Victor Adebowale, the cross-bench peer, raised two concerns about the NHS (Report, 26 December). First, that it risks paralysis while it waits for Wes Streeting’s 10-year plan for reform. Second, long waiting times this year, compared with a similar period in 2009, for diagnostic scans and elective care, and in A&E.
My concern is not that the NHS is paralysed while waiting for the 10-year plan, but that its intentions have been overtaken by the package of NHS reforms of zero tolerance for failure announced on 13 November by the Department of Health and Social Care. That package looks like the regimes of the 2000s: sacking persistently failing managers, sending turnaround teams into struggling hospitals, rewarding the best performers with autonomy, and aiming to reduce waiting times from 18 months to 18 weeks.
A key to the NHS successes of the 2000s was a decade’s annual real-terms increases in NHS expenditure of 5%. Now the prospects are 3% for three years. Furthermore, in July 2024, 31 out of 42 of England’s integrated care systems were in deficit (total £2.2bn). These have to be eliminated by March 2025.
The board of Mid Staffordshire NHS trust gained the earned autonomy of NHS foundation status in 2008 by eliminating its financial deficit through draconian cuts in nursing staff. Robert Francis described how its consequential appalling care was hidden in plain sight from “a plethora of agencies, scrutiny groups, commissioners, regulators and professional bodies”.
In October, the Dash report found “significant failings” in its review of the Care Quality Commission (CQC), resulting in a substantial loss of credibility within the health and social care sectors, and a deterioration in the CQC’s ability to identify poor performance and support a drive to improve quality.
Gwyn Bevan
Emeritus professor of policy analysis, London School of Economics; former director of the Office for Information for Healthcare Performance at the Commission for Health Improvement
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