Alarm bells are ringing loud and clear in the NHS – what will the new PM do to fix it?

On Monday we will find out who will be the new prime minister. But as summer makes way for autumn, the alarm bells are ringing loud and clear in the NHS.

Nick Triggle Health correspondent www.bbc.co.uk

And while the cost of living crisis has dominated the attention during the leadership contest, talk to anyone in the NHS and they will tell you they are worried what the coming months will bring.

Put simply, this summer has been worse than any winter this century. Dr Adrian Boyle, of the Royal College of Emergency Medicine, says the demise has been so sharp that the service is “struggling to perform even its central function – to deliver care safely and effectively”.

It is easy to see why he and others are worried. Wherever you look, the system is on its knees. The waiting list for non-urgent treatment has ballooned, with nearly one in eight people in England currently waiting for care.

And those who are seriously ill are facing dangerously long waits. It is taking three times as long as it should for ambulance crews to reach heart attack and stroke victims.

Meanwhile, those who have suffered a cardiac arrest are waiting more than two minutes longer than they should – every minute’s delay reduces the chances of survival by 10%.

But it is not only the ambulance service which is struggling. When patients come to A&E, long waits for a bed are becoming increasingly common, with those of 12 hours at a record level.

Put this all together, experts warn, and patients are at risk. The Association of Ambulance Chief Executives warned that in July alone, nearly 40,000 patients may have come to harm.

Problems years in the making

So what can be done about it? There is no simple solution. The problems being seen have been years in the making – they are not just pandemic-related.

Firstly, the NHS is drastically short of staff – one in 10 posts is currently vacant, the highest it has been since records began five years ago – and this limits the ability of the health service to expand services.

Many countries face shortages, but per head of population the UK has fewer doctors and nurses than many other Western European nations.

It takes time to train more and while the numbers entering training are now increasing, the NHS has certainly been hampered by decisions made in the mid-2010s when bursaries were taken away from nurses and there was limited action by ministers to boost the workforce.

Jeremy Hunt, who was health secretary during that period, is on record as saying it was probably his biggest single mistake of his stewardship of the NHS.

Does the NHS need more money? Many argue it does.

A decade of austerity saw the health service awarded much smaller rises than it has historically received, although the government has gone some way to rectifying that now.

But in thinking about the budget, it is also worth considering just how much of day-to-day public spending is now diverted to the NHS.

At the turn of the century, the health service took just over a quarter. Now it is fast approaching a half.

‘It is time to rethink approach to NHS’

There is clearly a limit to how much the budget can keep going up – resources are not infinite. It is a point made in a new book by former British Medical Association president Prof Sir David Haslam, chairman of the National Institute of Health and Care Excellence, the body which decides what treatments should be made available on the NHS.

In the book, Side Effects, in which he recounts his experience of being treated for cancer as well as his thoughts on the health service, he makes the case for continuing with a universal system that means no matter how rich or poor you are, you are entitled to the same treatment.

But he also says the time has come to rethink the NHS’s purpose.

He points out that if the budget had been rising as quickly as it did in the 2000s, it would have been consuming close to 100% of gross domestic product by the mid-2070s.

The book goes on to lament the medicalisation of everyday life and our increasing anxiety about our health despite, in general, being healthier than ever.

And Sir David rebukes his fellow doctors for overtreating patients because of a risk-averse culture, which means it is easier to do something for patients than not, even if that means using ineffective medicines.

And, in particular, he is critical of the trend in medical science to pour more and more money into aggressively treating seriously ill patients who are close to death with ever more expensive treatments.

It is time, he says, to work out what the boundaries of the health system should be.

Social care more in need than NHS?

Indeed, some argue that instead of focusing on the NHS, the service may be most helped by increasing the funding given to another service.

One of the main reasons the emergency system is struggling is that hospitals are struggling to discharge patients who are medically fit to leave, but cannot because there is no support available in the community. Much of that is provided by the social care system which is run by councils.

Data from the early summer shows that more than half of patients ready to leave could not.

Unlike the NHS, social care has not been getting more money over the past decade. Once inflation is taken into account, spending has dropped.

The government is planning to introduce a cap on care costs, but that is about protecting people assets rather than getting more money into the system.

The challenge facing the new PM is huge. And it is not just about the winter, it’s about the entire future of the NHS.

 

Action has support of Celebrities Hugh Fearnley Whittingstall, Simon Pegg, Stephen Fry, and Daniel Lismore are supporting the action, alongside Conservative politicians Henry Smith MP, Sir Peter Bottomley MP and Theresa May’s former Downing Street environment advisor Lord Randall, as well as the Green Party’s Caroline Lucas MP. Their names were stencilled onto the boulders before being dropped into the ocean.

