I trust that the latest episode of “Hancock’s Half Hour” made you laugh a lot.

The transcript of his speech, exactly as it was delivered on 20 July 2018, is available here, in case you missed it.

It was the same script, more or less, but delivered by a different newsreader.

As once said, it was the ‘same meat but different gravy’.

One of the lines delivered is this:

“Paramedics, doctors, nurses, community health staff, managers, IT workers and support staff all working together to provide the best care possible.”

Trish Greenhalgh immediately saw the problem with this.

 

 

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As Brenda once wisely said, “Oh no. Not again.”

Matt Hancock picked his five ‘fundamentals’ he wished to focus on: “NHS values”, “Long term plan”, “Workforce”, “Technology” and “Prevention”.

Intriguingly, there was nothing on the openly fraudulent activity of using the “NHS logo” to badge up private providers in the discussion of “NHS values”.

Integration wasn’t given its own heading, but was mentioned twice.

In relation to “prevention”, Hancock said:

“The integration of the NHS and social care and wider services in local government is vital to getting this right.”

The most parsimonious explanation for the drive towards integrated services, across health and social care, has been, apart from the clinical case to drive up ‘value’ and to focus on ‘clinical outcomes’ meaningful to the patient, has been to harmonise the NHS with other jurisdictions to attract inward investment in the drive towards post-Brexit globalisation.

This of course has a long ideological history. In the U.S., prevention was a critical feature of the development of their health system based on private insurance systems.

As explained in the New York Times,

“At least one of Kaiser’s dreams has foundered. Because H.M.O.’s dish out care for fixed prepayments, they argue that they will practice preventive medicine to keep people healthier. Dr. Garfield, in his desert days, after treating an epidemic of wounds in the feet of workmen caused by nails protruding from boards, used to go out and hammer the nails down himself.

Kaiser had touted the idea of the annual checkup for everyone, until a Kaiser study concluded that it was a waste of time. The plan still offers lifestyle programs, but it admits that it has no idea what good they do.”

There is a long history of England looking to other jurisdictions for inspiration.

Look at Prof Sir Chris Ham’s observation on the U.S. giant Kaiser Permanente:

“We agree with Black that improved bed management is not expensive and with Badrinath that other evidence supports our argument that the NHS can learn from Kaiser.”

Interestingly, likewise, “patient safety” did not have its own heading. It was shoo-horned into “technology”, however.

“Not only can the right use of technology save time and money, it can improve patient safety.”

Patient safety is addressed in an oblique reference to safe staffing, e.g.

“First it means receiving the best training and support – the right number of people with the right skills so you are able to provide the safest, highest quality care to patients.”

But there is no real explicit recognition of the recruitment and retention crisis across the board, especially in general practice. Many reasons have been given for the problems faced in primary care, including over-the-top regulation, but Hancock managed to reduce the discussion to one line.

“GPs need more assistance to tackle with their substantial workloads.”

There was quite a long and interesting mention of “technology”, however.

“Emphatically the way forward is not to curb the technology – it’s to keep improving it and – only if we need to – change the rules so we can harness new technology in a way that works for everyone: patient and practitioner.”

But this idea is particularly intriguing.

“We are working with Amazon so the NHS Choices health information that millions use each day can be tailored for voice activated devices.”

But how far will Hancock want to ‘changing the rules‘?

Is it possible that someone will want to see a voice-activated device to run ‘diagnostic algorithms’ akin to “Babylon”?

Such a public-private partnership could badly skew the market, but the Conservatives’ track record on competition is not real competition at all, but delivering highly rigged markets which returns massive shareholder dividend for a few oligopolistic players.

On Babylon, Hancock gives good product placement.

“The discussion around my use of a Babylon NHS GP, which works brilliantly for me, has been instructive.”

Was there anything on the catastrophic effect Brexit might have on the social care workforce?

No.

Was there anything on the colossal PFI debt?

No.

Was there anything admitting to privatisation?

No.

Was there anything on nurses’ pay?

No.

Was it ‘business as usual’?

Yes. Very much so.

@dr_shibley

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