As the Guardian has reported this morning:
An independent investigation will be held into the performance of the NHS, the health secretary has announced.
Writing in the Sun, Wes Streeting said the investigation would be aimed at “diagnosing the problem” so the government can “write the prescription”.
Streeting said: “It's clear to anyone who works in or uses the NHS that it is broken. Unlike the last government, we are not looking for excuses. I am certainly not going to blame NHS staff, who bust a gut for their patients.
“This government is going to be honest about the challenges facing us, and serious about solving them.”
To make clear how serious he was the report noted:
Streeting said the investigation would be led by the former health minister Lord Ara Darzi, who he has asked to “tell hard truths”.
Darzi has a history of advising Labour governments to do things in the NHS that do not work and simply divert resources from where they are needed, often duplicating services and creating confusion in the process. This is bound to work well then.
But let me make three further observations.
First, why wasn't this done by Labout before getting into office?
Second, is funding within the remit? If not, what is the point of doing anything?
Third, how long will all this take? Is the aim to delay action until Reeves has delivered growth? In that case, Darzi had better take his time.
Candidly, this looks utterly ill thought out and the clearest indication of a lack of preparedness for office. Streeting has had years to work out what he wants from the NHS, and now he has the chance to do something he is choosing inaction by sending everything out to a tame consultant, who just happens to be a Labour friendly peer. To describe this as pathetic is to be overly kind to Streeting.
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The comments by Streeting fall into the class of grooming: “It’s clear to anyone who works in or uses the NHS that it is broken” – which means that it needs some serious “fixing” & that will mean getting the privaet sector to “help” in fixing it. This is all code for more privatisation by an MP funded by companies that want to be given pieces of the NHS so that they can make money. New gov, new faces, same policies, same rhetoric.
(2010 Camoron “UK society is broken” – code for austerity and circa 130,000 dead people by 2015 – one wonders what the body count in 2029?).
All very predictable but many voters are so shallow all warnings wash over their heads then they whinge when it goes pear-shaped. NHS safe in Wes Streeting’s hands when after all this time out office he pretends he’s clueless what to do with it? Pull the other one it’s being setup for privatisation! NHS should soon end up like the water and sewage companies, appalling service but increased cost, monopoly driven oligopoly!
Isn’t research one of the things for which Short money is paid?
Has Silly-Boy Wes been sniping for the last few years without any idea of the proper target?
I fear Streeting’s plan is to just delay further, to run down the NHS even more, so that at the end of the consultation the answer will be – “sorry, but the NHS is so broken now that the only solution is to bring in private money, as obviously the tax payers can give no more”.
I’m disappointed, but not in the least surprised. Streeting is all hat and no cattle, as the Americans say.
Agreed. However, the CV of another of Streeting’s “advisors” is also very alarming. Alan Milburn has firm as a previous Health Secretary but his continuing involvement in private health care is alarming. From his Wikipedia entry:
“In 2013 Milburn joined PricewaterhouseCoopers (PwC) as Chair of PwC’s UK Health Industry Oversight Board, whose objective is to drive change in the health sector, and assist PwC in growing its presence in the health market.[28][29] Milburn continued to be chairman of the European Advisory Board at Bridgepoint Capital, whose activities include financing private health care companies providing services ito the NHS,[30][31] and continued as a member of the Healthcare Advisory Panel at Lloyds Pharmacy.[32][33] As of 2022 he remains a Senior Adviser to PwC.”
Agreed
That looks like a straight conflict of interest – and under whatever rules there are , surely disqualifies him?
The whole system of money and vested interests and politics stinks – and needs a top to bottom clean up.
Starmers Downing Street speech said its now all about ‘service’ – so obviously things are soon going to be fine.
Streeting’s like a dog who’s made much of chasing cars for years and now to his amazement he’s finally caught one he has, predictably enough, no clue at all what to do with it. So, he’s stalling…
On a lighter note, I’m reminded a lot lately of one of the popular sayings attributed to a former legendary captain of the Starship Enterprise (D); “Shut up, Wesley!”
Where’s Picard when we need him?
Pure politics of the worst kind. When it all goes wrong, he’ll just say “the big boy made me do it”. The more I hear of Streeting, the more I dislike him.
Wes DOES need consultants to tell him what’s wrong!
…. and junior doctors, nurses, porters, radiographers, pharmacists etc., etc., etc.
Listen to the people who actually do the job.
