I don’t often stick work stuff on here… but here are a couple of videos of me and Michelle Henderson (one of my colleagues) talking about World TB Day, which is today!

Tomorrow is #WorldTBDay. Watch @sjhoward and Michelle Henderson talk about unique challenges of TB in the North East and symptoms to look for. pic.twitter.com/dEN8ejN5DA

— PHE North East (@PHE_NorthEast) March 23, 2018

#WorldTBDay the quicker TB is diagnosed the sooner it can be treated – watch the below to find out why early diagnosis is so important ⬇️ pic.twitter.com/SkzZGi2Tdd

— PHE North East (@PHE_NorthEast) March 23, 2018

When people accuse politicians of lying, I generally roll my eyes. Almost a decade ago, I laid into my local MP for sending me an inaccurate letter. Guido Fawkes picked it up and called the poor guy a moronic liar. The episode was a whiny hurling of personal insults that achieved nothing of value. I still slightly regret it.

And these days, too often people choose to quote politicians out of context, wilfully misunderstand their position, or turn slips of the tongue into conspiracy theories. I have no interest in any of that.

And yet. And yet. And yet, I have noticed a lot of inconsistency in Government statements on the Junior Doctors’ Contract dispute. I’m not accusing anyone of lying. I’m not even accusing anyone of being deliberately misleading. I’m just highlighting statements which, as far as I can see, don’t match one another.

Look through the list yourself. Check out the sources. Draw your own conclusions.

There will be no imposition.

Source: Government statement in response to petition, 21 March 2016

There has been no change whatsoever in the Government’s position since my statement to the House in February … We are imposing a new contract, and we are doing it with the greatest of regret.

Source: Jeremy Hunt, speaking in Commons debate, 18 April 2016

Is it really the Government’s position that “no imposition” and “we are imposing a contract” mean the same thing?

No trainee working within contracted hours will have their pay cut.

Source: Jeremy Hunt, speaking in Commons debate, 11 February 2016

No one will see a fall in their income if they are working the legal hours.

Source: Ben Gummer (Parliamentary Under Secretary of State for Health), speaking in Commons debate, 21 March 2016

Is it the Government’s position that “contracted hours” and “legal hours” mean the same thing? Or did Gummer choose to to undersell the Government’s own guarantee on 21 March?

It will actually cost us more. If you’re going to ask more doctors to work at weekends, you’re going to have to pay more.

Source: Jeremy Hunt, on The Andrew Marr Show, 7 February 2016

[We have agreed] the cost neutrality of the contract

Source: Jeremy Hunt, in letter to Professor Dame Sue Bailey, 5 May 2016

Does the government consider “cost neutrality” and “it will actually cost us more” to have the same meaning?

What we do need to change are the excessive overtime rates that are paid at weekends. They give hospitals a disincentive to roster as many doctors as they need at weekends.

Source: Jeremy Hunt, speaking in Commons debate, 13 October 2015

What we’re actually doing is giving more rewards to people who work the nights and the more frequent weekends.

Source: Jeremy Hunt, on The Andrew Marr Show, 7 February 2016

Was the Secretary of State mis-speaking when he said that the contract reduced excessive overtime rates at weekends, or when he said that the new contract increased them?

Certain features of the new contract will adversely impact on those who work part-time, and a greater proportion of women than men work part-time; women, but not men, take maternity leave and some aspects of the new contract have certain adverse impacts regarding maternity; certain features of the new contract will potentially adversely impact on those who have responsibilities as carers.

Source: Government Equity Analysis of new contract, published 31 March 2016

Shorter hours, fewer consecutive nights and fewer consecutive weekends make this a pro-women contract that will help people who are juggling important home and work responsibilities.

Source: Jeremy Hunt, speaking in Commons debate, 18 April 2016

Is it the Government’s position that it got its own Equality Assessment wrong when it concluded that it discriminated against women?

No doctor will ever be rostered consecutive weekends.

Source: Jeremy Hunt, speaking in Commons debate, 18 April 2016

Good practice guidance will be published in the near future to support employers, including guidance on rotas and scheduling, and will make clear that, where possible, routine rostering of consecutive weekends should be avoided.

Source: NHS Employers, 31 March 2016

Does the Government consider that “ever” and “where possible” mean the same thing?

