Revealed: Boris Johnson’s controversial policy chief leading secretive NHS task force

Munira Mirza heading up group meeting ‘daily or weekly’ to plan ‘radical NHS shakeup’. Open Democracy 19.11.20

Boris Johnson’s government has for the first time confirmed the existence of a prime ministerial task force which is reportedly planning a “radical shake-up of the NHS”.

Freedom of Information disclosures to openDemocracy show the new “No.10 Health and Social Care Taskforce” reports to a Steering Group chaired by Munira Mirza, the influential head of Boris Johnson’s policy unit, and that it “met weekly” from July to September with a further meeting in October.

Mirza, a political appointee who previously worked for Johnson when he was London mayor, has no background or policy experience in health.

The disclosures also reveal that whilst some Department of Health officials do attend the task force, it is led by four senior civil servants based at the Treasury, and none of whom are from the Department of Health.

The government has not published any information about the task force’s existence, work, terms of reference or membership – and has refused to answer questions about the nature of its work.

However in July, The Guardian reported that Boris Johnson was planning a “radical and politically risky reorganisation of the NHS” – in response to “frustration” with the NHS’s performance during the COVID crisis.

And in September, the Financial Times reported that inside sources had revealed an interdepartmental health task force with a wide remit, “determining what the health service’s goals should be”.

The government has previously claimed that rumours regarding the work of the task force are “pure speculation,” and did not even formally confirm its existence, insisting that instead: “As has been the case throughout the pandemic, our focus is on protecting the public, controlling the spread of the virus, and saving lives.”

Not only is the group now confirmed to exist, but Mirza’s leading role and the lack of leaders from the Department of Health suggest that its work is politically focused.

Jackie Applebee, Chair of Doctors in Unite, told openDemocracy, “It is shocking that people with no background in health are meeting regularly to determine the future of health and social care. COVID-19 has surely shown us that putting people with no health experience in charge of the NHS is a disaster.”

Meanwhile Tamasin Cave, a lobbying expert, has called Mirza “a political hire who is unqualified to mess around with the NHS”. She also questioned the timing: “Why are they doing this now, given how much the NHS – and the country – has on its plate already?”

The revelations come as concerns are mounting about post-COVID pressures on the NHS.

Kailash Chand, former deputy chair of the British Medical Association, told openDemocracy. “The waiting lists have built up to an awful level, and they’ll use that as an excuse to bring the private sector in, as they did under the previous Labour government.”

He described Boris Johnson as “dangerous” and having “no faith in public services.”

Secrecy ‘the worst possible way’ to do NHS reform

In their Freedom of Information responses, the Department of Health, the Treasury and Number 10 have all denied having a full record of who has been attending the task force and steering group meetings.

Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, has criticised the government’s secretive approach as “the worst possible way to design a major reform.”

“Secrecy encourages groupthink. The government rightly stresses the importance of public and patient involvement and co-production with users when designing new models of care. It is bizarre to reject these ideas for the really big decisions.”

What today’s disclosures do show is that the task force’s civil service policy lead is Adrian Masters. An alumnus of the management consultancy McKinsey, Masters played a key role in shaping the last major piece of NHS legislation, the 2012 Health and Social Care Act.

McKinsey was reported to have drafted large parts of that bill, which was criticised as enabling increased fragmentation and private sector outsourcing of large parts of the NHS.

The task force also includes William Warr: Johnson’s health advisor and a former lobbyist at the firm of Lynton Crosby, who masterminded numerous Conservative Party election campaigns and Johnson’s successful 2008 London mayoral bid.

Warr described the NHS as “outdated” in a Telegraph article penned shortly before he and Johnson entered Downing Street last year, suggesting that the incoming prime minister should ask himself: “If I created the NHS today from scratch, what would it look like?” Warr answered: “Nothing like the monolith we have today.”

Boris Johnson’s first Queen’s Speech in December last year promised to “bring forward detailed proposals” and “draft legislation” to “accelerate the Long Term Plan for the NHS, transforming patient care and future-proofing our NHS.”