But he des not need this type of consultant …
Don’t get me started on the subject of consultants, especially “independent” consultants. In my experience their sole purpose is to advise, at great expense, the management of a organization to do what they wanted to do anyway.
Hospital Consultant. So who came up with Streeting’s rob Peter strategy to pump more money into GP surgeries by taking billions from hospital budgets.
This man is the biggest danger to the English NHS since Hunt. Let’s hope he’s moved pretty quickly to a position where he can do less damage.
Wes Streeting is just one of Starmer’s crew who are playing the Mandelson game. Mandelson has been instrumental in the manifesto, the furtherance of private ‘partnerships’ in the NHS (‘I am going to open the door wide to them’; Streeting) and in the election.
This is dinosaur Mandelson directing Starmer’s government as a Blair advisor.
Already they are poised to ‘borrow’ money from BlackRock to get waiting lists down.
This Labour manifestation (which is far away from the proper Labour Party version) is not going to put right any of the fundamentals that the NHS has been starved of – investment in training places, buildings and maintenance while trying to sell the ‘Hospital at Home’ version which will rely on non-existent care workers.
It’s all there in Lansley’s Health and Social Care Act 2012 – instituted with the help of McKinsey and Simon Stevens, former Blair advisor who went to the USA to be global vice president of the biggest US medical insurance company, United Health, for ten years and was recalled by Cameron to see through the legislation to end the NHS as we know it (it is now 42 autonomous Integrated Care Boards) and gradually starve them into a bare Medicare system.
Anyone who thinks this Labour Government is going to do anything different from the Tories just hasn’t been looking behind the front cover. The Establishment was happy to have them in power because it poses no risk to its pattern for the country and the western world.
Bringing in the consultants suggests one or more of the following:
* Streeting does not know what is wrong
* Streeting does know what is wrong, but does not know what he can do about it
* Streeting does know what to do, but he wants some cover from so-called independent consultants (for which read political allies) to tell him what he already knows or believes
* Streeting does know what to do, but he doesn’t want to do it now, so bringing in the consultants allows him to kick the can down the road.
Always important in this sort of scenario are the terms of reference (what have the consultants actually been asked to do, like the pay review bodies asked to recommend pay increases within an overall budget), how long will it take (days, weeks or months), how much will it cost (thousands or millions, which could have been spent on something else such as healthcare), and what are we going to do in the meantime (is Streeting going to sit on his hands, and watch things get worse, while he waits for “independent” Labour peer Lord Darzi to tell the Labour minister what to do).
Everyone knows the main problem is money. Where are the new hospitals, where are the qualified staff, where are the GP appointments. Are the existing human and physical resources being fully utilised to the extent reasonably possible, and if so why not?
Have you been watching Yes Minister? It reads like it – and nothing wrong with that!
I admit I have borrowed the four reasons for a Tweet
I wish “Yes Minister” was available for streaming in the USA.
Let’s of good clips on YouTube
https://youtu.be/nb2xFvmKWRY?feature=shared
There’s also the possibility that Streeting doesn’t know which of the four reasons apply.
It’s an old neoliberal corporate restructuring model. Call in the independent consultants (the “experts”) to tell you the answers you want to hear. Then you have the excuses in place to execute the changes you knew you wanted to make. No doubt difficult decisions will need to be made but Labour will not shy away from them (insert sad faced ironic emoji here). It won’t be Wes who dunnit – the finger will always be pointed at the consultants.
If you can find billions for defence (but there’s no money!) you can find billions for health, social care and all the other desperate needs in the UK. Continuity Tory indeed.
I wonder if Streeting noticed the result of the investigation by the Centre for Health and Public Interest.
https://www.theguardian.com/society/article/2024/jul/10/eye-doctors-say-private-cataract-operations-have-hurt-the-nhs
Basically using private providers to carry out simple cataract operations has damaged the ability of the NHS to carry out more complex work, financially and professionally.
I wonder if he will understand it, even if he reads it.
Spot on
The Ophthalmology service at the John Radcliffe hospital in Oxford raised the alarm about this when this cherry picking of the easy stuff first came about – was it in Patricia Hewitts day, or Alan Milburns ? – to “help bring down the waiting lists”. ( sound familiar?).
Due to the disfunctionality of how the tariffs were set for procedures teaching hospitals like the JR with world class and pioneering specialities would rely on routine ops in their specialisms such as cataracts (& knees & hips for orthopaedics ) as a source of regular, predictable revenue that generated a bit of profit for reinvestment. This they used to cross subsidise the less routine work for which there were no straightforward tariffs, or developmental work which is fundamental to finding new and more effective procedures for patients. In the interim surgical registrars nd below would do the bulk of the routine ops as part of their intensive training. The JR warned before the changes were made that it would have long term negative consequences. QED.
