Category Archives: In Depth

NHA’s Dr Louise Irvine is progressive alliance candidate for SW Surrey

The National Health Action Party‘s Dr Louise Irvine has been selected as the progressive alliance candidate in Jeremy Hunt’s seat of South West Surrey:

“At a packed meeting in Farncombe today, 6th May 2017, organised by SW Surrey Compass group it was overwhelmingly agreed that there should be one progressive alliance candidate for SW Surrey in the coming general election, in order to have the best chance of unseating Jeremy Hunt. The meeting was attended by people from the 4 progressive parties: Liberal Democrats, Labour Party, Greens and National Health Action Party, as well as many non party aligned people.

The meeting overwhelming supported Dr Louise Irvine of the National Health Action Party to be the candidate.

The Green Party has declared they would stand down in favour of Louise as a progressive alliance candidate. Local Labour Party members and several Liberal Democrat members have said they will campaign for Louise as part of that alliance. It is now hoped that the Liberal Democrat and Labour Parties nationally will agree to withdraw their candidates so there is just one candidate.” (Source:

Dr Irvine previously took on Hunt at the 2015 General Election, taking 8.5% of the vote. The Labour, Liberal Democrat and Green candidates all did similarly well, and UKIP came second. With the impending collapse of UKIP and a progressive alliance supporting Dr Irvine, the result could look very different this year.

hunt sw surrey 2015

We All Have A #PublicDuty

Following a tweet from NHA’s Dr Alex Ashman, the #PublicDuty hashtag has really taken off as NHS staff, teachers, emergency services and many others whistleblow on cuts to public services. NHSpace looks at the story behind the tag.

In the run-up to the 2015 elections, NHA’s then-leader Dr Clive Peedell tweeted about his public duty to tell the public what was happening to the NHS. Within just hours the message had been re-tweeted thousands of times.

The NHA party quickly responded with an organised Twitterstorm which resulted in around 30,000 tweets, and drew the attention of Online Journalism blog, who sensibly asked “#PublicDuty – mass whistleblowing or political campaign?

More recently, in March 2016, the party repeated the feat in support of the junior doctors’ strikes. So seeing #PublicDuty trending isn’t a new phenomenon.

What’s different this time is that nobody organised a Twitterstorm. Instead, NHA’s Dr Alex Ashman tweeted a new #publicduty message along with the #voteNHS tag, which was retweeted around 3,000 times, and the idea just took off.

As of the evening of 25th April, the hashtag is now peaking at 400 tweets per hour:


Perhaps thanks to its spontaneous origin, this new Twitterstorm has caught the attention of bloggers:

Some familiar faces have joined in:

If you’re on Twitter, why not tweet the hashtag and then head to the #publicduty thread and get retweeting?

‘Removing the four hour A&E target – stupid, or sinister?’

Having previously reduced the A&E four hour wait target from 98% to 95%, Jeremy Hunt wants to exclude minor injuries patients from the target. But is he just moving the goalposts, or is this part of the plan to create an ’emergencies only’ NHS with private firms hoovering up all the elective and semi-urgent work?

Big Up the NHS

So Jeremy Hunt has announced that he will get rid of the four hour emergency department maximum waiting target for the less serious cases (minors) as his only response the the looming NHS crisis. I spent 5 years as a medical director running emergency services for a large NHS trust so I know something about how it all works.

I believe that removing the four hour target for minors is a very bad idea. It will not help the emergency crisis and will cause permanent damage to the integrity of the NHS.

Let me explain.

The essence of the current “humanitarian” crisis is that thousands of patients get stuck on trolleys in emergency department corridors because there are no beds in the hospital to admit them. They suffer appalling indignity and discomfort while receiving second rate care. Ambulance crews cannot offload their patients so they become stuck in hospital car…

View original post 919 more words

Let’s End The NHS “Bottomless Money Pit” Myth

NHSpace questions the common assertion that the NHS is an insatiable resource sink.

Read about the NHS in the media, and you’ll find plenty of comments about how expensive the NHS is. Just the other day, BBC health correspondent Nick Triggle was referring to ministers being ‘frightened’ by ‘how much cash the NHS is swallowing’. The prevailing idea is that we’re already spending too much, and that the government is having to be tough and draw a line.

If you’re reading this, you’re probably willing to question this assertion. But if we want to keep the NHS running as a universal service, how much more funding does it need? Can we as a nation afford to spend that much? And is frontline care benefitting from the increased spending, or is it being siphoned off thanks to government reforms?