We will make the NHS more convenient for you. We want England to be the first nation in the world to provide a truly 7 day NHS.

Source: Page 38 of the Conservative Party Manifesto, 2015

There is concern that the government may want to see all NHS services operating 7 days. Let me be clear: our plans are not about elective care.

Source: Jeremy Hunt, speaking in Commons debate, 25 April 2016

Were the Conservatives up front about not including elective care in their plan to make the NHS more convenient with a truly 7 day service?

Source: First line of the first page of the Conservative Party Manifesto, 2015

The first line on the first page of this Government’s manifesto said that if elected we would deliver a seven-day NHS.

Source: Jeremy Hunt, speaking in Commons debate, 25 April 2016

Will Hunt correct the Parliamentary record for misquoting his own Party’s manifesto?

It is now not possible to change or delay the introduction of this contract.

Source: Jeremy Hunt, in letter to Dr Johann Malawana, 19 April 2016

We will pause introduction of the new contract for five days from Monday should the Junior Doctors’ Committee agree to return to talks.

Source: Jeremy Hunt, in letter to Professor Dame Sue Bailey, 5 May 2016

Is Hunt claiming to have achieved the impossible? Or was was his earlier statement erroneous?

Images used under by or by-sa licence as appropriate. Sources (in order of appearance): Ted Eytan, Roger Blackwell, University of Salford Press Office, Garry Knight, Ted Eytan (again), Garry Knight (again), NHS Confederation, Roger Blackwell (again). Thank you all!

There are roughly half a million beds in residential or nursing care homes in the UK.¹ Private providers operate almost all of these beds (90%) though the sector isn’t particularly lucrative: the average operator draws a profit of less than £5 per resident per day. Most beds are funded either in full (40%) or in part (10%) by local authorities. The NHS pays for a few (5%).

Central Government funding to local authorities was cut by 25% per person over the period of the last Government, though these cuts were not uniformly distributed across the country. This came on top of smaller reductions in funding over the previous five years. As a result, local authorities had much less to spend on social care. The number of day care places plummetted by 50% over a decade. About 20% fewer people received local authority funded care in their own home. And, partly as a result of this, the number of older people in residential or nursing care homes rose by more than 20%.

Over the next five years, we will see a perfect storm in social care for elderly people. The number of people aged over 75 is predicted to grow from 5.3 million today to 6.1 million in 2020 (a virtually unprecedented rate of increase, almost double what happened over the last five years). Yet Central Government funding to local authorities is to be cut further. Funding is being reduced while demand is predicted to increase more than ever before.

The burden will fall on the NHS, as it is in NHS beds that people often wait for care home places. The absurdity of this is that the average per-night cost of staying in an NHS hospital is three times greater than the average care home cost.

Yet there is another insidious factor imposed by Government which will push this situation from ‘substantial problem’ to ‘perfect storm’.

Most workers in residential and nursing care homes are paid minimum wage. By 2020, this will rise fromt £6.50 to £9.

Few could argue with giving hard-pressed workers a living wage. But given that average care home profits are less than 21p per patient per hour, care homes cannot maintain their current charges while increasing staff wages by £2.50 per hour. Yet they cannot raise their fees because Government cuts mean that local authorities can’t pay.

So what happens when care costs increase and funding decreases? First, care is cut: HC-One, Britain’s third-largest care home provider, is already training carers to take on highly skilled tasks which were previously done by more experienced and expensive nursing staff. But, since the cost of those carers is also increasing rapidly, this is only a stop gap solution. As Southern Cross, previously the UK’s largest care home provider, showed in 2011: care home providers can and will collapse.

As care home companies collapse, the supply of care home beds collapses with them. More elderly people get ‘stuck’ in NHS beds, at much greater cost to the taxpayer, and much greater risk to their own health.

And, to add extra thunderbolts to the storm, the number of NHS beds is decreasing rapidly: by nearly a quarter over the last ten years, with no sign of slowing. In this context, an increase in elderly people needlessly occupying NHS beds due to a lack of social care will cause the NHS to grind to a halt.

The underlying problem here is that the Government fails to understand that protecting NHS funding does not protect NHS services. Health and social care are two arms of the same beast: cutting one leaves the other with more to do. Yet the long-term solution isn’t obvious: there are limits to the burden of tax people are willing to carry to fund health and social care services.

The forecast is for bigger storms ahead.