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The ball's in whose court?


The ball's in whose court?

Our correspondent believes Professor Stephen Hawking served up an ace with his recent lecture on his concerns for the NHS

I don’t tweet, and I don’t follow anyone who does. In fact, I can’t think of much that would interest me less. However, many people do, and the thoughts of a plethora of famous and not-so-famous people feature in the news every day.

Donald Trump probably attracts the most attention, but recently I discovered that our Health Secretary, Jeremy Hunt, is also a regular tweeter. Now, I get it that the whole point of Twitter is to express your thoughts in a very concise way. Keep the tweets short and pithy. But to use a tweet to dismiss the carefully considered and constructed argument of one of the world’s most highly respected scientists is surely the height of arrogance.

I’m referring, of course, to the spat that has ensued following Professor Stephen Hawking’s lecture at the Royal Society of Medicine regarding his concerns about the NHS. Professor Hawking made a number of points: he called for health policy to be based on peer-reviewed research and proper evidence; he accused Mr Hunt of cherry-picking the evidence about the so-called ‘weekend effect’ where patients in hospital allegedly die because of poor care at weekends; and he expressed concerns about the potential for the NHS to be transformed into a US-style insurance system run for profit by the private sector.

Hunt responded by tweeting: ‘Stephen Hawking is brilliant physicist but wrong on lack of evidence 4 weekend effect. 2015 Fremantle [sic] study most comprehensive ever’. What the Freemantle study actually says is somewhat different: ‘It is not possible to ascertain the extent to which these excess deaths may be preventable; to assume that they are avoidable would be rash and misleading.’ Rash and misleading – could they have been trying to impart a warning to Mr Hunt, do you think? It seems that Hunt not only cherry-picks the study, he’s also selective in ignoring the parts of the study that don’t support his point of view. I wonder if he has even read it.

The editor of the BMJ (where the study was published) wrote to Hunt to rebuke him publicly for misrepresenting the study’s findings. 15-love to Professor Hawking, I think. In two further tweets, Hunt wrote: ‘Most pernicious falsehood from Stephen Hawking is idea govt wants US-style insurance system. Is it 2 much to ask him to look at evidence?’ followed one minute later by: ‘NHS under Cons has seen more money, more docs and more nurses than ever in history. Those with private med insurance DOWN 9.4% since 2009!’ Mr Hunt is making no bones about it – he’s calling Professor Hawking a liar, and a pernicious one at that.

It’s an interesting word, pernicious: it means destructive, ruinous or fatal. Strong words indeed: Professor Hawking has clearly touched a nerve. Hunt’s strategy here could be quite risky. What if there was evidence that the NHS is moving towards a US-style system? Where does he go from there?

System shake-up
The NHS in England is being reconfigured (again) as we speak into regional Accountable Care Organisations (ACOs) that are intended to permit even more involvement of the private sector in providing NHS services. If, in primary care, the move from traditional GP services to multi-speciality poly-clinics continues, the opportunities for the private sector are obvious, and such a system would come to bear a remarkable similarity to the US.

Is it a coincidence that the head of NHS England, Simon Stevens, is a former senior executive of the US health insurer/provider United Health? In fact, Hawking didn’t say the government wanted a US-style system, he said that the NHS was moving in that direction. Hunt asserted that over the last year, private sector involvement in the NHS rose by only 0.1%. Hawking pointed out that this was more cherry-picking, that from 2006-7 to 2015-16, the private sector share of NHS contracts has gone from 2.8% to 7.6%, nearly a 3-fold increase. 30-love to Professor Hawking.

But it doesn’t stop there. In the US, organisations similar to ACOs have existed for a long time. They’re called Health Maintenance Organisations, or HMOs. One of the biggest has the strange name Kaiser Permanente, and runs a network of hospitals and clinics. Is it another coincidence that in a hearing of the Commons health select committee in 2016, Hunt specifically referred to Kaiser Permanente as a potential model for future budgetary arrangements in the NHS? 40-love, Hawking.

And what about Hunt’s claim that the NHS has more doctors, nurses and money ‘than ever in history’? Hunt seems to be in denial that there is a staff recruitment crisis in the NHS. We hear stories every day about staff shortages and the increasing use of agency workers. The number of nursing vacancies increased by half between 2013 and 2015 and currently stands at around 40,000. On top of that the number of vacant medical posts is also on the increase; as we all know, it’s becoming more and more difficult to get a GP appointment and waiting times in A&E departments and for an increasing range of surgical procedures are going only one way – up, up and up!

As Stephen Hawking pointed out – record funding is not the same thing as adequate funding. Game, set and match to the Professor.

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