From today’s Western Morning News

Greenpeace UK has placed 18 limestone boulders on the seabed in the South West Deeps (East) Marine Protected Area to block what it claims is “destructive industrial fishing.”

On Thursday, campaigners and crew on board Greenpeace ship Arctic Sunrise sailed to the western English Channel to make a portion of the South West Deeps off-limits to bottom-trawling.

But the move has been criticised by the fishing industry and the Marine Management Organisation, (MMO) who say they are already accelerating plans to extend protection for the UK’s Marine Protected Areas.

And, they warn, dumping boulders into the sea in this way potentially puts fishermen’s lives at risk.

The Fishing Daily reports that after an earlier boulder drop at Dogger Bank, the MMO took Greenpeace to court for environmental breaches, but the case was dropped in February this year after a judge at Newcastle Crown Court invited the MMO to reconsider, saying prosecution was not in the public interest.

The MMO told the fishing publication that Greenpeace was aware it was delivering accelerated protection measures within Marine Protected Areas. “As such, we are surprised and disappointed by the announcement made by Greenpeace of their intention to undertake further unlawful activity within this specific MPA at South West Deeps (East),” the MMO said.

Greenpeace say the latest boulder action off the South West coast took place days after UK leaders failed to help secure a Global Ocean Treaty at IGC5 in New York. That failure threatens the Government’s aim to achieve at least 30% ocean protection by 2030 the environmental organisation claims.

Greenpeace alleges: “Across the entirety of the South West Deeps (East) – more than 4,600 km2 – there is not one metre of protection from destructive industrial fishing. It is one of the most heavily fished so-called Marine Protected Areas in the UK. In the last 18 months, the South West Deeps experienced almost 19,000 hours of industrial fishing, 3,370 hours of which was bottom-trawling. The majority of industrial fishing vessels in the area were from France (53%) followed by Spain (30%) and Great Britain (9%).

Celebrities Hugh Fearnley Whittingstall, Simon Pegg, Stephen Fry, and Daniel Lismore are supporting the action, alongside Conservative politicians Henry Smith MP, Sir Peter Bottomley MP and Theresa May’s former Downing Street environment advisor Lord Randall, as well as the Green Party’s Caroline Lucas MP. Their names were stencilled onto the boulders before being dropped into the ocean.

The 18 boulders are Portland limestone, and each weighs between 500kg and 1,400kg. They make it impossible for bottom-towed fishing gear to be dragged along the seabed.One boulder has giant ammonite sculpture carved into it. 

Neither of the candidates for leadership of the Conservative party has made a convincing pitch to rural voters, despite that demographic being one of the biggest sources of Tory power, the head of the UK’s biggest rural business organisation said.

Fiona Harvey www.theguardian.com 

Mark Tufnell, president of the Country Land and Business Association (CLA), which represents about 30,000 landowners and rural businesses, said Liz Truss and Rishi Sunak had done too little to show how they would boost the countryside economy and deal with pressing concerns such as planning, rural broadband, and farm support.

“I don’t think either candidate really understands what is happening in the countryside, and what the real issues are,” Tufnell said. “Both of them have said nice things about farms. But there is no understanding of what is actually happening in the countryside. They have not said much about it.”

He warned that the failure could cost the party at the next general election. “They assume that we [in the countryside] vote Conservative, and that they don’t really need to worry about us. But they should,” he said.

At the 2019 election 46% of voters in rural counties voted Conservative and only 29% voted for Labour. But polling conducted by the CLA before Boris Johnson’s resignation found a sizeable swing of about 7.5% from the Tories to Labour, putting the two main parties neck and neck in some rural areas.

The Liberal Democrats are also making inroads, with strong local election showings and the capture of the formerly safe blue seat of Tiverton and Honiton in the June by-election.

“[The Tories] have taken countryside voters for granted,” said Tufnell. “They’ve shown a lack of interest.”

While Truss and Sunak have sought to reassure farmers during their campaigns, Tufnell pointed out that the bulk of countryside voters and businesses were not farmers.

Farming accounts for only about 4% of the rural economy, and 7% of rural jobs are farming related. About 85% of rural businesses are not related to farming or forestry, and while 12 million people of voting age live in rural areas of the UK there are only about 100,000 farmers.

For rural businesses outside farming key issues include connectivity, since rural broadband and mobile phone access lags far behind that available in urban areas, and planning regulations, as many businesses chafe against some planning rules. The CLA has also said that a lack of affordable rural housing is stifling growth.

Both Truss and Sunak have promised to retain or tighten planning laws. Sunak promised no building on green belt land and Truss vowed to drop house-building targets. Each would restrict the building of solar farms and onshore wind farms.