The British Medical Association (BMA) has characterised this Long Term Plan as a “plan for a market-driven healthcare system”.

Kailash Chand, the former BMA deputy chair, told openDemocracy he believed the purpose of the task force was part of a wider effort to drive forward more NHS privatisation: “These people are really clever at bringing these things in disguise. This is essentially about getting us towards… big pickings for private companies. It’s not going to happen overnight but this is the road map.”

Referring to McKinsey’s regular NHS recommendations that were implemented under the Cameron government, he said: “McKinsey were brought in previously to recommend financial savings. The easiest way for hospitals to achieve those targets was to cut beds, cut nurses and the salary bill. And we’re still suffering today.”

Political appointments

Boris Johnson has faced criticism for appointing political allies with no health experience to key roles in the COVID-19 response. Test and Trace head Dido Harding, another former McKinsey employee and Tory peer, is in the process of taking over a large portion of the soon-to-be-abolished Public Health England’s remit, the government announced in August. She has also been tipped as favourite to take over as chief executive of the English NHS from the current incumbent, Simon Stevens, next year.

Stevens’ own proposals for major NHS reform last year attempted to allay fears about further privatisation, though campaigners raised concerns that they could make outsourcing less transparent.

Both the Department of Health and the NHS now appear to be taking a back seat in policymaking. Stevens is not on the task force, and none of the four top senior servants in charge comes from the department.

Open Democracy approached Munira Mirza, Adrian Masters, Number 10 and the Treasury for comment, but all have declined to respond by the time of publication.

This is a reprint of an aricle in Open Democracy by Caroline Molloy 19.11.2020: https://www.opendemocracy.net/en/opendemocracyuk/revealed-boris-johnsons-controversial-policy-chief-leading-secretive-nhs-task-force/

One Stop Shops – trick or treat?

The media recently highlighted the fact that NHS England has announced:

The NHS is set to radically overhaul the way MRI, CT and other diagnostic services are delivered for patients . . . . Community diagnostic hubs or ‘one stop shops’ should be created across the country, away from hospitals, so that patients can receive life-saving checks close to their homes. The centres could be set up in free space on the high street or retail parks.”

“The need for reform of NHS diagnostics was recognised in the Long Term Plan” – so begins the recent report by Professor Sir Mike Richards, ‘Diagnostics. Recovery and Renewal’.

The key recommendations are:

  • Acute and elective diagnostics should be separated wherever possible to increase efficiency.
  • Acute diagnostic services (for A&E and inpatient care) should be improved so that patients who require CT scanning or ultrasound from A&E can be imaged without delay. Inpatients needing CT or MRI should be able to be scanned on the day of request.
  • Community diagnostic hubs should be established away from acute hospital sites and kept as clear of Covid-19 as possible.
  • Diagnostic services should be organised so that as far as possible patients only have to attend once and, where appropriate, they should be tested for Covid-19 before diagnostic tests are undertaken.
  • Community phlebotomy services should be improved, so that all patients can have blood samples taken close to their homes, at least six days a week, without needing to come to acute hospitals.

Motherhood and apple pie

On the surface of it, these are laudable aims that have been welcomed by hospital bosses. The COVID-19 pandemic has had a devastating effect on management of non-covid conditions with, for example, a 75% reduction in cancer referrals and a reduction in 210,000 imaging procedures each week. Before the pandemic there were 30,000 patients who had waited longer than 6 weeks for a diagnostic test, a figure that has now increased to 580,000. Urgent consideration must be given both to how the NHS is put back on its feet and how it addresses the huge backlog of problems as well as the ongoing pandemic. There is logic in separating acute and non-acute service provision into covid and covid free areas, and who could object to patients having convenient and rapid access to the best available technology? This does of course depend on many factors, not least having an efficient coronavirus testing system at some point in the future, but raises other crucial issues.

Where will the staff be found?