The NHS certainly needs more money to continue in its current form. Virtually every NHS Trust in England is now in deficit. If it were just a few isolated cases, you might blame poor financial stewardship. But, as the King’s Fund states, for the vast majority to suffer a shortfall indicates that central funding isn’t keeping pace with the demand for healthcare services.

If we actually want a universal health service able to follow current best practices, how much more do we need to spend right now? Based on the fact that NHS trusts were balancing their books up until 2012/13, NHAspace previously calculated that the NHS is currently underfunded to the tune of £15bn. This assumes that the cost of running the NHS had increased by around 4% each year, which is the historical trend. But can we afford to put in this extra funding?

The simple answer is yes. According to the OECD and WHO datasets, the UK still spends less (both per capita and as a % of GDP) on healthcare than France, Germany, Austria, Holland, Denmark, Norway, Belgium, Canada, Japan, and various other western nations. Per capita, the NHS costs less than half as much as the US healthcare system. But there’s no need to match US spending! Even with an additional £15bn per year, we’d still be lagging behind France’s expenditure per head of population.

The final question then – is the funding reaching the front line? A CHPI report estimates that, following the introduction of the external market by the Health & Social Care Act 2012, the NHS now has 53,000 contracts with the private sector, requiring 25,000 staff and an annual budget of at least £1.5bn to administer. Adding this to other administrative costs brings the total spent on market bureaucracy to an estimated £4.5bn.

Meanwhile the cost of PFI deals, in which the government has tied the NHS into loan repayments for several decades, is at least £2bn per year. And thanks to poor workforce planning and the resulting shortage of permanent staff, the NHS currently pays around £3.5bn per year to agencies for temporary staff.

Between marketisation, PFI loans and agency costs, at least £10bn a year of NHS funding is being diverted. (And that’s in addition to the £12.2bn or more being handed to the private sector each year to run the outsourced NHS services.)

So, next time you hear someone say that the NHS is a ‘bottomless money pit’, remember to point out that we can afford the NHS, but we can’t afford the government’s mishandling of it. We should increase NHS funding to meet demand, but we should also renationalise the NHS and stop the siphoning off of funds by the private sector.

‘There is a toxic culture at the top of the NHS’

A clear insight into the way NHS England try to gloss over what’s happening to the NHS. This is why we cannot allow politicians to shirk their duty to provide a functional NHS.

Big Up the NHS

I know because I have worked in several senior NHS positions and have seen it first-hand. It works like this…..

  • All major NHS institutions from NHS England down are managed by a board consisting of Executive Directors (EDs) who do the actual work and Non-Executive Directors (NEDs) who are there to hold them to account.
  • The EDs are appointed by the NEDs, who also have the power to remove them if they are not up to the job.
  • EDs are required at intervals to provide the board with assurance that things are going well and that if this is not the case that there are plans in place to correct the situation.
  • It is essential that the board accepts this assurance. If they are not assured they must report up to their regulator – usually NHS Improvement.
  • If they are not assured the easiest action they can take is to…

View original post 710 more words

How Badly Is The NHS Underfunded?

So the story of NHS underfunding has finally made it back into the mainstream media. It’s not like NHSpace haven’t done our bit since we were founded in 2014:

  • “Simon Stevens of NHS England will shortly be unveiling an NHS roadmap […] Looming large is the matter of the claimed £30bn funding gap, an artefact of the Tory policy to stagnate NHS funding rather than commit to real-terms growth.” – NHS England And The £30bn Funding Gap, October 2014.
  • “David Nicholson and Simon Stevens have both used their time as NHS England CEO to implement austerity measures, leading to a cumulative shortfall in funding of at least £35bn per year by 2020” – 5 Things You Should Know About STP, August 2016.

But how much money would be needed to resume normal service?

With the NHS being asked to save tens of billions each year, it’s a miracle that hospitals are only in approximately £3bn of debt right now. The ‘Nicholson challenge‘ from 2010 to 2015 demanded efficiency savings of £20bn. The ‘Stevens Challenge’ (the STPs and Five Year Forward View) is asking for another £22bn. Some of these savings come from cutting beds and staffing, resulting in the increased waiting times, rationing of care, and missed targets that we are increasingly seeing.