Tufnell is also concerned that the new Tory leader could bow to pressure from some on the right wing of the party and dismantle reforms to farm support payments, which are being gradually introduced.

Unlike the EU system of payment for the amount of land farmed, under environmental land management contracts (ELMs) farmers will be paid “public money for providing public goods”. In return for the subsidies they will be asked to nurture soils, plant trees, improve water management, protect wildlife, and take other measures that help to clean the air and water, and safeguard nature.

The National Farmers’ Union has spoken out against the reforms, arguing that at a time of rising food prices the focus should switch to supporting farmers to grow more food. Tufnell, whose 28,000 members own about half the land in England and Wales, urged Sunak and Truss to stay with existing policy and give farmers stability.

Tufnell, who owns and manages a mostly arable farm in the Cotswolds, and is a Conservative party member, said: “It’s a false argument, that you need to stop ELMs to grow more food, you can do both. Without clean air and water and nurtured soils you can’t produce food anyway. And if you’re taking money from the public purse you should show a benefit to the public.

“ELMs are world beating, they are very forward thinking. They are the way the rest of the world will go eventually, but at a slower pace.”

Both candidates represented rural constituencies, Tufnell noted, Truss in east Anglia and Sunak in Yorkshire, but he said their policy ideas had focused on towns and cities. “The main focus still remains on the metropolitan and urban areas. There is a lack of focus on the countryside.”

Even the drought, which has scorched pasture and left crops dying in the fields to the despair of farmers across the Midlands, and south and east of England in particular, had failed to elicit much response, he added. “I’m not sure how much notice either of them has taken of the drought – they have just been running round the country.”

Tufnell called for the winner of the leadership election to install a “proper rural champion” in Downing Street who would advocate for policies reflecting the needs of rural Britain.

The CLA has estimated that investing in the countryside to bring the key infrastructure in rural areas – such as housing, transport, communications and technology – into line with that in towns and cities would improve the UK’s economic productivity by £43bn.

“There is a lack of infrastructure that is holding the countryside back,” said Tufnell. “There is enormous potential, but it needs political focus.”

The council has faced persistent allegations in the past two years that it had kept councillors and the public in the dark about its investments, with opposition members claiming they have been “fobbed off and misled” over the deals.

Patrick Butler www.theguardian.com 

The government has launched an urgent investigation into the finances of a Tory-run council amid “grave concerns” that local services are at risk from the authority’s exposure to more than a billion pounds in loans it took out to fund a series of commercial investments.

The communities secretary, Greg Clark, said government-appointed commissioners would take full control of Thurrock’s finances because of fears over “the exceptional level of financial risk and debt incurred by the council”.

Thurrock, in the ceremonial county of Essex, has become one of the most indebted and highly leveraged of all English local authorities after borrowing £1.5bn in recent years, including more than £900m in short-terms loans from other councils, to enable investments in a string of solar farm businesses.

Clark bypassed normal protocols on Friday when he rushed to appoint external commissioners to run the council’s finances, citing the “pressing case for urgent government action to protect the interests of residents and taxpayers of Thurrock”.

“Given the serious financial situation at Thurrock council and its potential impact on local services, I believe it is necessary for government to intervene,” he said.

An explanatory memorandum published by the Department for Levelling Up said: “The scale and nature of the issues is emerging very quickly, and the secretary of state is concerned that further evidence of failure could come to light very quickly and require prompt action.”

Although the government revealed little precise detail about its concerns, there are understood to be fears over the ability of Thurrock to repay its borrowing should the investments turn sour, as well as doubts over the ability of the council to cope with potential losses estimated by some at £200m.

A recent investigation by the Bureau of Investigative Journalism found that hundreds of millions borrowed by Thurrock had been effectively lent to companies owned by the multimillionaire businessman Liam Kavanagh to invest in 53 solar farms.

The council has faced persistent allegations in the past two years that it had kept councillors and the public in the dark about its investments, with opposition members claiming they have been “fobbed off and misled” over the deals.

Thurrock council’s leader, Rob Gledhill, resigned on Friday after the government announcement, saying: “It has become clear over the past few months that the situation regarding council investments, and subsequently its finances, has not been as reported. As leader of the council the political buck stops with me.”

John Kent, the leader of Thurrock council’s Labour group, said the group had been repeatedly “stonewalled, ignored, falsely reassured, lied to, fobbed off and misled” by officials and cabinet members when it tried to get information about the council’s borrowing and investments strategy.

“For a long time now, we have had no confidence in the honesty or integrity of Cllr Gledhill’s leadership or that of his cabinet colleagues. It’s right for Gledhill to have finally done the right thing and resign. But there are others, who have been in Gledhill’s cabinet throughout his disastrous leadership, who share collective responsibility and are equally responsible – they must also consider their positions”.

