Andrew Haldenby and Nick Bosanquet: Building new hospitals is the wrong priority for the NHS

15 Jan

Andrew Haldenby and Professor Nick Bosanquet are co-founders of Aiming for Health Success, a new health research body.

During the run-up to Christmas, some Conservatives began to ask why the NHS had not increased its capacity since the beginning of the pandemic. For example, Anne Marie Morris said, when lockdown regulations were debated in Parliament, that the “capacity issue … has hardly been addressed at all”.

NHS capacity is indeed a key factor, determining the ability to cope not only with Covid-19 but also with normal demand. But it is crucial, especially for Conservatives, to understand why capacity has not increased. It’s not the fault of unaccountable NHS leaders or the “Blob”. On this occasion, the Government has stuck for too long with obsolete policies. A renewed approach could improve the situation quickly, in two distinct ways.

The Party has a clear policy to increase capacity: to build or refurbish 40 acute hospitals. This was a key policy in the 2019 Manifesto and has been promoted by Ministers and the Prime Minister many times since then. The problem is that this method to raise capacity is by far the most expensive and time-consuming way to do it.

Extra NHS capacity is needed now but hospitals take years to build or upgrade. Delays are likely because these are complex projects, subject to national regulatory approval and political intervention. Earlier this year, the Government’s in-house rating agency found that the 40 hospital programme was “unachievable” by the target date of 2030. The total cost of the programme has been estimated at up to £24 billion. Little wonder that worldwide, building large hospitals is seen as a solution from the past.

The good news is that building hospitals is not the sovereign and lone way to more capacity. We would propose two ways to increase capacity with benefits starting in 2022.

The first is to improve access to social care. The real capacity problem is that up to 25 per cent of patients in hospital beds need not be there. That has been known for many years but developing new services to solve this problem has had little priority.

During the pandemics Trusts have paid for out-of-hospital support packages and this could be developed further, starting straight away. Care provided in the home is a massive resource which did not exist 20 years ago. This could provide support both immediately post discharge and over the longer term.

For residential care, access is set to worsen as homes close. An immediate positive change would be to enable local authorities to pay homes at realistic and sustainable rates. Currently, care homes use the much higher fees paid by private residents to subsidise their local authority residents, but this is a pernicious arrangement which weakens all types of access.

The second step is to develop care teams outside hospitals which can deliver care closer to home with results within two years. Integrated Care Systems should have the lead in developing services, measured against their ability to deliver care most efficiently. Care “closer to home” is likely to mean two types of service: joint primary care / secondary care hubs in community sites, and diagnostics, rehabilitation and direct care provided in the home itself.

These hubs could provide the support for high-risk patients who were shielded during the pandemic. Paramedics are already showing how it is possible to treat children and elderly patients at home.

A realistic first target would be to reduce local hospital admissions by ten per cent, releasing resources for treating patients who are on the backlog. Reducing admissions would also free up resources for investing in end-of-life care.

The infographic shows that NHS leaders are ready to respond to this approach. It was published by the Devon Integrated Care System. As the Devon ICS says, “whilst our first priority is always to provide high quality and compassionate care, we have a duty to do this within the available budget. To enable us to continue delivering high quality care within our budget we need to shift our resources from hospital beds to the care surrounding patients in their own homes”.

These hubs could offer big advantages to elderly patients. Hospital admissions can offer specific treatments, and this will remain vital for some, but they often reduce capability for independent living outside the hospital through weakening physical resilience and support networks. Hospital admission is often the first step towards permanent care. The new hubs can involve and help carers through respite care, falls prevention and social support. For elderly patients, minimizing admissions is a key step towards better outcomes and continued quality. It also shields them from deeply worrying financial problems. Such support will become more important as increasing numbers of people over 85 live on their own.

We understand that the hospital refurbishment programme has much political capital invested in it. Still, Conservatives must ask whether a new approach is needed, which delivers much faster results in terms of capacity and which greatly improves outcomes for elderly people within the next two years.

Andrew Haldenby: If the Government truly wants to level up Britain, it must improve national health outcomes

22 Dec

Andrew Haldenby is co-founder of Aiming for Health Success, a new health research body.