But some hospital execs aren’t happy making such swingeing cuts. There came a point where the cuts would go too far and lives would be at risk. This wasn’t palatable, so instead of making further cuts, those execs chose to run a deficit and put their trusts into debt. This graph shows just how common this practice has now become:


Let’s assume from this graph that 2012/13 was the year that the NHS couldn’t take any more cuts. It’s also the year that the Health & Social Care Act was enacted. If we take the funding from 2012/13 (102bn for NHS England) and apply ‘NHS inflation’ of 4%, then this year’s funding should be £120bn just for the NHS to scrape by. For comparison, the 2016/17 budget is £105bn. So the NHS is currently about £15bn behind, increasing to a gap of around £35bn in 2020/21 if the government continue with their current plans.

The good news is that our NHS is truly a budget service right now, and we can afford to increase our spending.  If we were to catch up with the French, Germans, Canadians, Swiss, Japanese, etc, we’d spend about £35bn more on the NHS. The bad news is that the government, be it through ideology or deliberate maleficence, are refusing to spend that much. The great irony is that increased NHS spending would actually stimulate the economy, helping us get out of the austerity rut. We can only hope that the political choice to underfund the NHS will be overturned now that more and more professionals are speaking up.

5 Things You Should Know About STP

The Sustainability and Transformation Plans have divided the NHS in England into 44 local areas, and each has been told to cut services as part of a nationwide ‘financial reset’. But what’s actually going on, and how much of the government’s reasoning is just spin? NHSpace brings you a handy myth-busting guide.

1 – NHS Trusts aren’t overspending

The narrative of STPs is that our hospitals are in debt due to overspending. That would be true if the government had matched the NHS budget to the actual healthcare needs of our country, but they haven’t.

The cost of healthcare increases by 4% each year. In the UK, this is referred to as ‘NHS inflation’. If NHS funding doesn’t keep pace with this inflation, then services have to be cut or closed.

David Nicholson and Simon Stevens have both used their time as NHS England CEO to implement austerity measures, leading to a cumulative shortfall in funding of at least £35bn per year by 2020:

Year Increase Needed Actual Increase Shortfall
2010-2015  £20bn  £7bn  £13bn
2015-2020  £30bn  £8bn  £22bn
Total (2010-2020)  £50bn  £15bn  £35bn

The NHS is underfunded, and is actually spending less than it should on healthcare. That’s quite the opposite of an ‘overspend’!

2 – The NHS isn’t unaffordable

Pundits love to tell us about the new challenges facing the NHS, claiming that we now cannot afford universal healthcare. We are told that hospitals are overspending and that they are in debt.

In fact, the NHS is extremely affordable. Here’s a list of healthcare spending in several westernised countries in 2014:

Country Per person ($) % of GDP
Belgium 4,884 10.6
Canada 5,291 10.4
France 4,959 11.5
Germany 5,410 11.3
Holland 5,693 10.9
United Kingdom 3,935 9.1
USA 9,402 17.1

As the table shows, the UK could easily choose to dedicate an extra percent of its GDP to healthcare, providing the NHS with the funds needed to sustain a modern health service.

3 – Hospitals aren’t overstaffed

The ‘financial reset’ planned for the NHS includes a limit on staff recruitment, the implication being that hospitals need to cut back on excessive hiring of permanent staff. Considering the billions spent on hiring agency staff to fill rota gaps, this is certainly not true.

The underlying issue here is safety. Following the Francis Report into the Mid Staffs scandal, hospital managers decided that they would rather exceed their budgets and hire more staff, than be guilty of manslaughter. Fed up with being ignored, the DoH is now coming down on managers with an iron fist. Anyone caught protecting staffing levels by overspending will be subject to a ‘failure regime’.

4 – This Isn’t About Centralisation 

Centralisation of specialised services can improve outcomes for patients with specific illnesses. But trauma, cardiac and stroke services have already become centralised. For many other illnesses, and for maternity and step-down care, it’s important to have smaller District General Hospitals (DGHs) and Community Hospitals. These provide care closer to home and take the pressure off the big, specialised centres.

So don’t be fooled. Closing A&Es and taking services away from local hospitals isn’t centralisation. It’s un-evidenced vandalism in the name of cost savings.

5 – This Is About Creating A Two Tier System

The level of cuts and closures required by the STPs is such that the NHS will become unable to provide a universal service. Rationing will increase, so that most routine procedures will be refused funding. Once various DGHs have closed, the hospitals still standing will struggle with their increased catchment areas and will be forced to provide essentials only.

This was already envisaged by Simon Stevens, who is keen to separate emergency care from routine care. Emergencies will be handled in NHS hospitals, whilst the routine work will be handled by the private sector. Patients wishing to undergo non-essential procedures will find themselves needing to pay to have their cataracts and hernias treated or their tonsils removed.