He added: “It’s now time for openness and honesty, the people of Thurrock have a right to know what has been going on and where their missing millions are.”

Thurrock is the latest council to have run into financial difficulties after borrowing huge amounts in the hope of generating income to offset huge budget gaps created by government cuts. Croydon and Slough councils have both declared effective bankruptcy, in part due to problems caused by extravagant borrowing.

The National Audit Office warned two years ago that many English councils were financially badly exposed after embarking on a £6.6m borrowing spree to invest mainly in commercial property. Ministers have become increasingly nervous about the massive scale of loans taken out by a number of councils.

Neighbouring Essex county council has been appointed by Clark to take full control of Thurrock’s finances. It will also carry out a review of Thurrock’s governance, audit and scrutiny functions, and prepare an improvement plan.

In a statement Thurrock council said: “[We are] treating this situation extremely seriously and has been working with the government in recent weeks, as well as independent financial and legal experts to fully understand how the situation has arisen and establish a comprehensive resolution plan to safeguard the council’s financial position.”

Boris Johnson has been accused of trying to “intimidate and bully” an inquiry into claims he misled MPs over Downing Street parties, after No 10 took the highly unusual step of commissioning a senior QC to scrutinise the legal basis for the process at a public cost of almost £130,000.

Peter Walker www.theguardian.com 

The crossbench peer David Pannick had argued that the Commons committee on privileges and standards was “proposing to adopt an unfair procedure” in examining allegations that Johnson falsely told the Commons he knew nothing about lockdown-breaking gatherings.

Pannick said Johnson should be permitted a lawyer and any sanction on him for inadvertently misleading MPs “would be likely to have a chilling effect on ministerial comments in the house”.

But the 22-page document prompted puzzlement from legal and constitutional experts, who said Pannick was assessing a parliamentary process as if it was a judicial one. Downing Street has declined to release the “instructions to counsel”, which set out the basis for a barrister’s opinion.

While ministers routinely seek legal advice, Johnson will face any consequences from the inquiry as a backbench MP. His successor as prime minister, expected to be Liz Truss, will take over on Tuesday, with voting in the Tory leadership campaign having ended on Friday afternoon.

However, Downing Street argues that the inquiry relates to his conduct as prime minister and thus has wider consequences for government.

Government sources confirmed the contract to Pannick, via a firm of solicitors, is one totalling £129,700 for four months of “legal services” beginning in August, published on Friday.

In a highly choreographed process seemingly intended to discredit the inquiry before it begins in the coming weeks, Pannick’s findings were briefed to a handful of friendly newspapers on Thursday night, which ran stories describing the opinion as “devastating”.

Chris Bryant, the Labour MP who stepped back from leading the investigation over previous criticism of Johnson, said it appeared to be “an attempt to intimidate and bully the committee”.

Pannick, Bryant added, “does not acknowledge that the motion from the House of Commons setting up the inquiry does not refer to ‘knowingly misleading the house’ at all. It simply says, ‘misleading the house’. Second, he doesn’t seem to understand that lots of standards processes have changed over the last 20 years.

“We now have a process for ministers to formally correct the record when they have made an inadvertent error. Boris Johnson has not done that in relation to this. But ministers used this process 200 times this year.

“So the question of how culpable Boris Johnson is depends on several things, one of which might be whether he knowingly lied. One might be whether he was really careless about the truth. One might be whether he ever bothered to correct the record properly. All of those are in the mix.”

Pannick declined to comment.

Mark Elliott, a professor of public law at the University of Cambridge, described Pannick’s opinion as “very odd”, adding: “Much of it is concerned with the fact that the committee’s process may not adhere to legal standards that are wholly inapplicable to a political, parliamentary process.”

Thangam Debbonaire, Labour’s shadow Commons leader, condemned what she called “yet another example of the Tories playing fast and loose with rules and standards in public life”.

She said: “This investigation does not undermine democracy; it does the exact opposite. It is vital that these well-respected committee members, a majority of whom are Tory MPs, are allowed to properly investigate whether the prime minister is in contempt of parliament.”

Christine Jardine, the Liberal Democrats’ Cabinet Office spokesperson, had called on Downing Street to reveal the cost of the advice, adding: “People are tired of these expensive attempts by this government to manufacture ways for Boris Johnson to wriggle out of any consequences of his actions.”

The committee, now chaired by Harriet Harman, is set to look into whether the prime minister misled the Commons when he claimed “all guidance was followed in No 10” and there was “no party” breaking lockdown rules.

Johnson, who in recent days has refused to rule out a political comeback, could be suspended or even kicked out of the Commons after a recall petition if he is found to be in contempt of parliament.