What does “levelling up” mean for health and the NHS? The Prime Minister’s main speech on levelling up so far referred to differences in life expectancy between regions but stopped there. The forthcoming levelling up white paper could give health much more attention.

Improved health is key to rising local incomes and living standards. Poor health takes older people out of the workforce, reducing local incomes and buying power. It takes children and young people out of school and reduces achievement. From one generation to the next, it undermines the attractiveness of the community to employers.

New Aiming for Health Success research shows that the Red Wall seats have high levels of need in regard to long-term conditions such as asthma, COPD, coronary heart disease and diabetes. As the table above shows, the combined prevalence is close to 45 per cent of the population.

Prevalence of risk factors for disease is also very high. Obesity affects 14.2 per cent of the population and depression 13.8 per cent. This means that more than half of the population is affected by illness, for themselves or for their neighbours.

The data also show that the level of need is higher in the Red Wall than in other parts of the country. The combined prevalence for long-term conditions is around 37 per cent for England as a whole.

These demands point to new services delivered through expanded primary care teams, led by GPs, rather than the over-stressed hospital system. Some local patients are in a revolving door of repeated hospital admissions and very poor results. A&E attendances are twice as high in Red Wall areas.

New services can include personal and intensive programmes for the occupational health of adults, traditionally underserved by the NHS. As a long-term COPD patient said to the research authors: “We are in a rut.”

New programmes would be for people in all age groups who want to get into work including both younger people and over 45s who want to stay in their jobs. They would collaborate with local fitness centres and leisure centres and where needed could involve counselling as well as advice on diet and activity. They can be helped by GPs through social prescribing as a complement or alternative to traditional medicines.

Too many young people in the next generation are growing up with poor health and poor confidence. The child obesity rate at 10-11 years old is 31 per cent in low-income communities. With poor health goes a high absence rate and low school achievement, all of which affects retention of teachers.

Primary care teams can work with local schools and colleges to design some attractive new programmes with additional funding via integrated care systems. These would fund local sports events and organise internships and visits to local sports teams. They would help with reading and maths skills as well as testing for any sight or dyslexia problems. They would show children that somebody minds how you perform and wants to help you to do better.

Local voluntary groups such as the Scouts and other youth groups could also be encouraged to expand their activities. Helping younger people also has positive effects for older people as they can take pride in their positive energies and achievement.

These programmes recommended above could produce results in less than two years. They would increase the local sense of achievement and show results from local initiative. They would also help with the very serious and usually ignored problem of high crime rates among young people.

Speed of delivery is key. In the last few days, Conservative MPs such as Anne Marie Morris have asked in Commons debates why NHS capacity has not been increased in order to help the service cope with the pandemic and prevent lockdowns. Ministers may point to the programme of refurbishment of 40 hospitals but these are massive projects not due to complete until eight years from now on the very best estimate.

To put it another way, two general elections will likely come and go before the refurbishments come on stream. Primary care improvement can happen much more quickly, as well as being more cost efficient and tailored to the needs of the Red Wall.

The other key step to increase capacity is to redirect funds from the NHS to social care and other providers. Care home standards in Red Wall areas are falling and there is a shortage of home care support. As new national figures showed last week, over ten per cent of hospital beds are occupied by people that are medically fit but cannot be discharged. Eliminating that number would be the equivalent of building 25 new hospitals overnight.

A national programme of hospital refurbishment does not speak to the needs of the Red Wall. Boost the new primary care and social care to make a difference before the next election, Prime Minister.

Red Wall seats included in this research

East Midlands: Bassetlaw, Ashfield, Bolsover

North West: Workington, Leigh, Heywood and Middleton

North East: Sedgefield, Bishop Auckland, Blyth Valley

Yorkshire and the Humber: Great Grimsby, Wakefield, Don Valley

W Midlands: Dudley North

McVey, Walker and Wragg. The most rebellious Conservative MPs in our survey of major votes.

22 Jun

Last week, ConservativeHome published a list of the 49 Conservative MPs who voted against the Coronavirus Regulations. As we said at the time, it was the biggest Covid rebellion since December 2, and a reminder that even if a Government has a huge majority, it can easily be rocked about by unprecedented events (a pandemic).

