As the Guardian has reported in a newsletter this morning:
Wes Streeting has decided it's time to bring [a] competitive edge to the NHS. Yesterday, the health secretary delivered a “bullish” and contentious speech confirming the government will publish a league table ranking hospitals in England, after a “no-holds-barred, sweeping review” of NHS performance. Those at the top will be rewarded with more funding and autonomy, while those at the bottom can expect “turnaround teams” and sackings.
Streeting's statements follow an independent review of the NHS that found hospital productivity has sharply declined in the past five years.
Let's ignore the fact that ‘productivity' in the NHS is an almost meaningless measure that is heavily distorted by the prosperity of the area being served because the wealthy are healthier, are more disciplined with regard to healthcare, and even tend to turn up to appointments more often (because, for example, they have their own means of transport and are not dependent on buses that do not run) than those in lower-income areas. Streeting should know that but clearly does not realise that if there's a decline in NHS productivity, this is a major cause of it.
Instead, let's look at the stupidity of Streeting's proposal, which produced wholly negative outcomes when Alan Milburn last introduced it as Labour health secretary about twenty years ago and is now being introduced again because Milburn is now back at the Department of Health as a non-executive director and advisor, and has nothing more to contribute now than the crass ideas he rolled out and failed with last time he was near the place.
What will this league table measure:
- The relative poverty of areas served
- Tory bias over the last 14 years in better-funding Tory voting areas
- The difficulty of meeting needs in areas left devastated by Tory austerity
- The consequence of that austerity on the lives of millions
So what does Streeting want to do with his 'league table'? He wants to reward prosperity and punish those seeking to do what Nye Bevan always wanted - which was to deliver healthcare to everyone, whoever they were and whatever their means might be, even though healthcare for those with the least is often the most expensive care to provide.
Rightly, NHS staff are furious.
Rightly, they know this will unfairly punish them.
Rightly, they know that this will increase health inequality - and so other forms of inequality - in the UK.
And rightly, they did not expect this from a Labour health secretary.
But then, Wes Streeting is LINO (Labour in name only) and about as much a socialist as David Cameron ever was.
It appears that lacking imagination, not caring, and being utterly indifferent to the harm you might cause by your actions are the qualifications for serving in Starmer's cabinet. Streeting stupifies those who do.
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I was reading Roy’s Lilley eLetter yesterday and thought this was bonkers. I work for a hospital trust in the North East, and we need more well-trained staff so the patients can be well looked after and the staff doesn’t have to crawl out of the hospital physically and mentally drained after each 12-hour shift. Not a stupid league table.
I agree, entirely
Might this be a repeat of the Education Re/Deform legislation of the Conservatives, (1988 onwards) which enforced the presentation of performance data and information without so relevant contexts?
« Context set information presents opportunities for genuine, humane improvement: context free information does not. » (From David Snowdon)
Yes
It was an exercise in how to alienate the professional staff.
This will be the same.
Leagues require divisions which take into account various factors which affect the competitiveness of the teams. That is why Premier League teams do not compete against amateur teams from villages for example. Both play the same game but have vastly differing resources and support. Therefore introducing a league table for the NHS is ridiculous. No level playing field exists so any competitive comparison is not only unhelpful it is extremely unfair.
I fail to understand why anyone with an iota of intelligence could possibly think this a good idea. League tables are not the solution to providing good care for all as was so aptly demonstrated by the equivalent strategy in education, providing so called “choice” rather than good education for all. It is the most demoralising process and hardly what a demoralised and exhausted sector needs.
There seems to be a massive appetite for a punitive style management amongst the managerial classes in this country – I worked in an excellent department in an FE college, addressing the needs of the most vulnerable students that was all but destroyed by this approach – all stick and zero encouragement and appreciation.
Good management values and nurtures their staff to enable them to give their best, which is what most people want.
I despair at every twist and turn of this government.