And low and behold we have PM Bliar and his coterie back with their feet under the table and friends with vested and conflicts of interest pulling the strings of Starmer, Reeves and Streeting .
Not sure the electorate saw that on the ballot paper.
What could possibly go wrong.
May I say this concept “would rely on routine ops in their specialisms such as cataracts (& knees & hips for orthopaedics ) as a source of regular, predictable revenue that generated a bit of profit for reinvestment.” makes me shudder. How can an NHS hospital, performing NHS work, generate revenue? The internal market was one of the worst ideas in decades of bad ideas for the NHS. How much admin time is spent on pointless work charging other NHS departments or organisations?
Thank you, Vicky.
It’s interesting that toff and now Tory Patricia Hewitt.
Streeting, Hewitt and Mandelson go back over two decades. Hewitt had Streeting placed at PWC as an expert on public sector reform, a role that he had no professional background in / for.
It’s interesting how the internet has been scrubbed for Streeting and Hewitt.
I never trusted Hewitt
Starmer, Reeves, Streeting fit for office? Pull the other one! It’s quickly become very obvious in less than a week since the general election that they aren’t! What a country!
“ ARA DARZI LONDON HOLDCO LIMITED” this Ara Darzi? The one who also works for BUPA?
Yes
Thank you and well said, Richard.
Since Labour took office and listening to what Streeting has been saying, I have a fear that, perversely, Streeting’s marginal seat and near rejection will embolden him to render the NHS a state fig leaf for his donors / owners, knowing that a golden parachute, or golden parachutes, from said owners / donors awaits. He’s the Blairite lead candidate to succeed Starmer, so could be parachuted somewhere safer nearer the time.
It’s not as if the Labour membership and unions will or can be bothered to do anything about it. Opposition to Streeting will have to come from outside.
https://morningstaronline.co.uk/article/streeting-will-follow-labours-well-trodden-path
Well worth reading
Thanks
This is merely performative yet meretricious nonsense.
Of course all the data needed is freely available and could have been analysed well before the GE. .
Of course the NHS requires huge transfusions of funds.
A figure of £39bn pa + the £8bn pa already committed has been cited by the Health Foundation. (Hardly a bastion of far left socialism)
Of course Wes Streeting, mal-abetted by Milburn wants to outsource the NHS, but they need a coathanger on which to hang their highly contentious plans. This report will be that trojan horse.
Blair blabbing on about monetising NHS patient data, to release private sector investment in the NHS, earlier this week, was merely the softening up act.
I’ve even seen social media threads lauding this pragmatic ‘partnership’ approach, and the centrists do love it, as they still accept corporate liberalism as the acceptable face of neoliberalism, well, the centre right lobby do, anyway. And that is now Labour conventional wisdom again.
The Blairite Facebook model of data mining to allow the continued existence of a ‘free at the point of delivery’ NHS service is even more insidious than his ID cards proposal.
Yet it is nothing compared with the Milburn type plans, already hatched, for quasi-privatisation of the NHS and the fulfilment of marketisation for its own sake.
He’s been banging on about this for longer than Reeves has been insisting that growth is the only way out of the Tory mire.
Not unrelated, Richard and readers may be interested in: https://www.nakedcapitalism.com/2024/07/something-rotten-in-the-state-of-albion.html.
Scanned
Totally fair comment
Thanks
If the price of democracy is eternal vigilance nobody bothered telling British voters!
During my sabotaged NHS retraining I was shocked to discover the totally unnecessary burden that mismanagement of training places on our NHS. I doubt that this gross inadequacy was simply an aberration that only occured at my University; sadly I think it is common to most NHS training programs throughout the UK. Basically the failure of the University programs to teach the fundamental curriculum of required basic knowledge reinforced by practical sessions in clinical practice labs, offloads a heavy teaching responsibility onto overworked medical staff. This is an unacceptable waste of resources; universities must be required to supply the bulk of preparatory training to take this burden off NHS staff.
