The row over NHS treatment of the elderly shows up the limits of localism

By Paul Goodman
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Last week, the Daily Mail reported that David Cameron intends to improve the treatment of older people by the NHS by ensuring that the following measures are implemented:

• Nurses will carry out hourly rounds of their patients.
• Every NHS ward will have a "dementia champion".
• There will be a "friends and family test" of the standard of care in NHS institutions.
• Every NHS organisation will have a "dementia nursing expert".
• "Nurses and midwives at the beginning of their career will be given the opportunity to become 'care markers', a new initiative to use volunteer ambassadors in hospitals and homes to improve care."

Today, Jeremy Hunt writes in the Sunday Telegraph that he intends to improve the treatment of older people by the NHS by ensuring that the following measures are implemented:

• A "friends and family test".

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Will Jeremy Hunt and Andy Burnham break (organic, non-fattening, nutritionally-balanced) bread together?

By Peter Hoskin
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I was going to write a LeftWatch post about Andy Burnham’s new crusade against unhealthy foods, but then something intriguing happened that made it more of a ToryDiary post. So, here is that ToryDiary. But let’s start with Mr Burnham anyway.

As reported in the papers this morning, the shadow health secretary is mooting the idea of greater regulation of foods. Specifically, he suggests that the state might clamp down on foods that are high in sugars and fats, and particularly those aimed at children. He’s even proposed a 30 per cent cap on the sugar content in breakfast cereals such as Frosties. As he sees it, the Government’s current “voluntary” arrangements with food companies just aren’t bringing about the desired results.

Cue much ridicule of Mr Burnham across Twitter, not all of it unjustified. The shadow health secretary may have some very proper motivations driving him on, but there’s still something slightly, unavoidably ridiculous about him ruling over the sugar levels in kids’ cereals. “Leave my Sugar Puffs alone,” as the 4-year-old girl on YouTube puts it.

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David Cameron’s new, tougher love for the NHS

By Peter Hoskin
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Back in the days before the Coalition, there was always a sense that David Cameron’s love for the NHS was unconditional. Sure, he’d criticise the health service from time to time, but the basic thrust of his policy was exemplified by that election slogan, “I’ll cut the deficit, not the NHS”. His emphasis was largely on protecting the providers, not the patients.

But now, it seems, that relationship is changing. The Tory leader will today announce a new package of measures, all of which carry an implicit message for the NHS: “Buck up, now.” The Daily Mail contains a particularly full account of the package, but some of the standout measures include an obligation on nurses to carry out hourly rounds of their patients, and a plan to ask patients a single question — “Would you recommend the service to friends and family?” — about the care they receive at all levels, from GPs surgeries to district hospitals. It’s not yet certain whether the answers from these inquiries will be published online, but they could be.

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Eight pieces of New Year advice for David Cameron

By Tim Montgomerie
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In my Times column (£) I offer eight pieces of New Year advice to David Cameron:

1. Offer an In/Out referendum in your January speech on the EU. Nothing else will quite restore goodwill amongst traditional supporters in the country and press. In today's Sun, Trevor Kavanagh agrees.
2. Communicate regret rather than relish about having to squeeze benefits. The squeeze is necessary for deficit reduction and to incentivise the leap from benefits to work but no Conservative should give any impression that below inflation increases will be easy for already hard-pressed families.
3. Throw everything at the IT challenge that endangers the Universal Credit. Whitehall isn't good at IT and the Coalition's reputation for competence is at stake if this flagship reform fails.
4. Don't retreat on gay marriage but do reassure Christian and other traditionalists that you're are on their side. Recognise marriage in the tax system. Promote faith schools. Fight against religious persecution overseas. I presented other ideas on Christmas Eve.
5. Give more one-to-one interviews and fewer speeches because you are at your most persuasive in these fora.
6. Respond to the Lib Dem disloyalty. Don't personally sink to Clegg's level but authorise Grant Shapps to counter punch at the constant Lib Dem attacks on the Conservative Party.
7. Lovebomb your party for the next two-and-a-half years. Appoint someone like David Burrowes MP as a second PPS to help you reconnect with the parliamentary party.

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We ought to be much, much more angry about hospital treatment of the very elderly

By Paul Goodman
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Perhaps the most noticable difference between photographs of modern nurses and their predecessors is the disappearance or downsizing of nursing caps.  My sense is the change gathered pace at roughly the same time that nursing became a graduate profession.  The cap's origins seem to have been connected to the religious origins of hospitals.  It didn't follow that nurses had to be Christians, or that hospitals run by churches.  But the cap was a nod to the ineradicable fact that medical care in the west was shaped and sustained by a Christian ethos.