The plan as set out requires the recruitment of around 11,000 staff including 2000 radiologists, 500 Advanced Practitioner radiographers, 3,500 radiographers, 2,500 assistant practitioners, 2,670 administrative staff and 220 physicists. Bear in mind the current staffing crisis on the NHS, with around 140,000 vacancies across the board exacerbated by low pay and workplace stress. Cancer Research estimated that staff would need to double by 2027 to meet demand, with one in ten posts in diagnostics unfilled at the start of the pandemic. Furthermore, massive investment in equipment will be needed. The report points out that in relation to the 20 other countries making up the Organisation for Economic Cooperation and Development, the UK ranks bottom for CT and 3rd from last for MRI scanners. The Clinical Imaging Board claims that nearly 30 per cent of the UK’s MRI stock is at least ten years old, with no replacement plans for almost 40 per cent of systems more than seven years old.

All that’s left to find – money and staff

The last settlement for the NHS was £20.5 bn, which over a five year period amounted to an annual increase in budget of 3.4%. This did not include funding for training and employing the staff of the future. Most commentators thought a minimum 4% increase in funding was needed, and the Office for Budget Responsibility put the figure at 4.3% in order to meet increasing demand. COVID-19 has now blown all these estimates out of the water with the additional costs of restarting and sustaining the service, dealing with COVID-19 long term and developing and implementing a workforce transformation.

Private sector – the spectre lurking in the wings

In Simon Stevens’s letter to health care providers in July this year, he mandated:

Ensuring that sufficient diagnostic capacity is in place in Covid19-secure environments, including through the use of independent sector facilities, and the development of Community Diagnostic Hubs and Rapid Diagnostic Centres”.

As pointed out in The Lowdown in a comment on diagnostic hubs:

“References . . . to high street and retail park sites are possibly of no real concern – perhaps they’re more about exploiting cheap-to-rent locations during the pandemic-driven economic recession than a push to link-up with high-profile brand sponsors – but the well-established presence of private sector interests operating in the diagnostic and pathology arena suggests there may be rich pickings on offer somewhere in the hub programme, if only until the backlog is cleared”.

In fact the privatisation of diagnostic and laboratory facilities is already well underway. There is no comfort here in Professor Richard’s report which even cites as a case study:

The East Midlands Radiology Consortium (EMRAD) was launched in 2013 to create a common digital radiology system. Pioneering work led to the development of a Cloud-based image-sharing system through which the seven NHS trusts involved in the partnership could share diagnostic images, such as X-rays and scans. In 2018, EMRAD formed a partnership with two UK-based AI companies, Faculty and Kheiron Medical, to help develop and test AI tools in the breast cancer screening programme in the East Midlands.”

There is no mention of the fact that EMRAD paid £30m for the picture archiving and communication system from GE Healthcare but refused to pay full service costs until GE sorted out chronic problems causing a dangerous backlog of CT and MRI images.

Like many of the aspirational service developments contained within the Long Term Plan, ‘one stop shops’ could offer real value to patients. As the report by Professor Richards recognises:

These new services will require major investment in facilities, equipment and workforce, alongside replacement of obsolete equipment. Training of additional highly skilled staff will take time but should start as soon as possible. International recruitment should be prioritized.”  

This is no small ask and needs to be part of a generous new funding settlement for the NHS by government.  This should be an investment in the NHS as a public service rather than a source of rich pickings for private companies.

This article was written by John Puntis for Keep Our NHS Public

NHS 72nd Birthday

5th July 2020

The 72nd birthday of the NHS takes place in the shadow of the COVID 19 pandemic.

The progress of the virus underlines the absolute importance of having an NHS as Bevan intended when it was founded in 1948, a comprehensive health service, publicly funded from general taxation, publicly provided and free at the point of delivery for all. The aim was to end inequalities in access to healthcare and July 5th 1948 famously saw queues of people round the block in a powerful demonstration of the size of the previous unmet need.