From 2020 and 2021, we have been keeping track of rebellions. It’s worth adding that rebellions can take various forms – Chris Green resigning as a ministerial aide, for instance – and that there have been many minor ones, so there may be one MP who is technically the most rebellious on less prominent issues. However, for the purpose of one article we’ve focused on major voting events. So who exactly has pushed back the most?

First of all, here is a list of the rebellions we tracked – with a nickname and link to recap on what each was about:

And without further ado, we can reveal that Esther McVey, Charles Walker and William Wragg are joint first in our “most rebellious MP” league table – with nine rebellions to their names. Here’s how they rebelled.

Esther McVey:

  1. Huawei
  2. Coronavirus Act 1
  3. Rule of Six
  4. Curfew
  5. Lockdown
  6. Tiers
  7. Third lockdown
  8. Coronavirus Act 2
  9. Coronavirus regulations

Charles Walker:

  1. Coronavirus Act 1
  2. Rule of Six
  3. Curfew
  4. Lockdown
  5. Tiers
  6. Third lockdown
  7. Genocide Amendment
  8. Coronavirus Act 2
  9. Coronavirus regulations

William Wragg:

  1. Huawei
  2. Coronavirus Act 1
  3. Rule of Six
  4. Curfew
  5. Lockdown
  6. Tiers
  7. Genocide Amendment
  8. Coronavirus Act 2
  9. Coronavirus Regulations

MPs who have rebelled on eight occasions:

Graham Brady:

  1. Huawei
  2. Rule of Six
  3. Curfew
  4. Lockdown
  5. Tiers
  6. Third lockdown
  7. Coronavirus Act 2
  8. Coronavirus regulations

Philip Davies:

  1. Coronavirus Act 1
  2. Rule of Six
  3. Curfew
  4. Lockdown
  5. Tiers
  6. Third lockdown
  7. Coronavirus Act 2
  8. Coronavirus regulations

Richard Drax:

  1. Huawei
  2. Rule of Six
  3. Curfew
  4. Lockdown
  5. Tiers
  6. Third lockdown
  7. Coronavirus Act 2
  8. Coronavirus regulations

Andrew Rosindell:

  1. Huawei
  2. Curfew
  3. Lockdown
  4. Tiers
  5. Third lockdown
  6. Genocide Amendment
  7. Coronavirus Act 2
  8. Coronavirus regulations

Desmond Swayne:

  1. Coronavirus Act 1
  2. Rule of Six
  3. Curfew
  4. Lockdown
  5. Tiers
  6. Third lockdown
  7. Coronavirus Act 2
  8. Coronavirus regulations

MPs who have rebelled on seven occasions:

Philip Hollobone:

  1. Huawei
  2. Coronavirus Act 1
  3. Rule of Six
  4. Tiers
  5. Genocide Amendment
  6. Coronavirus Act 2
  7. Coronavirus Regulations

Tim Loughton:

  1. Huawei
  2. Curfew
  3. Lockdown
  4. Tiers
  5. Genocide Amendment
  6. Coronavirus Act 2
  7. Coronavirus regulations

Anne Marie Morris:

  1. Huawei
  2. Curfew
  3. Lockdown
  4. Tiers
  5. Third lockdown
  6. Coronavirus Act 2
  7. Coronavirus regulations

Henry Smith:

  1. Huawei
  2. Rule of Six
  3. Curfew
  4. Lockdown
  5. Tiers
  6. Coronavirus Act 2
  7. Coronavirus regulations

Robert Syms:

  1. Huawei
  2. Rule of Six
  3. 10pm curfew
  4. Lockdown
  5. Third lockdown
  6. Coronavirus Act 2
  7. Coronavirus regulations

MPs who have rebelled on six occasions:

Peter Bone:

  1. Coronavirus Act 1
  2. Rule of Six
  3. Curfew
  4. Lockdown
  5. Coronavirus Act 2
  6. Coronavirus regulations

Christopher Chope:

