From this morning’s Daily Mail, is the story that the head of A4E, which delivers the government’s work programme, was rewarded with a 300 per cent pay rise, despite the company failing its targets.

The  newspaper reports:

“Details of the massive payment were revealed during a hearing of the Commons public accounts committee into the Government’s flagship Work Programme.

“A4e is one of the main contractors and receives payments for helping the long-term unemployed find a job. Half of its work is subcontracted to charities, generating millions in management fees.

“MPs voiced astonishment at the size of the payment to Mrs Harrison, and questioned why the firm had continued to win contracts despite the ‘abysmal’ record.

“The company even received a share of £63million in ‘termination fees’ when the DWP ended a previous back-to-work programme in which the firm was involved and replaced it with a new one.

“MPs were told that A4e had missed its target of getting 30 per cent of people on the previous ‘Pathways to Work’ programme into a job. The committee heard the success rate was 9 per cent.

Across the outsourced sector, we have seen problems in getting value for money for taxpayers and the delivery of poor sources:

• The failure of the Care Quality Commission to monitor state-funded private home cares adequately, as shown up by the routine abuse uncovered at Castlebecks’ Winterbourne View by Panorama.
• That in the Conservatives’ flagship borough of Barnet, the so called ‘EasyCouncil’ where a maximum-outsourcing strategy was adopted, a private security firm was hired without a contract.  MetPro, that secretly filmed members of the public in council meetings, hired employees without the necessary authorisation.
• The ongoing scandal, being investigated by Stella Creasy MP, of companies who bid for PFI contracts as part of a process that assumes they will pay taxes under normal arrangements, enabling them to charge more, but then go to extraordinary lengths to avoid paying that tax.

This is all at a time when the government intends to vastly extends the amount of outsourcing in the NHS. Left Foot Forward has argued before that Cameronism is essentaiily about championing taxpayer-funding big business.

With transparency desperately needed for the outsourced sector, surely the time has come for the Freedom of Information Act to cover these companies?

It appears the health bill, which has been teetering on the edge of collapse for months, is now crumbling to pieces.

The Guardian reported last night that the ConservativeHome website “have almost been instructed to write” an editorial against the bill by three cabinet members who have clued up to what a mess it is.

And sure enough, the website Fleet Street loves to call the ‘Voice of the grassroots’ proclaimed this morning:

“The greatest mistake of his time as prime minister has been to put it [The NHS] back at the centre of political debate…

“Many Conservatives think that the NHS needs fundamental reform but for far-reaching reform to succeed certain pre-conditions must be met.

“The public needs to have been persuaded that substantial change is necessary.

“The government cannot be distracted by other consuming projects but its best brains must be focused and single-minded in ensuring the policy’s success. The Whitehall machine needs to be prepared and co-operative.

“The health secretary needs to enjoy significant goodwill amongst NHS staff and possess exceptional communication skills. Few – perhaps none – of those preconditions exist.”

We know the health profession is against the bill. We know the public are suspicious. We know it will make more bureaucracy not less, and will probably push up costs.

It is bad policy and bad legislation. Time to put it out of its misery

Update: As we should have made clear, ConservativeHome are specifically calling for the government to “[remove] all contentious components of the Bill”.

See also:

• The Financial Times comes out against the NHS bill – Alex Hern, February 9th 2012

• Ten reasons peers should vote against Lansley’s anti-NHS bill – Shamik Das, October 12th 2011

• Miliband goes on attack as fight to save the NHS stepped up – Shamik Das, February 6th 2012

• Sign my petition to drop Lansley’s monster – Dr Kailash Chand OBE, November 24th 2011

• Don’t believe the spin – the health reforms are Cameron’s just as much as Lansley’s – Shamik Das, February 8th 2012

The pro-NHS reform Financial Times has published a leader today pushing for the government to drop the “mess” that is the health and social care bill.

The paper begins by attacking the prime minister for failing to live up to his manifesto pledge to avoid top-down reorganisations of the NHS, but then praises the ultimate objectives of the bill. It lays the blame for its failings squarely at the feet of the “political skill”, or lack thereof, of the government, and Andrew Lansley in particular.

