HSJ expanded its comment section in October with the launch of The Bedpan, a Sunday morning fix for health policy junkies in the form of interviews by our editor Alastair McLellan.
The column’s title derives, of course, from the famous quote attributed to NHS founder Nye Bevan: “If a bedpan is dropped in a hospital corridor in Tredegar, the reverberations should echo around Whitehall.”
The Bedpan thus seemed a fitting name for a series of sitdowns with prominent political figures, some of whom have already heard the bedpan’s clamour, some of whom still have that level of accountability (perhaps) to come, and some of whom are non-political figures whose role is to judge how well the bedpan management is handled by the others.
The first subject was Spectator editor Fraser Nelson, who believed that fixing the NHS is a project on the scale of Soviet Perestroika, and the Tories “don’t want to be Gorbachev”.
“If you were to slip a truth serum into any Tory’s gin and tonic he would tell you that the NHS’s problems are caused only to a small degree by a lack of money, and that there is still staggering waste and inefficiency,” he said, but “they’ve inherited something that is too big to reform effectively”.
He feels that NHS chief executive Simon Stevens is the right man for handling the immense task of running the health service. Mr Nelson was particularly impressed by the way the NHS England chief stood up to the PM during her first year of office.
Caved in
“Before last year’s disastrous general-election she was all up for machine-gunning any signs of independent life in her own cabinet or outside of it. They all wimpishly caved in, except Simon Stevens, who fought back. Good for him - he’s a difficult man to reshuffle and he knew it. I just wish the cabinet displayed the same fortitude that he showed under fire.” Read the full interview.
Next up was Paul Mason, an award winning journalist and film maker, who is one of the intellectual driving forces behind the resurgent radical left.
In a surprising echo of the views of health secretary Matt Hancock, the journalist turned economic futurist is a champion of new technology as the catalyst for radically reconfigured and improved health services. (In fact, prevention and workforce – Mr Hancock’s second and third “priorities” – appeal to Mr Mason’s other preoccupations too).
Mr Mason’s vision is of services driven by “innovation on both sides” – technology, and the “human models” of service planning and delivery. They key dynamic is the “interaction” of small, innovative and diverse local services with significant community input; with step change technological advances overseen by government, but with significant private sector involvement.
Of his beefs, his biggest is that from the early 1990s onwards UK governments decided to engineer “profit making opportunities for a private sector that was not producing them itself”. He adds: “It’s not the state’s job to hand easy quantifiable profit-making opportunities to companies that would not exist unless it did.”
Next under the HSJ microscope was John O’Connell, chief executive of the TaxPayers’ Alliance, an organisation that remains highly influential on Conservative attitudes to public spending, as well as being consistently controversial.
To begin with he said the TPA does not “necessarily see a problem with spending more money on the NHS per se”, adding: “Richer countries tend to run out of things to spend on other than keeping themselves alive, which is a great thing.”
Feast and famine
The TPA is also no fan of US healthcare – something which Mr O’Connell says it is regularly accused of. To the contrary, he said, the campaign group has no love for a system which combines high insurance premiums and significant taxpayer subsidy.
It does however, question whether the NHS’s tax payer funded model is sustainable in the long run and think it “sensible” that alternative approaches – such as those used in Germany, France or the Netherlands – are worthy of exploring and might avoid the cycle of “feast and famine” to which the NHS is so often exposed.
“In terms of action I have only seen an escalation in the mental ill health of our country”.
Find out what projects he’d rather see left alone to help fund the NHS, what he thinks of managers’ salaries and more here.
The following week’s interview took a swing to the left when Alastair met Luciana Berger, Labour MP for Liverpool Wavertree, who is a fearless campaigner on a wide range of issues – most notably mental health.
When HSJ caught up with her, she was railing against the chancellor’s comments on mental health, going on to argue that government policy on the area amounts to a lot of “big announcements”. “In terms of action I have only seen an escalation in the mental ill health of our country”, she said.
Ms Berger detected further “nonsense” in the government (and NHS England) claim that more money is being spent on mental health services. She suspected “a lot of creative accounting” and diverting of mental health funding.
She does, however, believe Theresa May is sincere in her desire to tackle the “burning injustice” of poor mental health provision. However thanks to Brexit, says Ms Berger, the PM’s “eye is off the ball”. Read more.
Sarah Wollaston, Conservative MP for Totnes and chair of the Commons health committee, is a regular presence in the top 20 of the HSJ 100 – our ranking of the most influential people in healthcare.
The former GP is a fervent Remainer and has been one of the leading proponents on the right of a second referendum. The Daily Telegraph front page identifying her as one of the Tory “Brexit mutineers” has been framed and given a prominent position in her Westminster office.
This stance has earned her the attention of the wealthy Brexit champion Aaron Banks, whom Dr Wollaston accuses of running “a very aggressive campaign to de-select me”.
Brexit poses a real threat to sustaining an adequate NHS workforce, she says, and to the “complex interactions” and “close networking” that is essential in the development, manufacturing and supply of pharmaceuticals and medical devices. Such disruption would cause “profound” harm, she declares. See the original story.
The following week saw us quizzing another Tory MP, Johnny Mercer, who stood for election saying his primary goal was to improve the treatment and life chances of armed forces veterans. The centrepiece of his proposed reforms was a “department of veterans’ affairs” or a “veteran’s commissioner”, whose responsibility would be to co-ordinate the state’s support for the former service members, as happens in the US and elsewhere.
Abject failure
His hope was to “professionalise the offer to our veterans” by, for example, reducing the huge number of service charities and spreading the practice of evidence-based care. Find out why he considers his mission “an abject failure”, and what he thinks about technocrats and managers.
Our most recent intervieweee was Philippa Whitford MP, SNP health shadow, the most experienced medic in the House of Commons.
She tells how soon after her election she found herself at loggerheads with health secretary Jeremy Hunt.
“I find Jeremy fairly arrogant. He took different approaches and in the first year or so [he paid] me lots of compliments, ‘the honorable lady’s huge experience, blah blah blah’. Then it gradually became kind of trying to find ways of attacking me. I would ask a health question and his response was ‘yes, but in Scotland people die younger’.”
Things came to a head when the former health secretary began his drive to achieve 24-7 working in the NHS.
“I was sitting there on 16th of July 2015 when he started to attack consultants and junior doctors about people dying at the weekends and talking about us not working out of hours. [I thought] ‘Excuse me, pal. I’ve spent 33 years working out of hours - my husband’s going to think I’ve been having affairs if you say that’.” Read the full interview.
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