Since 1948, and accelerated since 1990, the founding ethos of the NHS has been under threat. One of the most cost-effective health care systems in the developed world, the NHS is nevertheless subject to repeated cuts and calls for efficiency savings, along with privatisation, fragmentation and competition, which was enshrined into NHS procurement by Andrew Lansley’s dastardly 2012 Health and Social Care Act. Public Health departments have been hollowed out and side-lined, at huge cost to their vital functions.

COVID 19 has laid bare the disastrous effects of the undermining of the NHS. People of BAME origin and the poor are far more likely to die of the virus. Years of NHS underfunding and outsourcing to the private sector has left it without the spare capacity to cope with the challenges of the pandemic. There has been insufficient appropriate PPE for health and social care workers, testing for the virus has been chaotic and outsourced to the private sector with no coordination with GP services, community contact tracing that has served well countries such as New Zealand, South Korea, Iceland and even Liberia, where they are used to dealing with Ebola so know what needs to be done, has been side-lined in the UK with reliance on a national system which has been deemed by Independent SAGE as not fit for purpose.

The result of this is that the UK has the ignominious honour of having the highest death toll from COVID in Europe, and, as I write, the third highest in the world, behind Brazil and the US.

BAME staff have died disproportionately yet they are the backbone of the NHS, often employed in the lowest paid of jobs on precarious contracts. To add insult to injury the hostile environment makes some of them ineligible for free NHS care. The Tories have done a U turn and said that the health surcharge will not apply to health workers, they have yet to implement this so the pressure needs to be maintained, but it does show what can be achieved through sustained campaigning.

A publicly run health service with adequate funding and planning based on need not profit, would have mitigated many of the challenges that COVID 19 has presented.

So, on this the 72nd birthday of our NHS we must keep fighting to have it restored into public ownership. The Black Lives Matter movement chimes with the disproportionate death toll amongst our BAME brothers and sisters, everyone should have equality of opportunity in life and equal access to health care. This can only be achieved in a society based on need not profit.

We have a job to do. If we fight, we can win.

Open letter to the Prime Minister about the UK’s Covid-19 strategy from NHS and Social Care workers

Open letter for anyone working in Health and Social care to sign and distribute.

Sign here:

https://docs.google.com/forms/d/e/1FAIpQLSfdk4q_YaJnNrMAGtaz9W32WCYLyWnE1rvLPFR3Y376tydRZg/viewform

Dear Prime Minister,

We are writing to ask you urgently clarify our Covid-19 strategy. Herd immunity was abandoned early on as it became clear hundreds of thousands would die. We entered lockdown in order to “flatten the curve” under the slogan: “Stay at home – Protect the NHS – Save lives”. Despite high levels of ongoing viral transmission, lockdown is now being eased with the injunction: “Stay alert – control the virus – save lives”. Slogans, however, do not constitute a strategy. Given the terrible cost of the pandemic, both in terms of lives lost and lasting damage to the economy, we call on you urgently to set out an explicit strategy in relation to Covid-19. We need an overall strategy for the UK, that is agreed with all the Devolved Nations. It must be flexible to allow for regional differences and decision making with a clear framework for how such decisions will be made.

Colleagues in Ireland, north and south, have set out a very clear vision of what must be done. We face the same choice: either live with the virus under a long-term mitigation / containment strategy waiting (possibly forever) for a vaccine or effective antiviral treatment, or suppress and eliminate new infections. They designate the latter approach “Crush the Curve”. Mitigation means accepting an ongoing toll of illness and lives lost, and living under the constant threat of local surges and possible national waves of infection and deaths. It also means public transport running at minimal capacity, insurmountable challenges for schools, businesses and services to run properly, indefinite restrictions on gatherings and socialising, and an NHS which will collapse under the combined weight of Covid-19 cases and the huge backlog of untreated patients with cancer and chronic conditions.