The leader concludes (£):

There is no easy escape from the mess the government has created. But its objective should be to pursue the course that offers the best chance of securing the substance of the reforms.

Dropping the bill and pursuing change without omnibus legislation looks on balance the better bet, even if it comes at a cost. The NHS is already adapting to the new structures. Some bureaucratic machinery might have to be rebuilt. Mr Lansley’s position would be weakened – perhaps fatally.

Although the FT is pro-reform, wrongly believing that “if the NHS is to become more efficient, as it must, there should be more clinical involvement in healthcare commissioning”, they have joined the CPHVA, RCGP, CSP, UNISON, UNITE, GMB, RCM, RCN, BMA, RCP, RCR, MiP, COT, IHSM and the Faculty of Public Health in calling for the government to drop the bill.

In May last year, Nick Clegg announced:

No bill is better than a bad bill.

Now that the consensus is that this is a bad bill, the time has come for him to live up to his words and join the coalition to save the NHS.

See also:

• Ten reasons peers should vote against Lansley’s anti-NHS bill – Shamik Das, October 12th 2011

• Miliband goes on attack as fight to save the NHS stepped up – Shamik Das, February 6th 2012

• Sign my petition to drop Lansley’s monster – Dr Kailash Chand OBE, November 24th 2011

• Don’t believe the spin – the health reforms are Cameron’s just as much as Lansley’s – Shamik Das, February 8th 2012

• Lord Owen turns on coalition health plans – Will Straw, January 19th 2011

Ahead of the return of the health and social care bill to the House of Lords today, the papers are full of stories David Cameron is seeking to distance himself from the coalition’s heavily-criticised reforms and hang them round the neck of Andrew Lansley.

The truth, of course, is vastly different to the lines briefed out by Downing Street – the bill is as much the prime minister’s as it is his embattled health secretary’s. As the excerpts below show, he says he helped design it, he has repeatedly backed it in public and he is responsible for it – this is David Cameron’s disastrous NHS reorganisation.

• In July 2010, David Cameron, alongside Nick Clegg and Andrew Lansley, personally signed the foreword to the white paper – “Equity and Excellence: Liberating the NHS” (pdf) – which set out the government’s NHS reorganisation plans:

“The NHS is a great national institution. The principles it was founded on are as important now as they were then: free at the point of use and available to everyone based on need, not ability to pay. But we believe that it can be so much better – for both patients and professionals.

“That’s why we’ve set out a bold vision for the future of the NHS – rooted in the coalition’s core beliefs of freedom, fairness and responsibility.

“We will make the NHS more accountable to patients. We will free staff from excessive bureaucracy and top-down control. We will increase real terms spending on the health service in every year of this Parliament.

“Our ambition is to once again make the NHS the envy of the world. Liberating the NHS – a blend of Conservative and Liberal Democrat ideas – sets out our plans to do this.”

• In April 2011, Mr Cameron told Sky News’s Dermot Murnaghan he had “been involved in designing these changes way back into opposition” with Mr Lansley, and takes “absolute responsibility with him for all the changes we are making”:

DM: “Well you were ploughing on until you ran into so much political trouble. Mr Lansley for a long time seemed to be in charge of the process himself, it was only when Number Ten took on board the enormity of the proposed changes, isn’t it?”

DC: “No, not at all. I mean I have been involved in designing these changes way back into opposition with Andrew Lansley, I take absolute responsibility with him for all of the changes we are making but I do think it is right when you have an asset as precious as the National Health Service, if you have the time to just stop and make sure you are getting everything right and at the same time what I’m finding is when you go particularly to hospitals, a lot of this is about reassuring clinicians in hospitals, hospital doctors, that they will have a really big part in this future NHS.”

