel4.com\/news\/health-secretary-matt-hancock-defends-40-new-hospitals-claim\"><span style=\"font-weight: 400\">40 new hospitals<\/span><\/a><span style=\"font-weight: 400\">\u201d Hancock had been promising only a few weeks before. Nor are they brand new builds but upgrades. There was a commitment to \u201cmulti-year indicative envelopes\u201d for capital funding rather than one off payments. And more \u201cstreamlining.\u201d Again, credible detail was absent. Nor did the Queen\u2019s speech shed more light. <\/span><span style=\"font-weight: 400\">Both <a href=\"https:\/\/www.nuffieldtrust.org.uk\/news-item\/hospital-pledges-raise-capital-concerns\">the Nuffield Trust<\/a> and <a href=\"https:\/\/fullfact.org\/health\/six-hospitals-not-forty\/\">the \u201cFull Fact\u201d site<\/a> have debunked the original claims.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Overall, Hancock\u2019s proud defence and promotion of his speech seems incongruous given the key policy areas completely ducked, and the many details missing.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Still, he did ask me to read it properly and I was happy to oblige.<\/span><\/p>\n<p><b><i>David Oliver<\/i><\/b><i><span style=\"font-weight: 400\"> is a consultant physician in Berkshire and writes the weekly BMJ \u201cAcute perspective\u201d column. <\/span><\/i>Twitter <a href=\"https:\/\/twitter.com\/mancunianmedic?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor\"><span style=\"font-weight: 400\">@mancunianmedic\u00a0<\/span><\/a><br \/>\n<b><\/b><\/p>\n<p><em><b>Competing interests: <\/b><span style=\"font-weight: 400\">None declared<\/span><\/em><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A couple of weeks ago Matt Hancock, the Secretary of State for Health and Social Care in England gave a speech at the annual NHS Providers\u2019 Conference.\u00a0 Unexpectedly, he popped [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/10\/25\/david-oliver-a-speech-to-be-proud-of\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":45947,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5759,236],"tags":[],"class_list":["post-45946","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-david-oliver","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>David Oliver: A speech to be proud of? 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