I was trained in the US where medical training is governed by three core principles. Firstly, in a highly litigious society, there is a very low tolerance for risk; students are expected to reach a safe level of competence before entering a hospital. Secondly, ‘there ain’t no free lunch’ so you are expected to know the task you will be expected to perform; all students must be a net asset on day one not a burden to the paid staff. Lastly, students in the US have a very low attention span; wading through articles of tangential relevance to the learning objectives is not well tolerated. While US training courses still require a great deal of study, practical tasks are well rehearsed in the safety of a practice lab with a strong focus on achieving levels of safe practice before entering the clinical setting.
My Surgical Technology training in America was typical, extremely thorough and comprehensive, providing a well rounded knowledge base before our students were ever allowed into surgery for the first time. ‘Alexanders, Care of the Patient in Surgery’ was our principal curriculum text book. The weight of several house bricks, we were expected to absorb the entire content of Alexanders ‘soup to nuts. A&P, microbiology and another hefty book on surgical instruments complemented this core text. Familiarization with all of the instruments and surgical skills were practiced daily in the skills lab which comprised three-quarters of our class. There was weekly testing on our understanding of the subject mata to ensure that we were well prepared before we started into clinical rotations in the OR. Once assigned to an OR and a surgical case, we were expected to demonstrate our competency to our mentors during surgery.
In the UK students quickly became disillusioned as the course lead elaborated on the plan for what was essentially self-taught haphazard discovery of the course basics. We were expected to find articles in so-called ‘learned journals’ that covered the subject matter of our elusive curriculum, and write about the relevance to that poorly defined curriculum! Instead of learning to recognize the instruments we would be expected to pass during surgery we had a lecture of less than an hour on ‘form and function’. Despite several large, well equipped skills labs, the very brief ‘show and tell’ sessions we attended were grossly inadequate with the skills labs barely used.
Instead of working through the subject matter we were eager to learn ‘lectures’ focused on obscure group discussions on our attitudes towards various things. There was an entire week of reflection on the Victoria Climbie case and our responsibility to protect the vulnerable by reporting. There was an obscenely lengthy three hour ‘sob-a-thon’ on ‘Death and Dying’ where we were expected to share our personal experiences. Large boxes of kleenex were provided and the session began with ‘mood music’ the Gregorian Chants and the Muslim call to prayer, which as far as I know has nothing to do with either death or dying. This ridiculous session epitomized the time wasted at university where we should have been learning about our role in Surgery.
After a few short weeks of learning precious little the students were assigned to clinical practice, for which most of our cohort were grossly unprepared. Armed with a set of ‘Competencies’ covering the areas of practice we were expected to learn about from the already overworked staff, we were assigned to mentors. Lack of training ment that most students were relegated to just ‘stand and gauk’ observation only, but they still placed a net burden on staff who were expected to teach students all the basics from scratch! Below each competency was an area in which one was expected to document proof of a satisfactory leve;l of understanding to complete that competency: I kid you not, in a 7″x1.5″ box!
Due to my US training I did not feel intimidated and could have safely participated if the Clinical Educator had not decided to place additional restrictions on my clinical practice. The university had decided that including an older student would look good on the stats, but I would be encouraged to drop out early. The Course Lead wanted to pretend that their University training was so far superior to my training in the US that even after five years working in the OR at America’s top Hospital I could not meet their high standard! I was the only student prohibited from scrubbing into surgery, my former role in the US, and one of four required areas of the ODP training. My training was already being sabotaged long before I reported the mentor who failed to do instrument counts.
Although I had some excellent mentors in areas of practice I was totally unfamiliar with in Anesthesia, Nurses had to divert attention away from their patients to spend time teaching me. Some very good nursing staff are not great teachers and some who are will be called on by many other staff. There is no comprehensive curriculum of required learning so the entire training is haphazard and piecemeal. This leads to huge gaps in the required knowledge with students qualifying while still improperly trained in all areas of practice. On one occasion an ODP who graduated from our university the year before required the Nurse to talk her through a simple embolectomy case; I was shocked at her lack of knowledge.
A well trained Surgical Tech who understands the surgical procedures, the instruments required and the order in which to pass them, can reduce the time spent during a case. This is the standard I was taught to work towards, but students in the UK, through no fault of their own, are still requiring supervision and guidance well after completing their course. Universities are earning high fees for providing training which obsesses over academic nuances like correct referencing while ignoring necessary learning. Few of the ODP graduates from my UK university would have the skills to make it through basic orientation at Johns Hopkins where I worked in the US. Without any additional funding we could take a significant burden off the NHS by demanding thorough relevant training from our universities.
UK medical education was in three stages according to my wife (MRCP and MRCGP)
1. See one
2. Do one
3. Teach one
She now thinks stage 1 has gone, and so too has stage 3 as a result.