• The prime minister has regularly defended the reorganisation inside and outside Parliament:

“First of all, let us be clear about the fact that the reforms are about cutting bureaucracy and improving patient care. They were drawn up by us as a coalition to improve the NHS.” – PMQs, March 2011

“It’s because I love the NHS so much that I want to change it… Because the fact is the NHS needs to change. It needs to change to make it work better today and it needs to change to avoid a crisis tomorrow.” – Speech at Ealing Hospital, May 2011

“Three weeks ago, I made the case for change in our NHS. I said we would be kidding ourselves if we thought we could simply stick with the status quo. We need to change the NHS to make it work better today.” – Follow-up speech on the NHS, June 2011

“Of course there are doctors in the health service who don’t like the idea of greater choice and competition and other organisations being able to provide free healthcare services to patients. But I believe patients want that sort of choice and rapid, quality treatment and that’s why it’s right to make these reforms.” – Interview with the BBC, October 2011, in response to a Telegraph letter from doctors and academics warning “the proposed reforms will disrupt, fragment and weaken the country’s public health capabilities”

• Cameron’s former No. 10 adviser James O’Shaughnessy recently revealed that during the “pause” last year “it did take the energy of Steve [Hilton] and the prime minister and Oliver Letwin and others to keep pushing it through”:

“We came in with what we thought were fairly well thought through proposals that then did seem to be running into opposition at a variety of levels, whether it’s the House of Lords or staff or other groups.

“I think there was a lesson in there for all of us which is actually, if you look where we’ve got to with the health bill, the fundaments of what we were trying to do are still there but it did take the energy of Steve and the prime minister and Oliver Letwin and others to keep pushing it through, to weigh in behind that and adopt different tactics in order to get the same principles across.” – “David Cameron’s Big Idea” (listen), BBC Radio 4, January 2012

• And just last week, at PMQs, David Cameron made it clear he would not back down – even citing Tony Blair in his support:

“Let me tell the Right Honourable Gentleman something that Tony Blair once wrote about the process of reform. Now there is a man who knows a thing about bonuses and pay.

“He said this – listen, listen:

‘It is an object lesson in the progress of reform: the change is proposed; it is denounced as a disaster; it proceeds with vast… opposition; it is unpopular; it comes about; within a short space of time, it is as if it has always been so. The lesson is instructive: if you think a change is right, go with it. The opposition is inevitable, but rarely is it unbeatable.’

“That was someone who knew a thing or two about reform.”

Mr Cameron may run, but he can’t hide from the reality that these are his reforms, that he has resolutely stuck by them, and that he is ignoring pretty much everyone who cares about the NHS and is refusing to kill the bill.

See also:

• Miliband goes on attack as fight to save the NHS stepped up – Shamik Das, February 6th 2012

• Sign my petition to drop Lansley’s monster – Dr Kailash Chand OBE, November 24th 2011

• Cameron’s fantasy list of NHS reform backers – Shamik Das, September 7th 2011

• Doctors still fear coalition health reforms – Daniel Elton, June 27th 2011

• So who backs Lansley’s health reforms then? – Dominic Browne, June 1st 2011

• Doctors tell Lansley: “Stop this bill” – Dominic Browne, March 15th 2011

• So, Mr Cameron, who backs your NHS reforms? Erm… – Shamik Das, February 2nd 2011

A week ago, David Cameron tried to embarrass Ed Miliband by claiming a doctor in his Doncaster constituency supported the health reforms – a doctor, that is, who has quit his commissioning group and doesn’t even live in Doncaster – yet today, a real doctor in his own Witney constituency has said “things are going to fail, hospitals will close” as a result of the health and social care bill.

The senior GP has told the New Statesman:

“I would say very few GPs are happy with [the NHS reform] at all… [It's] not a question of supporting it, it’s a question of going along with it… In my practice, nobody supports the changes…

“People think there should be more clinical involvement in commissioning. But I don’t think many people think that GPs are the right people to commission. They need input into it – but if we wanted to be managers we would have trained to be managers, not doctors.”

Adding:

“Most GPs are incredibly worried about conflict of interest. How can you be a patient’s advocate and look after the money?

“A lot of people think the whole thing’s designed to fail so they can bring private providers in. It’s the one big bit of the economy that hasn’t got private money in it.”

And of the effects to patients from the health service overhaul, the Witney GP warns:

“The public have just got no idea what’s hitting them… Things are going to fail, hospitals will close, because the money’s not going to be there. Things will get taken over. And if you’re going to have to make a profit out of it, you’re not going to have the same service.”