Rachel Clarke has an excellent and rightly, very angry article on this.
https://www.theguardian.com/commentisfree/2024/nov/13/wes-streeting-hospitals-league-tables-nhs-staff?CMP=share_btn_url
Rachel Clarke is very good on this
More cruelty as spectacle again – the pleasure of persecution, yet again, but Labour’s duplicity of it all is sickening – one minute celebrating the NHS, the next criticising it – trying to no doubt please everyone but in the end siding with those who want a fully privatised service.
So predictable but so depressing.
He/they will say anything eyecatching except – as Milano/Lilley says – get and keep enough staff to do the job.
And the only concrete things they have done – are precisely wrong – such as CCS
BBC wont ask Streeting about this – sorting out the staffing situation – GP’s closing, doctors without jobs, nurses and doctors leaving the NHS. its ruled out (we all agree ‘there is no money’
The fact that you think that ‘productivity is a meaningless measure in the NHS’ (or any public Service) is exactly the reason why, despite real increases in spending each and after year, service continues to worsen.
Public sector workers clearly feel that they are above the basic economics factors that private sector workers live with on a daily basis. They simply should not think this way, and until the mentality changed, our public sector will continue to be a shambles.
Go on then
Tell me how you would increase the productivity of a nurse sitting with a dying person?
Or a doctor telling person they have cancer?
Or the GP who has to wait whilst an elderly person takes their clothes off, and then puts them back on again?
Come to that, how can you spend less than five minutes with the patient who needs five minutes to tell you what they think is wrong?
If you’re so clever, tell me how you would do that and the myriad of similar things that are the day-to-day reality of healthcare?
And then tell mme why you would want to make things so muh worse?
There are plenty of areas where ‘productivity’ is relevant and plenty of areas where it is not.
Coming up with some cherry-picked scenarios where it is not, proves nothing.
Your final comment is just your usual abuse of people that don’t agree with you – anyone that challenges your poorly thought-through analysis must have malevolent intentions.
In fact, in the main, people having different options to you often have the same underlying objectives, they just don’t have the same prejudices, selfishness and exaggerated sense of superiority as you clearly do.
So you have no answers at all
I suggest you have not a clue about what you are talking in that case
Tim is completely sold on what is best defined as as an “imaginary”, which is the whole basis of neoliberal economics, wherein the aim is to make the world conform to a utopian, economistic vision of how the world is supposed, in theory, to work.
Of course it doesn’t, but why should a niggling little matter like that get in the way? We can see the consequences of that kind of thinking around us every day.
Streeting is just another politician caught up in it.
Suggest you go and look at some actual data. The Kings Fund is the go-to place for stats on the NHS, including productivity.
https://www.kingsfund.org.uk/insight-and-analysis/data-and-charts/productivity-nhs-health-care-sector
It shows that in fact the NHS had been steadily improving productivity through until Covid. At that point the steady run down of staff, beds, IT and scanners combined with Covid hit the service hard. It has not really recovered, still lacking in capacity. You don’t fix years of underfunding overnight.
See also data from the Commonwealth fund which benchmarks health services globally.
https://www.kingsfund.org.uk/insight-and-analysis/blogs/comparing-nhs-to-health-care-systems-other-countries
The NHS under the Tories has ended up with seriously less resources than comparable health systems. Under Labour it had climbed to top of the tree, recovering from the damage done to it under previous Tories.
Look closely, and you’ll see that NHS productivity has improved rather more than the private sector whose productivity in the UK is notoriously poor compared to other comparable economies. Funnily enough, failure to invest, outsourcing et al might also be part of the problem there too.
And Streeting clearly has not a clue about both the real state of the NHS and the causes, or how to improve a real organisation. Beatings will continue until morale improves is just damaging. He is no better than Lansley at the moment.
Thanks Robin
Appreciated
A notice recently appeared at our GP reception, advising patients that we can only discuss one health issue per appointment with our GP.
That basically destroys the whole point of visiting a trained diagnostician. It’s the route to a lot of very serious misdiagnoses. Don’t tell your wife Richard, she might blow a gasket.
After all we know that in Wes Streeting’s world every patient has only one disease, every disease has only one symptom, and only one, cost effective (profitable) treatment.
Tim Groves – your thinking is the epitome of what is wrong with our country…including your observations of the private sector.