It appears to us that the Westminster government has chosen the path of mitigation, characterised by the analogy to the arcade game ‘Whac-a-mole’ where infection is expected to keep ‘popping up’ and those in charge do their best to guess where to put limited resources. Once more this is a slogan and not a strategy.

Many countries have successfully chosen to suppress the virus and eliminate infections, including South Korea, New Zealand, Australia, Austria, Greece, China and Iceland. Their people are once again using public transport, returning to school, going out to eat and to shop, with healthcare systems caring for all patients, not only those with Covid-19, and economies already recovering. They demonstrate very clearly that eliminating the infection represents the best strategy in terms of both public health and protecting the economy.

This means having a much more ambitious target of suppressing the number of new cases to zero as soon as possible, and keeping it there. This requires continuing public health measures, such as maintaining social distancing, universal use of face masks in enclosed spaces, sensible travel restrictions, and setting up countrywide community based, efficient and rapid ‘find, test, trace, isolate and support’ infrastructure across the country, including at our borders. If done effectively and comprehensively this would successfully suppress the virus in a matter of weeks, and then keep it there.

We should be prepared to learn from other countries so that our people can also enjoy the considerably greater freedoms and prosperity this will bring. Travel, tourism, and trade with such states would be straightforward and beneficial. Our children will be back at school, vulnerable citizens and precious key workers protected.
The sacrifices made so far have reduced the number of new cases and deaths significantly, but a nadir has been reached with current measures, and we may now even be seeing a rise in infections. The national R value is perilously close to one and it is a question of when, not if, flare ups will occur, or even worse a second wave engulf us once again.

We think it is time for the government to develop and communicate a clear strategy and declare which path all of the UK will follow at this critical juncture.

Yours sincerely…

Matt Hancock offered to auction his football shirt for the NHS – we need proper funding, not charity gimmicks

Doctors in Unite would like to remind the Secretary of State for Health and Social Care that the NHS is not a charity but a government funded health service, set up in 1948 with the specific intention to remove health care from the precarious state of reliance on income or beneficence.

Matt Hancock has his hands on the levers of government, he should be using his time and influence to bring investment in the NHS and Social Care up to the levels needed to redress the years of systematic underfunding, fragmentation and privatisation which have contributed hugely to the failures we now see in the government’s ability to cope with the challenges of COVID-19, not trivialising matters by suggesting that all of the problems can be solved with the sale of a football shirt.

Dr Jackie Applebee is the chair of Doctors in Unite

The government can’t hide behind grateful applause: they must now fund the NHS properly

The solidarity expressed through weekly applause for the NHS, carers and key workers has been truly inspiring, and a great source of support for all staff. 

But we need those in power to do more than just clap for us. The NHS and local authorities have been starved of resources for the last ten years. The current crisis has been worsened by a decade of government hostility towards a publicly funded health service. Low staffing levels are a direct result of budget cuts and limits on pay.

We cannot go back to an NHS that lurches from winter crisis to winter crisis. The government should admit that their past approach to health and social care was wrong. There should be a review of pay for NHS and social care workers, which at minimum adds back money denied, compared to inflation, as a result of pay rises that have been capped for years at 1%. Below inflation pay rises are a cut in spending power. The public sector has been ‘awarded’ 1% for ten consecutive years; their wages have shrunk below pay growth in the private sector.

An apology and pay correction would be a starting gesture for people who are now accepted to be courageous, brave and essential to all of us. It turns the admiration shown on our streets every week into a tangible benefit, which would boost the morale of the people now working in dangerous and difficult circumstances.

We, the undersigned, acknowledge the supreme importance of NHS and social care staff. We recognise that they are indispensable.

We call on the government to:

Publicly and formally apologise to NHS and social care staff for past policies that led to a 1% limit on pay rises and cuts to the services in which they work.

Begin a review of wages and salaries for these workers that, at minimum, restores pay lost compared to inflation from 2010 to 2020, and sets above-inflation pay rises for 2021 and thereafter.

Fully fund the NHS and social care.