This lunchtime, the prime minister was again quizzed over the NHS reforms at PMQs, with Miliband again telling him to drop the bill.

As Left Foot Forward has reported many times before, as the links below show, next to nobody in the NHS supports the changes; now that even a senior GP in his own constituency has articulated that opposition, will David Cameron finally listen?

See also:

• Sign my petition to drop Lansley’s monster – Dr Kailash Chand OBE, November 24th 2011

• Lansley told to his face why his NHS reforms are wrong, wrong, wrong – Shamik Das, October 14th 2011

• Cameron’s fantasy list of NHS reform backers – Shamik Das, September 7th 2011

• Doctors still fear coalition health reforms – Daniel Elton, June 27th 2011

• So who backs Lansley’s health reforms then? – Dominic Browne, June 1st 2011

• Doctors tell Lansley: “Stop this bill” – Dominic Browne, March 15th 2011

• So, Mr Cameron, who backs your NHS reforms? Erm… – Shamik Das, February 2nd 2011

One year on from the introduction of the health and social care bill into the house of commons, and the day that the Royal College of Midwives and the Royal College of Nursing have declared their “outright opposition” to the bill, it is worth looking back at why it is that the bill still incites such opposition.

1. Breaking the link of legal and parliamentary responsibility of the secretary of state for health for the delivery of a comprehensive health service.

As Jos Bell wrote in her parliamentary sketch:

Secretary of state Lansley has done all he can to abdicate ‘the duty of the secretary of state for health to secure the provision of services under Section 1 of the NHS Act’, placing instead those duties on clinical commissioning groups and Monitor…

So where exactly – as Lord McKay later said – does the buck stop? If not the SoS then who will ultimately bear responsibility for maintaining a health service free at the point of need for all?

To ignore this, would, as Baroness Williams said ‘leave us in a world of deep twilight uncertainty’ for Lansley has serially failed to acknowledge that this will also result in a danger to provision in areas where the infrastructure fails - or indeed in the management of national emergencies.

2. Creating an economic regulator similar to Offgem and Offwat to ensure health services are bought and sold through a competitive market.

The bill requires Monitor to ‘prevent anti-competitive practice’.

As Tim Holmes wrote on the eve of UK Uncut’s protest over the bill:

With sharp constraints on the NHS budget in place, this can only force incumbents into atrophy or collapse. Profit-motivated companies are likely to cherry-pick the operations they provide, offering cheap, easy treatments, and leaving the public to pick up the tab for the rest. By competing toundercut each other, they could drive down standards across the board.

3. The lifting of the private patient cap, or setting of a limit of 49%, which sends a damaging message of the place of private income generation within NHS, at the expense of patient care.

Dr Kailash Chand explained the problem with this (and urges you to sign his petition against the bill):

Removing the barriers will mean that waiting lists will target patients with higher resources than the NHS tariff, private patients will be prioritised over NHS patients, and the real threat is that the elderly and the vulnerable, those with chronic mental health problems, those with chronic medical problems such as diabetics, renal patients, etc will be a low priority.

There is every possibility that the reformed NHS under these proposals will become exclusive rather than inclusive. Removal of a cap over private income will see Foundation Trusts competing over costs rather than quality, so that those that are run by poor management will risk the stability of the hospital to a much greater extent than prevails now.

4. Creation of a legalistic and complex bureaucracy which will lead our NHS to insurance base and huge costs not spent on patient care, through the use of EU procurement legislation, competition act and Office of Fair Trade

Dominic Browne detailed the changes in June:

In its response to the NHS Future Forum listening exercise (pdf) the government aims to create clinical senates, commissioning consortiums, health and wellbeing boards, a national commissioning board.That’s four types of bureaucracies for the price of the current two: Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs).

How much extra bureaucracy will this mean on the ground? See if you can untangle it for yourself:The clinical commissioning groups will need “authorisation” from the national commissioning board with “input from health and wellbeing boards and local clinicians”. If they don’t get authorisation they might exist in “shadow form”.

5. The risks and cost for patients, staff and managers in the NHS – at least three years potential progress lost in fragmentation of decision making, increased waiting lists, lack of collaboration and loss of expertise.