@Tim Grove.
The privatised industries, most of which were previously public utilities, are a beacon of light in demonstrating as you say “despite real increases in spending each and after year, service continues to worsen.”
(Possibly a bit of a typo there, do you mean “each and every year” or “year upon year”? Is it “real increases” or “real term increases”? Or is it non-productive thinking?)
As for the private sector, how do you marry the fate of big businesses such as Carillion, The Royal Bank of Scotland, etc. who possibly felt “that they are above the basic economics factors”, whatever that means.
If the doctor had to tell you that you unfortunately had cancer, would you tell him to euthanise you there and then, as it is the most productive outcome given the circumstances?
I didn’t think so!
You could perhaps tell us about where you live.
I live in one of the most deprived wards in S Bristol.
There are multiple factors affecting “productivity” of our primary & hospital care, and most are down to decades of austerity and under-resourcing by central government, not to mention incessant top-down re-organisation by ill-informed health secretaries.
League tables?
Utterly irrelevant.
They may work in football but healthcare is neither a sport nor a billionaire/gamblers’ playground. Yet.
Agreed
Today my daughter, a nursing assistant in the Acute Assessment Unit attached to A&E at West Suffolk Hospital started her shift and as immediately faced with a patient suffering cardiac arrest. The patient subsequently went on to end of life care. This in addition to other emergencies. The unit, along with the rest of the hospital is seriously understaffed and short of beds. What do you suggest they do? Perhaps encourage the patient on end of life care to just hurry up and die so the bed and nurse is freed up?
Staff will immediately be pressured into massaging the numbers, Trusts will be pressured into collecting and generating worthless churns of data, we’ll be measuring the wrong things and the people most efficient at playing the measurement game will get huge rewards. Actual performance will not improve.
Meanwhile, staffing pressures will be unaddressed, social and community care will be unaddressed, and the proliferation of contractors, agency staff and management consultants will continue to drain money away from building strong, resilient capabilities within permanent staff.
Thinking about it, is this not another arm of the atrocious ‘internal market reform’ that has led the NHS from being one of the best healthcare systems in the world to an utter mess?
Much to agree with
I thought the article was grotesquely unfair to Mr Streeting who is simply trying to secure his future, post LINO government.
We all have to find our own way in life, make a living and sometimes one has to do so by walking on the backs (faces?) of others. But where would society be if some competition is not introduced, and whilst it would be nice to say “& they all lived happily ever after” the reality is that following Mr Streetings proposed changes some will live a bit longer (& happily) and sadly others …….won’t. But that’s life in modern, happy(?) LINO Britain
(Irony alert)
PS: & spare a thought for all those nice civil servants who are facilitating this – how they must be tortured by their consciences (not).
Just think Mike, a few more votes for Leanne Mohammad and he would be looking for another job anyway.
I am reminded of a lunchtime sat with my daughter crying. She had been in meetings all morning with Virgin and United Health over privatisation of the premature baby Intensive Care Unit she worked. For those who don’t know, some babies in such units will die simply because there is no way to keep them alive (born without skin, organs outside body, anacephalic etc). they require 24 hour, soul breaking care. The private companies couldn’t see how to turn a profit, nor that the care offered in the face of definite death was worth it. My daughter’s tears were over the utter inhumanity of those companies and their lack of sense of other values than profit. Providing quantitative outcomes from such scenarios – not cherrypicking as Mr Groves suggests – are impossible. Such endeavours are recognised by people with a moral compass as the finest humanity offers.
John
You have my sympathy and understanding
My wife was a neonatologist in such units before becoming a GP
She has described nights sitting with a single baby, sometimes knowing that there was no hope, but knowing this was another human with people who loved then, and with a right to die as well as possible
Where does that fit in with productivity?
Richard
My suggestion might be that the highest priority needs to be to identify what can be done NOW.
How about offering to employ every medically qualified person currently in the UK?
Recruiting more ‘Radar’s’ – the Company Clerk in MASH who made the place run so the Doctors and Nurses could get on with their jobs, who can get appointments that come up at short notice filled etc etc
Sorting out Social Care, in the short term with a cheque book.
