Nhs

One of the many problems that Andy Burnham has encountered this week is that he has had to spend more time defending his record in the last Labour government than scrutinising the current government's changes to the health service. He has performed the first task in a rather emotional manner, and the Conservatives may well feel that politically this week has been rather successful. But now they're going after him on the policy side of things too, perhaps to underline how preoccupied Burnham is with his own reputation. Jeremy Hunt has this afternoon written a letter to Ed Miliband, seen exclusively by Coffee House, which demands to know whether Labour supports the government's new hospital inspection regime.

According to popular wisdom on the left — and even among some in the Conservative party — this ought to have been a tough week for the government. On Monday, the new £26,000 cap on benefits came into effect and with it a new principle: that no one on welfare should receive more than the average working family. Such a move, it was said, would expose the Conservatives to what is supposed to be their weak point: that they are the ‘nasty party’ who care about money, not people. Yet something remarkable has happened. Iain Duncan Smith’s welfare cap is turning out to be not just the boldest but the most popular reform undertaken by this government.

Alan Johnson and Stephen Dorrell have just conducted an impressively reasoned debate on the NHS on Radio 4. This was all the more impressive given both their parties have boxed themselves into corners on NHS care scandals, from which they will continue to lash out today at the last PMQs of the summer. Whether or not Andy Burnham bears responsibility for the hospital failings detailed yesterday, his circumstances significantly constrained his ability to scrutinise the policies the government announced. Because he is in the extremely uncomfortable position of shadowing the brief he held in government, Burnham spent more time defending his own record than he did anything else.

There is a lot of rage in Westminster today (beyond the everyday anger exhibited by some of its inhabitants that Parliament contains other people who disagree with them) about the 13,000 deaths figure that has been bandied around ahead of the publication of the Keogh review. It's worth noting firstly that Jeremy Hunt did not refer to this 13,000 in his statement to the Commons, but the figure made its way into the newspapers before the report's publication.  He did say that 'no statistics are perfect, but mortality rates suggest that since 2005, thousands more people may have died than would normally be expected at the 14 trusts reviewed by Sir Bruce'.

What to do about the NHS? I’ve just been on a Newsnight which took as its premise that the model is broken and needs to be fixed. "Uncaring. Cruel. Inadequate. Lax," said Kirsty Wark, opening the show. "Why is the NHS now failing so many patients?" The Keogh report is published tomorrow and is expected to be devastating - but not detailed enough: it’ll refer to 13,000 'excess' deaths across 14 hospital trusts but it will not explain why these people died. Or even who they were: those who suspect they lost a relative due to NHS blunder will be none the wiser.

At Prime Minister's Questions today, backbencher Philip Lee ambushed David Cameron on the subject of health tourism. He asked: 'As a doctor who once had to listen incredulously to a patient explain, via a translator, that she only discovered she was nine months’ pregnant on arrival at terminal 3 at Heathrow, I was pleased to hear the statement from the Secretary of State for Health today on health tourism. Does the Prime Minister agree that although the savings are modest, the principle matters? The health service should be national, not international.' The Prime Minister replied: 'My hon. Friend makes a very important point. This is a national health service, not an international health service. British families pay about £5,000 a year in taxes for our NHS.

The Chairman of the Royal College of GPs recently said that ‘general practice has radically altered over the last five years, with ballooning workloads and more and more patient consultations having to be crammed into an ever-expanding working day.’ The blame for this tends to be put on a growing and ageing population or an ever-increasing range of ailments. It might also be put on the last Labour government for changing the way in which GPs work, by rewarding them for preventing, not just treating, illness. Whatever the cause, the solutions are more numerous and often ineffective. NHS Direct is for the most part staffed by poorly trained non-medics who regularly tell people to go to hospital for fear of being sued if the caller dies.

The health service that employs you is under more scrutiny than ever before, with shocking cases of bad care, 'never events' and serious lapses crawling out of the woodwork. The regulator that was supposed to keep an eye on all of this is under attack, not just for missing it, but also for apparently deciding not to publish what details it did know, and then deciding to withhold key names implicated in a 'cover-up'. So what, in its eternal wisdom, does the trade union representing you do? The British Medical Association, which has always managed a veneer of respectability over and above many other public sector unions, today passed a motion of 'no confidence' in Jeremy Hunt as Health Secretary.

That former Care Quality Commission chief executive Cynthia Bower resigned so quickly from her current job after being named as one of the three executives involved in a discussion about covering up the Commission's failings simply underlines what an appalling mess this case has been from start to finish. The names were withheld ostensibly because of data protection, but when they appeared, it was clear that this was about another sort of protection. Perhaps this will be the tipping point against unaccountable NHS managers and inspectors staying safe whatever their failings. Jeremy Hunt certainly seemed to think that it could be, tweeting: 'Pleased to receive CQC letter naming the individuals involved. Clear sign NHS is changing.

Today's hearing of the Public Accounts Committee is going to be real box office stuff. Sir David Nicholson is giving evidence, supposedly on the NHS IT programme, but he'll find himself confronted by Tory committee member Steve Barclay, who, armed with freedom of information evidence of 52 gagging orders in the NHS, will demand that the health service boss step down immediately. This is what Nicholson told the Health Select Committee when he gave evidence on 5 March (full transcript here): Barbara Keeley: What do you think, as chief executive of the NHS, of a loophole like that existing-where £500,000 of taxpayers’ money could be used to gag somebody who wanted to talk about patient safety?

Health Secretary Jeremy Hunt is correct to say that there was a 'dramatic fall in confidence' in alternatives to Accident & Emergency units. He says that this has built up steadily since GP contract changes in 2004. He is right of course, and who can blame him for making the obvious political point that Labour government negotiations have helped fuel this present mess? They may have caused it, but he is in power to help solve it. As a group of NHS Trusts has warned that casualty departments could collapse within six months as a result if 'huge pressure', any long term strategy will frankly not alleviate today's problems. Patients cannot wait for Sir Bruce Keogh's much-anticipated review of A&E care to be published, scrutinised, responded to, discussed and eventually implemented.