As we revealed exclusively on Left Foot Forward, the NHS risk register for London details concerns over the negative impact of the reforms:

The consequence of this risk could be that the transformational changes in health services envisaged in London’s QIPP plans in response to the clear clinical case for change, may not be realised in full or are delayed, thereby undermining significant improvements in the health of Londoners.

While all the focus is on the government’s top-down re-organisation of the NHS, the negative aspects of their minor health policies have gone by largely unnoticed, including it, seems, by the department itself. It took them eighteen months to reverse their damaging no-targets policy, which has now led to 43 per cent of patients waiting too long for treatment.

See also:

• NHS assessment of Lansley’s plan’s risk makes for sober reading – Alex Hern, November 24th 2011

• How Tories wrecked the NHS (but learnt to love targets (too late)) – Alex Hern, November 17th 2011

• The House of Lords ties itself in noble knots over the NHS bill – Jos Bell, November 12th 2011

• UK Uncut: Stop the traffic to stop the NHS being run over – Tim Holmes, October 7th 2011

• Tories: The party of NHS bureaucracy – Dominic Browne, June 15th 2011

By Jessica Studdert, political adviser to the LGA Labour Group

Confirmation that cross-party talks to find a way to overhaul the English adult social care system will begin again this month is welcome – a consensus is much needed and long overdue. Research published by Labour’s shadow minister for Social Care Liz Kendall last week showed that service charges for elderly and disabled people were increasing.

Her predecessor Emily Thornberry had also shone a light on the pressures councils are under to deliver services; her survey of local authority directors of adult social services highlighting the narrow room for manoeuvre councils have in responding to increasing demand in light of cuts to council budgets, which was resulting in some tightening of eligibility thresholds.

It cannot be right that our most vulnerable citizens increasingly bear the brunt of the consequences of indecision at Westminster and Whitehall.

There are three main areas of pressures on the social care system.

First are changing demographics – the evidence on our increasing population of over-65s is well rehearsed, but these also include younger adults living longer with disabilities. Of course it is to be celebrated that in today’s society individuals are able to enjoy comparatively greater quality and longevity of life than previous generations, but we must recognise the impact this has on demand.

Secondly, funding pressures are long term and have not kept pace with rising demand over the years, but are compounded by the cuts to local authority budgets.

Councils are currently finalising budgets for the second of a four year period of real terms reductions of 28 per cent in their funding from central government. The autumn budget statement proposed that cuts to councils will continue for at least until 2017, so there is no end in sight.

The LGA has estimated an overall funding gap of £6.5bn for 2011-12 alone, and the Association of Directors of Adult Social Services has suggested that the service’s budget has already been reduced by nearly £1bn in 2011-12.

As adult social care is the largest area of controllable budget available to councils there will be unavoidable knock-on effects on the social care system’s already dwindling sustainability.

Finally, there is clearly an issue with navigation from the perspective of the user.

The consequences of unaddressed long-term demographic and funding pressures have resulted in councils being forced into short term responses to local demand, using the limited tools available to them such as assessments, means and needs tests, charges and eligibility thresholds.

Legislative tinkering around the edges with different aspects of adult social care codified in primary legislation, statutory instruments or set out in guidance adds to the complexity of the system. People have a right to know what the system will realistically offer them, how they can plan for it, and of course how much it will cost.

Perhaps largely due to this latter factor about complexity and variability, fears of unfair local variations (often described as a postcode lottery) in provision are real. The lack of transparency in the system causes uncertainty and the argument is frequently made that locally-led provision leads to a different level and quality of service depending on where one lives.

Yet as progressives, a primary driver for service delivery should be need, and a needs-led system must contain a large degree of local flexibility to be responsive.

The care needs of a seaside town with a large elderly population, for example, will vary markedly from a deprived inner city area with a comparatively larger number of younger adults with longer-term conditions. Transport needs in rural areas will vary from those of urban, and so on.

The personalisation agenda has rightly increased expectations of individuals to play an active role in decisions which affect them rather than be passive recipients of care.