I could go on
Neoliberalism is alive and well I see. Long live neoliberalism.
Clearly Wes is blessed with the gift of auto-absolution.
When will these politicians realise that unachievable targets or league tables are no better than football leagues. Some teams will win and others will lose whatever happens. I’m not a football person but wasn’t the secret of Gareth Southgate’s success about guiding and encouraging, not getting out a stick and beating. It is the people in all ‘businesses’ whether they be private or public that create the benefit. Value your people, encourage your people and the enterprise will flourish. Your employees are your most valuable asset. Beat your people and they will leave or at ‘best’ you hang on to the worst who certainly will miss the targets. It is the culture of an organisation that creates the climate in which things get better and objectives are achieved so improvements are made. I bet Wes (uncomplimentary additional name removed) Streeting didn’t ask the people who work in the NHS what they thought and how they would achieve the improvements the NHS needs.
Wes Streeting should watch ‘Dear England’.
When my eyes glanced over that idea (of a league) being proposed in a YT video title… I just thought I don’t think it is a good idea..
I don’t feel smart or intelligent..and wasn’t sure if I should ask others if it is a bad idea. I wouldn’t have been able to explain as to why it possibly is not a good idea (or I cannot recall what ideas I had).
But thank you for reassuring but providing a clear and coherent explanation as to why it may be a bad idea.
Thanks
When Wes Streeting appoints Sir Michael Marmot to assemble a board to run the restructuring of Care and Health services in this country, then and only then will he be taken seriously as a Health Secretary. He is clearly the mouthpiece of a conglomerate of SPaDS, private healthcare lobbyists, and Big Pharmaceutical Companies. He is so far removed from being on the side of health equality and all the measures required to be implemented in the policies required to eradicate poverty, and all the social determinants of health inequalities that conspire against improving the nations wellbeing.
Wellbeing is the key to improving productivity across the spectrum, getting people focussed on positivity and raising them up from the overwhelming sense of anxiety and hopelessness that is the real disease that’s tearing this country apart.
To state the obvious, NHS “productivity” sensibly measured would reflect the wider impact of the quality of service on the performance of the wider economy, including the much sought after inbound investment. Wasn’t this, together with quality of education services, recently identified by a group of potential investors over and above low tax? What’s more, there’s a particular danger associated with productivity related Performance Indicators when taken in isolation. For example, reducing patient length of stay, generally speaking, is good in itself. But it should not be an excuse to reduce bed numbers and staffing to a level which leaves a service lacking resilience-a safe service needs a degree of redundancy – as Covid exposed.
As a classic episode of “Yes Minister!” made clear, the introduction of patients to newly commissioned hospitals introduces all sorts of inefficiencies.
https://duckduckgo.com/?q=yes+minister+empty+hospital&t=fpas&ia=web
The episode beautifully demonstrates the lunacy of measuring the wrong outcomes.
The NHS is the one issue the Great British Public really do care about, after cost of living issues. I hope that soon Wes Streeting will be deluged with complaints from MPs, themselves deluged with complaints from their constituents.
It amazes me that so soon after all the OFSTED ructions following the suicide of a head teacher, that Labour should think that hospital league tables focussed on “productivity” would help improve things for patients. My family suffered under the NHS Infernal Market (not a typo) in a way that nearly drove me to despair. Never again! (except that it is already well under way).
I was amsued
“amsued”?
I hope not, but don’t worry, the left are good at raising defence funds.
Looks like the old Tory playbook of Defund, Blame and Privatise even further. Excellent post and comments.
On a different front, Wes Streeting coming in for criticism on the Electoral Disfunction podcast about how he has engaged with the assisted dying debate and deployed the department. When he should be staying neutral. (Podcast generally gets my recommendation and is a refreshing change from the ‘boys’ on Rest is Politics).
https://podcasts.apple.com/gb/podcast/electoral-dysfunction/id1613562765?i=1000677022407
SIllyBoy feels like someone for whom power has gone to his head.
Has he got a head?