2016 is widely seen as being a terrible year, but how was it for health and wellbeing policy?
I’ve been doing a weekly update of news items since 2012 but this is the first full year that it’s been on a database with a score of significance for each item. Which means that, at the touch of a button, I can read off the top 10 news items.
Except it’s not quite so straightforward. For a start, some stories encompass multiple news items, like the junior doctors’ strike. But perhaps more importantly, my scoring is, almost inevitably, flawed – subjective and inconsistent. So what I did was, look at the list arranged in order but then used a bit of common sense – and hindsight – to produce this top 10 of the biggest issues.
1. Top of the list, the vote to leave the EU. From my assessment at the time, this scored as the most significant item of the year. Perhaps that was partly the shock factor. While undoubtedly significant, it’s still not clear exactly what the impact will be on health and wellbeing. The other political earthquake, the election of Donald Trump, I didn’t record as a health and wellbeing item. Let’s hope that’s right, and it doesn’t affect our health, whether through weather extremes from climate change, or more chillingly, radiation sickness.
2. Although it might not have made the top 10 based on the scores of individual news items, with hindsight, the parlous financial state of health and social care, and the resulting impact on performance, has to be one of the most significant issues of the year. It’s hard to identify a tipping point for services in crisis, but when regulators like the CQC as well as advocates such as ADASS describe the state of social care thus, and Simon Stevens says give any money to them rather than health, it’s surely time to take notice (rather than ignore it, as Philip Hammond did in his autumn statement). (As for the general mess that is local government funding, with the gradual ending of government grant and return of the business rates, that’s perhaps an issue for another time). Unfortunately, the manifestation of a tipping point is likely to come in the form of a horror story affecting individuals (as per Baby P., Mid Staffs or Winterbourne View). Let’s hope that can be avoided in 2017.
3. Although down at 5 or 6 based on the scores I gave to individual items, I think in hindsight I’d rate the impact of the Government’s austerity policies more significantly. Despite Theresa May’s promise on becoming prime minister of an ‘all-out assault on poverty’, there are clearly serious problems. While there were statistics, cases of individual hardship and stories about food banks, perhaps the thing that drove it home for me were various reports by United Nations bodies. On 9th June, a UN committee said that the Government’s austerity and welfare policies are disproportionately affecting poorer children and undermining children’s rights (the UK is a signatory to the UN Convention on the Rights of the Child). On 7th November, a UN enquiry found that the Government's austerity policies amount to "systematic violations" of the rights of people with disabilities. And another UN committee said, on 28th June, that the UK was in breach of its international human rights obligations, with austerity measures having a disproportionate effect on the most disadvantaged citizens, including women, children, people with disabilities and low-income families. When such an external, international body tells you something’s wrong, perhaps it’s time to take notice.
4. The second most significant issue in terms of how I scored it at the time was the junior doctors’ dispute but at the current remove it is unclear (to me, anyway) what implications there will be either in terms of industrial relations or how the contract will impact on junior doctors. Tied in with it is the issue of the seven day NHS and whether it would actually cut death rates, where the evidence is still unclear. What seems clearer is that the Government has not budgeted for its implementation, seemingly expecting it to happen within existing, increasingly stretched budgets.
5. One of the biggest threats to our health and wellbeing in the coming years surely comes from climate change. On 12th July the government’s advisory Committee on Climate Change said the UK is poorly prepared for the impacts of global warming in the coming decades. On 25th November climate scientists said that rapidly melting arctic ice could trigger uncontrollable climate change globally. And on 9th November we heard that Donald Trump had been elected president of the United States. He later appointed a climate change sceptic as head of the Environmental Protection Agency.
6. There was better news for another potentially existential threat, antimicrobial resistance. Lord Jim O’Neill published his final report on 19th May, use of antibiotics decreased across all health settings (although antibiotics resistance increased across the EU) (18th November) and a declaration on antimicrobial resistance was signed by 193 countries at the UN (20th September).
7. The STP process could blow up in NHS England’s face, with public resistance to the ‘secret plans’, or it could just be a damp squib. Possibly, it could even have some worthwhile results. I’ve already said what I think elsewhere, so I won’t elaborate, but in brief, I think the problem is they’re top down, new geographies, limited public and patient involvement and potentially undermining existing mechanisms such as Health and Wellbeing Boards.
8. Also bubbling under the surface, in many cases driven by STPs, is reconfiguration. Expect to hear more about PACS, MCPs and Accountable Care Organisations in the coming year. I have to admit I’ve struggled to remember those abbreviations or understand the differences, but I think it’s that Primary and Acute Care Services combine primary and secondary care, Multispeciality Community Providers combine primary and secondary care and Accountable Care Organisations combine primary and secondary care. But I may have got that the wrong way round. I think this is one thing where change will actually happen (unlike prevention, despite being everyone’s top priority). After all, we all like a good re-organisation, don’t we?
9. Although I scored them quite highly at the time, in retrospect I’m not sure how important the various political stories were, such as the budget, Queen’s speech and Jeremy Hunt remaining as health secretary. The Budget promised the soft drinks levy (aka sugar tax) to which the much delayed childhood obesity strategy added little. The Children and Social Work Bill tried to give government more control over the profession, though there has been some rowing back on exempting local authorities from existing legislation. And Jeremy Hunt has defied expectations to be the longest serving health secretary (£) since the post was set up 28 years ago.
10. But to end on a positive note, Britons are healthier, better off, less likely to be victims of crime and living greener lives since the recession, according to a wellbeing assessment by ONS (23rd March). There were improvements in 17 of the reported measures, a deterioration in 8 and no change in 11. Most of the improvements were in objective measures such as personal finances and the employment rate, while deterioration was more often in subjective measures such as satisfaction with health. So the message surely is, we need to look on the bright side. Let’s have another drink.
A Happy New Year to you All!