Local authorities have a broad conception of what constitutes effective social care and support beyond the purely medical – beyond direct services, adult social care is also linked to initiatives on public health, leisure, housing and transport.

Individuals’ wide-ranging needs can be met far more creatively and effectively by local providers in communities who know their care requirements, than from a rigid one-size-fits-all model applied from the centre.

Clearly, it will be important to get the national-local balance right - national clarity of entitlement and assessments should be matched with local flexibility to meet needs appropriately.

Finally, a word on integration.

The NHS reforms underway are expensive and can be criticised on many levels. Yet for the purposes of social care, a major problem is their narrow conception of integration, focussing mainly on vertical integration and collaboration within the NHS, rather than horizontal across the NHS, public health and social care.

At present, the inadequacies of the social care system place an extra cost burden on hospitals and acute provision. The fact that one pound spent on social care yields an even greater saving to the NHS ought to spur reform.

Yet until services are fully integrated the mismatch between savings and costs within the wider health system will undermine investment and frustrate cost-benefit payoffs.

Both the Dilnot and Law Commissions last summer produced workable proposals, around which there was a wide degree of agreement in the sector.

There is cross-party consensus on the urgent need for reform within local government. This should set the tone for constructive national-level tri-partite discussion which must have the ultimate goals of political consensus and public buy-in. The question of how to properly fund a social care system which meets the needs of people who use it cannot be dodged any longer.

Everyone – government, opposition, councils, providers and individuals (both present and potential future care users) - must seize the opportunity to have an honest and open dialogue about reform, not least the costs associated with it – both to the individual and to the public purse. The risks of further drift are real – the costs of inaction will continue to fall on the most vulnerable in our society.

See also:

• Labour’s untenable position on social security and disability – Declan Gaffney, January 3rd 2012

• Life in the Lords logjam may be death for the health bill – Alex Hern, December 2nd 2011

• Though cost is important, we need to focus on the quality of social care – Laura Bradley, July 5th 2011

• Social care in crisis – June 10th 2011, Laura Bradley

• The social care system is at breaking point and needs reform – Hilary Evans, June 1st 2011

Former US Senator Rick Santorum made the headlines in Iowa last night as he became the Republican grassroots new “anyone but Romney” candidate in the race for the GOP nomination for the White House, so it’s now worth giving a closer look to Rupert Murdoch’s favourite candidate.

Prior to his presidential run, Santorum was most widely noted for his astonishingly regressive views on homosexuality. Famously in 2003, he shared his views on what homosexuality has in common on the one hand with incest and on the other with bestiality.

Watch it:

The snippet gained notoriety because of the fact that he compares “man-on-dog” to gay relationships, but the full quote is almost worse:

“If the Supreme Court says that you have the right to consensual [gay] sex within your home, then you have the right to bigamy, you have the right to polygamy, you have the right to incest, you have the right to adultery. You have the right to anything… It all comes from, I would argue, this right to privacy that doesn’t exist in my opinion in the United States Constitution…

“You say, well, it’s my individual freedom. Yes, but it destroys the basic unit of our society because it condones behavior that’s antithetical to strong healthy families…

“In every society, the definition of marriage has not ever to my knowledge included homosexuality. That’s not to pick on homosexuality. It’s not, you know, man on child, man on dog, or whatever the case may be. It is one thing.”

Santorum is also the candidate who criticised the NHS for causing the fall of the British Empire, liberalism for leading to the Catholic Church’s sex scandal, and the Bush government’s No Child Left Behind act for not mandating the teaching of intelligent design in science lessons.

How delightful.

See also:

• Sign up to our new weekly email on US 2012 and election news from across the globe, The World Outside Westminster

• After Iowa: Bloodied Romney on course for nomination as Obama smiles – Marcus Roberts, January 4th 2012

• Iowa 2012: Meet the candidates – Chris Tarquini, January 3rd 2012

• Romney remains least risible Republican candidate for another week – Alex Hern, November 14th 2011

• Republican elephants enter the room as rivals to Obama – Dominic Browne, May 26th 2011

This is our faaaaavourite, favourite video of the year 2011; enjoy!