I was hoping to be reassured hearing of your wife’s time as a Medical Student but, despite her own experience, it seems that high standards for Doctor training may now be slipping. Certainly the NHS Nurse training used to be excellent in the UK, but I fear after ‘Nurse 2000’ it deteriorated under university control. There has been a huge shift towards over-academasizing certain areas of medical training, with degree criteria taking precedence over essential patient care priorities. The program I attended obsessed over documenting ‘reflections’ where students were expected to constantly dwell on their failures and bare their sole documenting every minor inadequacy or misjudgement. It reminded me of Catholic self-flagellation: “forgive me father for I have sinned”! This was a confidence descemating experience, not a great way to learn.
Much to agree with
In reply to Kim Sanders-Fisher
My daughter is about to complete her second foundation year as a junior doctor in Liverpool having studied medicine at Bristol. She loved the course there, which was recently introduced, and seemed to be very hands on from the start, with lots of clinical experience. She is very much inclined to the practical rather than academic ( though good at that too) so would have been critical if that wasn’t the case. Obviously I can’t comment in detail as I don’t have the experience and she doesn’t have the comparison.
However I think that you’ll find a lot of variation, for example at Cambridge the first three years are purely academic. I discovered this after an encounter with two young men who were trying to help a fellow student who was on the verge of passing out in the street, and unable to stand. She’d clearly drunk more than she could manage but these young men didn’t have a clue what to do – when I asked what they were studying I was shocked when they told me they were second year medical students. They’d had no practical clinical experience… nor much basic knowledge!
I hope this offers a more optomistic view of at least some of the university training…. she was also doing this through the covid pandemic and remained enthusiastic and committed.
Thanks
Thank you to Richard re Patricia Hewitt.
Going back to the 1970s and her association with Harriet Harman, there was always something dodgy about her.
How William Paterson would laugh …..
On Radio4 c.5.30 this eve Mr Streeting was keen to say how he wanted to listen before introducing changes to the NHS. I hope he’ll be listening not only to Lord Darzi but to groups like Every Doctor. For some time now they’ve been telling everyone who’ll listen exactly what the threats to the NHS are. I imagine they’re more up-to-date than Lord Darzi, & they’re certainly passionate.
I support them
Written on our local hospital campaign group today:
Wes Streeting to ‘write prescription’ for NHS after independent investigation Guardian today. Darzi again… Kaiser Permanente… American Accountable Care Organisations in any other name.
The NHS is not ‘broken’ it is in crisis. It needs investment, repair and dedication to its real principles.
As John Lister says “Darzi has his own track record already as the author with McKinsey of the ludicrous polyclinic policy in 2007 that was rejected by patients, public, doctors and the finance directors who axed the few that opened.
“Dash was leading McKinsey in Europe when they drew up the plan to make ‘savings’ of £20 bn after the banking crash – basically by cutting out services, slashing consultation times etc. Few of the ideas proved workable in practice.
“The NHS now is coming of 14 years of underfunding, not 9 years of investment: these plans are even less appropriate today than they were then. How long will it take Streeting, Starmer et al to find out?”
April 2021 report
Starts
“Ribera Salud had recently appointed Alan Milburn , former British Minister of Health in the Blair government, as independent director of the Valencian company in order to “continue with the company’s expansion plans.”
Ends
Is Wes Streeting’s approach as during the Blair years and beyond, “confuse and conceal?”
These plans have deep roots.
It’s a long read but revealing.
calderdaleandkirklees999callforthenhs.wordpress.com/2021/04/14/how-centene-corporations
“It’s clear to anyone who works in or uses the NHS that it is broken……..”
“Works in”, perhaps. “Uses”? No. UTTER RUBBISH. Media has long hammered the NHS while patients have regarded their care as exemplary.
The problems the NHS experiences are mostly created by the meddling of politicians who have no notion of how it should work, does work and can work in the future.
Wes (Bloody) Streeting is the latest in a long line of meddling incompetents.
(In my opinion)
I am so happy with your way of explanation of every topic.
Its a shame it hadn’t been silly boy Streeting that lost his seat rather than John Ashworth. He always came across as sensible and knew his brief whilst shadowing Health. He would have likely been SoS if results had been reversed.
The NHS is the closest thing the English people have to a religion: said Nigel Lawson, perhaps the best consultants we could use to fix the issues with the NHS, are the faith leaders of the respective religions followed in the UK.
I don’t think so…