The range of care available in today's NHS would have strained the imagination of former generations of nurses.  There can be no turning-back to the age when most nurses weren't graduates.  And doubtless there was no golden age of nursing.  But would staff in any hospital, 25 years or so ago, have left a female patient unwashed for eleven weeks?  Would a male one have starved to death after being treated in a hospital for two months?  Would another man who could not feed himself have been taunted by nurses who took away his food uneaten?

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PMQs: Cameron attacks Labour's NHS record in pre-Autumn Statement warm-up

By Matthew Barrett
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Today's PMQs was lively, but was simply the warm-up act for the Autumn Statement that followed it. I will attempt not to detain you for long.

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As Jeremy Hunt waits on a bench, The Birds fly in. First one...then four...then seven...then -

By Paul Goodman
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I married my wife
In the month of June,
Risseldy, rosseldy,
Mow, mow, mow

Readers will remember the scene in Hitchcock's "The Birds" in which Melanie Daniels, played by Tippi Henren, sits on a bench outside a school as birds gather behind her and children sing -

I carried her off
In a silver spoon,
Risseldy, Rosseldy,
Hey bambassity,
Nickety, nackety,
Retrical quality,
Willowby, wallowby,
Mow, mow, mow.

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Jeremy Hunt aims to be angrier than any voter at NHS failures

By Tim Montgomerie
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I suspect there would be little argument with the proposition that George Osborne is the most important member of David Cameron's ministerial team but who has the second most important job? You could argue it was IDS. He's making landmark reforms to welfare and is responsible for delivering the biggest cuts of the deficit reduction programme. There is an argument for Michael Gove because of the scale and reach of his education reforms. Or what about Theresa May? She is responsible for flagship immigration, police commissioner and security policies. My argument, however, would be that Jeremy Hunt can probably claim to have the second most important and difficult job in the current government.

The first reason is that he leads the NHS at a time when it faces the most difficult financial settlement in its history. Throughout nearly all of its life it has received inflation-busting increases in its budget. Those increases have helped it to keep pace with the cost of caring for Britain's ageing population, the growth of lifestyle-related diseases and the higher-than-average rising costs of new drugs and other medical technologies. During this period of austerity the NHS is going to have to cope with inflation-only increases in its resource allocation. Not for one or two years but for perhaps five or six. It will only cope if it makes unprecedented economies including the amalgamation of certain facilities and greater specialisation. A report in today's FT (£) underlines the scale of the task. Reporter Chris Cook notes that the Nuffield Trust believes that "Britain’s ageing population, salary pressures and drug price rises could cost the NHS a further £34bn by the start of the next decade".

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Cut EU spending. Cut aid. Charge for missed appointments. Cap family benefits. Tory members vote for their preferred deficit reduction measures...

By Tim Montgomerie
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In the latest monthly survey of members we asked respondents to describe certain revenue-raising measures as acceptable or unacceptable. I've already reported the verdict on higher council tax bands and a mansion tax but here is the full set of results:

Deficit reduction measure: % saying acceptable / % saying unacceptable

• A cut in Britain's contribution to the EU: 95% / 4%
• A reduction in the aid budget: 86% / 13%
• A charge for every patient who misses an appointment with their GP: 76% / 19%
• No child benefits for families with more than two children: 75% / 19%
• Cuts to the benefits that go to wealthier pensioners: 74% / 22%
• Higher council tax bands on high value properties: 57% / 40%
• Charges for museums and galleries: 49% / 33%
• A reduction in the NHS budget: 36% / 58%
• A reduction in the defence budget: 25% / 72%
• A 1p increase in the basic rate of income tax: 23% / 75%
• An annual mansion tax on big homes: 22% / 73%

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Old or young, a similar set of political problems

By Peter Hoskin
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The past week has been neatly bookended by two policy stories. One is about the very young: last Sunday’s Observer reported on the Commission on Living Standards’ finding that it now barely makes sense for some “second earners” to work full-time, thanks to the rising cost of childcare. And the other is about the old: today’s Telegraph covers a government report which suggests that, thanks largely to an ageing population, the state will find it increasingly difficult to fund social care — with the result that more pensioners will have to stump up for it themselves.

The reason I mention both of these policy stories now is because they’re similar in a several respects. To list them briefly:

i) They’re both about affordability. In terms of the government’s fiscal measures, pensioners have got off relatively lightly from this period of austerity — but the combination of quantitative easing, low interest rates and persistent inflation will have had a shuddering effect on retirement incomes nevertheless, and now there’s the prospect of savings being excavated even further to cover the cost of care. As for the parents of young children, we already know about the controversies surrounding child benefit and all that.

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