For the slickness of the production, for the quality of the music, and for the power of the anger expressed within, Left Foot Forward’s number one video of 2011 is the Andrew Lansley Rap by MC Nxtgen and Rob Gee:

See also:

• Safe in their hands? Lansley, Cameron and the NHS in 2012 – Trevor Cheeseman, December 29th 2011

• Sign my petition to drop Lansley’s monster – Dr Kailash Chand OBE, November 24th 2011

• Lansley told to his face why his NHS reforms are wrong, wrong, wrong – Shamik Das, October 14th 2011

• Cameron’s fantasy list of NHS reform backers – Shamik Das, September 7th 2011

• “Andrew Lansley greedy, Andrew Lansley tosser…” – Shamik Das, March 25th 2011

You know someone’s true feelings when they highlight failings whenever they can, yet play down any success – so it is with the coalition and the NHS, writes Trevor Cheeseman

Andrew Lansley was strident in his criticisms of NHS failings when he first took office, and he and David Cameron have attempted to maintain this, despite the story over 2011 becoming his own reforms and their unpopularity.

Yet it remains rare to hear any official praise for “big ticket” achievements, lest they cast Labour in any positive light.

Two recent examples are public data on NHS satisfaction, and data on hospital mortality. Both highlight major achievement over the past decade.

On public satisfaction, the message from the British Social Attitudes Survey is clear:

70% of respondents in 2010 reported that they were overall satisfied with the NHS.

This is the highest figure ever recorded by the long-running survey – and for reference, the lowest was 34% in 1997, at the end of the Conservatives’ 18-year tenure in office.

There has been a 5% rise in satisfaction since the 2009 survey.

While dissatisfaction levels are similar in 2009 and 2010 (19 and 18 per cent respectively):

It is the proportion saying “neither satisfied nor dissatisfied” that has reduced – from 16 per cent in 2009 to 12 per cent in 2010.

The report also highlights that expectations about waiting times have improved dramatically over the last decade and:

…positive views on waiting times are linked to satisfaction with the NHS overall.

If you think this data should be useful to the coaltion, then sadly you are mistaken. The government decided last year to scrap its funding for the health questions, but fortunately the Kings Fund health institute have put up the funding to keep the questions going, and allow the public their say on the coalition’s stewardship.

Meanwhile, a recent report on outcomes, including death rates, in NHS hospital care shows “a remarkable” overall improvement since 2001, allied to major increases in NHS funding.

The Dr Foster Hospital Guide 2001-2011 (pdf) states:

Improvements in patient safety, reductions in infection rates and better waiting times have all contributed to an improved NHS.

There has been a remarkable fall in mortality rates. The death rate among the population is over 20 per cent lower than it was a decade ago, helped by better hospital care.

While Andrew Lansley tries to gain credit for his toothless national initiative on healthcare outcomes (pdf), it is actually Labour policy that delivered the improvements in stroke, fractured hips, heart disease, cancer and other major disease areas.

The Dr Foster report also analyses performance across hospitals, showing there continues to be unacceptable variation within the NHS based on a range of measures – including differences based on geography and day of the week patients are admitted.

In 2012, when the Francis public inquiry report comes out on the Mid Staffordshire NHS Trust scandal of significantly higher death rates and major concerns about quality of care, you can be sure Andrew Lansley will take to the airwaves. Unless questioned specifically though, you are unlikely to find him talking about the bigger national picture over a decade of declining NHS death rates and record NHS popularity.

Since his NHS reforms are a solution in search of a problem, however, perhaps this is not a surprise.

• To send a message to Lansley and Cameron, please sign the Drop the Bill petition.

See also:

• Life in the Lords logjam may be death for the health bill – Alex Hern, December 2nd 2011

• NHS assessment of Lansley’s plan’s risk makes for sober reading – Alex Hern, November 24th 2011

• Sign my petition to drop Lansley’s monster – Dr Kailash Chand OBE, November 24th 2011

• Safe in their hands? Tory peers, private health and the threat to our NHS – Shamik Das, November 2nd 2011

• Lansley told to his face why his NHS reforms are wrong, wrong, wrong – Shamik Das, October 14th 2011