For the first time in weeks I have no work this weekend, so I wanted to catch up with a couple of topics that I had written about previously, and which were finding their way back into the news.
For those who follow such things my old pal the Jim Reaper has left Whitehall and returned to Northumbria Healthcare to resume his roles as CEO. When he left Whitehall he let rip at the oversized centralised bureaucracy that has sprung up since the Lansley reforms.
The Conservatives made a big noise about reducing the size of the NHS management cost, but have instead created a dysfunctional centralised system, which adds nothing to patient care.
It is axiomatic that when an ambitious right wing politician announces a change programme that will reduce bureaucracy there will be more paperwork and more centralised administration afterwards. The more ambitious and right wing the politician, the bigger the pile of paperwork.
The Trust that Jim is returning to is part of one of the first Accountable Health Organisation pilots:
I am optimistic about ACO’s because they start and unpick the expensive management structures which sprung up around the internal market, and which have been a feature of the NHS from the Thatcher era onwards. I don’t for one minute think that this is something that Jeremy Hunt would have chosen ideologically, but the shortage of cash in the NHS is driving change in directions that the Government might not have chosen. The changes to drugs policy I wrote about last week is another example.
ACOs aren’t universally popular and Stephen Hawking has joined a legal action to try and stop the ACO pilots. They are the latest management vehicle to be accused of being part of a secret agenda to privatise the NHS:
I don’t for one minute agree with the basis of this legal challenge, and I think that Prof Hawking is badly misinformed here. The ACO structure doesn’t encourage or discourage private sector involvement in the NHS, it just reduces the costs to the system of maintaining a commissioner and a provider management team. It is just as possible to use ACOs to reduce private sector delivery as increase it, and I don’t agree that private sector involvement in healthcare delivery is always a bad thing…. it has been part of how the NHS has operated since 1947. The problem is that the companies who are getting the contracts are among the worse private sector providers while some of the really good private sector organisations are being locked out. This is giving private providers a bad name.
Apologies for writing so much on healthcare topics. I intend to revamp the blog in January, and return to more business and labour market issues.
The reason for so much health policy recently is because I am afraid that the NHS is entering into a period of profound crisis, which neither main political party really has a grip on, and which Brexit will make a lot worse.
To illustrate the impact this slow motion crisis is having I want to return to something I wrote about in the Summer about the impact of austerity on life expectancy. For some groups in society improvements in life expectancy had stalled and were starting to be reversed.
The latest ONS data on life expectancy is much much worse than I expected.
The ONS are remarkably calm about this, but it looks like pretty much all of the increase in life expectancy since 2017 has been reversed. The predicted average life expectancy for a man is now below 90 years again.
It is tempting to suggest that maybe there is a limit to how much we can increase life expectancy, and that the rate of increase will slow as we reach that limit. Japan, and Scandinavia still live much longer lives than us, and the reverses that we are experiencing aren’t happening there.
We do know that life expectancy links close to wealth inequality. The richer you are, the longer you live. The gap in life expectancy between the riches and poorest wards in Local Authorities like Westminister or Kensington and Chelsea are as big as the gap in life expectancy between the US and India.
There is no real need to construct elaborate theories about this. If you take a poor population and you make it poorer, less well fed, less securely housed, and colder you will increase the rate at which they utilise health resources and reduce their life expectancy.
For anyone interested in actuarial tables this means that the data which was used to raise the state pension age is now wrong, and the justification George Osborne presented no longer holds water. I doubt that this will change the decision.
I will be back next week with a longer blog, and a scary story for Christmas…..