  1. Huawei
  2. Curfew
  3. Lockdown
  4. Tiers
  5. Coronavirus Act 1
  6. Coronavirus regulations

David Davis:

  1. Huawei
  2. Curfew
  3. Tiers
  4. Genocide Amendment
  5. Coronavirus Act 2
  6. Coronavirus regulations

Stephen McPartland:

  1. Huawei
  2. Lockdown
  3. Tiers
  4. Third lockdown
  5. Coronavirus Act 2
  6. Coronavirus regulations

John Redwood:

  1. Huawei
  2. Curfew
  3. Lockdown
  4. Tiers
  5. Coronavirus Act 2
  6. Coronavirus regulations

David Warburton:

  1. Huawei
  2. Tiers
  3. Third lockdown
  4. Genocide Amendment
  5. Coronavirus Act 2
  6. Coronavirus regulations
Some more notes:
  • We have stopped with MPs who have rebelled a maximum of six times during this period (out of 10 in total).
  • It’s interesting to note that some “familiar faces” when one thinks of a Tory rebel aren’t included in our league – Mark Harper, for instance, who leads the Covid Recovery Group.
  • Lastly, there are some new faces to our rebellion list: Siobhan Baillie, Karen Bradley and Miriam Cates were some of the MPs to recently vote against Coronavirus regulations.

The twelve Conservative MPs who voted against the third lockdown

6 Jan
  • Brady, Graham
  • Davies, Philip
  • Drax, Richard
  • McCartney, Karl
  • McPartland, Stephen

 

  • McVey, Esther
  • Morris, Anne-Marie
  • Rossindell, Andrew
  • Swayne, Desmond
  • Syms, Robert

 

  • Walker, Charles
  • Warburton, David

The tellers were Christopher Chope and Chris Green.

53 Conservative MPs voted against the tiers plan on December 2, so a fall to twelve is clearly a substantial reduction.

We have set out some of the background here.

The forty-two Conservative MPs who voted against the Government on the 10pm curfew

13 Oct
  • Ahmad Khan, Imran
  • Amess, David
  • Baker, Steve
  • Baldwin, Harriett
  • Blackman, Bob

 

  • Blunt, Crispin
  • Bone, Peter
  • Brady, Graham
  • Chope, Christopher
  • Clifton-Brown, Sir Geoffrey

 

  • Daly, James
  • Davies, Philip
  • Davis, David
  • Davison, Dehenna
  • Doyle-Price, Jackie

 

  • Drax, Richard
  • Fysh, Marcus
  • Ghani, Nusrat
  • Green, Chris (pictured)
  • Hunt, Tom

 

  • Latham, Mrs Pauline
  • Loder, Chris
  • Loughton, Tim
  • Mangnall, Anthony
  • McCartney, Karl

 

  • McVey, Esther
  • Merriman, Huw
  • Morris, Anne Marie
  • Redwood, rh John
  • Rosindell, Andrew

 

  • Sambrook, Gary
  • Seely, Bob
  • Smith, Henry
  • Swayne, rh Sir Desmond
  • Syms, Sir Robert

 

  • Thomas, Derek
  • Tracey, Craig
  • Vickers, Matt
  • Wakeford, Christian
  • Walker, Sir Charles

 

  • Watling, Giles
  • Wragg, William

Plus two tellers – Philip Hollobone and Craig Mackinlay.

– – –

  • Seven Tory MPs voted against the Government on renewing the Coronavirus Act.
  • Twelve voted against the Government over the rule of six.
  • Now we have 42 this evening – enough to imperil the Government’s majority in the event of all opposition parties that attend Westminster voting against it too.
  • Fifty-six signed the Brady amendment, but it was never voted on, and wasn’t a measure related directly to Government policy on the virus.
  • We wrote last week that Conservative backbench protests would gain “volume and velocity”, and so it is proving.
  • There’s a strong though not total overlap between these lockdown sceptics and Eurosceptics.
  • We count eight members from the 2019 intake – and a big tranche from pre-2010 intakes.
  • Chris Green resigned as a PPS to vote against the measure.
  • He’s a Bolton MP and there’s clearly unhappiness there about these latest restrictions.