The NHS could become the coalition's biggest headache again

Patient care is set to worsen next year, warn NHS finance directors.

The NHS didn't receive a mention in Nick Clegg's speech yesterday, but the state of the service is likely to become one of the government's biggest headaches in 2013. The latest King's Fund survey found that 40% NHS finance directors expect patient care to "worsen over the next few years" and that two-thirds believe there is a "high" or "very high" risk that the service will not achieve efficiency savings of £20bn by 2015.

Although spending is ring-fenced, healthcare inflation is significantly higher than the general rate, so the NHS will be continually forced to do more with less, particularly if, as expected, George Osborne carves out £1.7bn from its budget in order to pay for social care reform.

The political problem for the government is that while it could have blamed the service's problems on the fiscal situation, its inept reforms (for which it had no mandate) mean that it will now take the flak. Patient satisfaction fell from 70% to 58% last year, the largest annual drop since 1983 , a trend that is likely to continue this year. The number of patients who are waiting for more than four hours in A&E, for instance, is at its highest level since 2005. And David Cameron's decision to appoint Jeremy Hunt as Health Secretary provides the media with every incentive it needs to highlight the NHS's failings.

Health Secretary Jeremy Hunt will struggle to prevent a further fall in patient satisfaction. Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

Photo: Getty
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A Fox among the chickens: why chlorinated poultry is about more than what's on your plate

The trade minister thinks we're obsessed with chicken, but it's emblematic of bigger Brexit challenges.

What do EU nationals and chlorinated chickens have in common? Both have involuntarily been co-opted as bargaining chips in Britain’s exit from the European Union. And while their chances of being welcomed across our borders rely on vastly different factors, both are currently being dangled over the heads of those charged with negotiating a Brexit deal.

So how is it that hundreds of thousands of pimpled, plucked carcasses are the more attractive option? More so than a Polish national looking to work hard, pay their taxes and enjoy a life in Britain while contributing to the domestic economy?

Put simply, let the chickens cross the Atlantic, and get a better trade deal with the US – a country currently "led" by a protectionist president who has pledged huge tariffs on numerous imports including steel and cars, both of which are key exports from Britain to the States. However, alongside chickens the US could include the tempting carrot of passporting rights, so at least bankers will be safe. Thank. Goodness. 

British farmers won’t be, however, and that is one of the greatest risks from a flood of "Frankenfoods" washing across the Atlantic. 

For many individuals, the idea of chlorinated chicken is hard to stomach. Why is it done? To help prevent the spread of bacteria such as salmonella and campylobacter. Does it work? From 2006-2013 the Centers for Disease Control and Prevention reported an average of 15.2 cases of salmonella per 100,000 people in the US (0.015 per cent) – earlier figures showed 0.006 per cent of cases resulted in hospitalisation. In 2013, the EU reported the level at 20.4 cases per 100,000, but figures from the Food Standards Agency showed only 0.003 per cent of UK cases resulted in hospitalisation, half of the US proportion.

Opponents of the practice also argue that washing chickens in chlorine is a safety net for lower hygiene standards and poorer animal welfare earlier along the line, a catch-all cover-up to ensure cheaper production costs. This is strongly denied by governing bodies and farmers alike (and International Trade Secretary Liam Fox, who reignited the debate) but all in all, it paints an unpalatable picture for those unaccustomed to America’s "big ag" ways.

But for the British farmer, imports of chicken roughly one fifth cheaper than domestic products (coupled with potential tariffs on exports to the EU) will put further pressure on an industry already working to tight margins, in which many participants make more money from soon-to-be-extinct EU subsidies than from agricultural income.

So how can British farmers compete? While technically soon free of EU "red tape" when it comes to welfare, environmental and hygiene regulations, if British farmers want to continue exporting to the EU, they will likely have to continue to comply with its stringent codes of practice. Up to 90 per cent of British beef and lamb exports reportedly go to the EU, while the figure is 70 per cent for pork. 

British Poultry Council chief executive Richard Griffiths says that the UK poultry meat industry "stands committed to feeding the nation with nutritious food and any compromise on standards will not be tolerated", adding that it is a "matter of our reputation on the global stage.”

Brexiteer and former environment minister Andrea Leadsom has previously promised she would not lower animal welfare standards to secure new trade deals, but the present situation isn’t yet about moving forward, simply protecting what we already have.

One glimmer of hope may be the frozen food industry that, if exporting to the EU, would be unable to use imported US chicken in its products. This would ensure at least one market for British poultry farmers that wouldn't be at the mercy of depressed prices, resulting from a rushed trade deal cobbled together as an example of how well Britain can thrive outside the EU. 

An indication of quite how far outside the bloc some Brexiteers are aiming comes from Foreign Secretary Boris Johnson's current "charm" offensive in Australasia. While simultaneously managing to offend Glaswegians, BoJo reaffirmed trading links with the region. Exports to New Zealand are currently worth approximately £1.25bn, with motor vehicles topping the list. Making the return trip, lamb and wine are the biggest imports, so it’s unlikely a robust trade deal in the South Pacific is going to radically improve British farmers’ lives. The same is true of their neighbours – Australia’s imports from Britain are topped by machinery and transport equipment (59 per cent of the total) and manufactured goods (26 per cent). 

Clearly keeping those trade corridors open is important, but it is hard to believe Brexit will provide a much-needed boon for British agriculture through the creation of thus far blocked export channels. Australia and New Zealand don’t need our beef, dairy or poultry. We need theirs.

Long haul exports and imports themselves also pose a bigger, longer term threat to food security through their impact on the environment. While beef and dairy farming is a large contributor to greenhouse gases, good stock management can also help remove atmospheric carbon dioxide. Jet engines cannot, and Britain’s skies are already close to maximum occupancy, with careful planning required to ensure appropriate growth.

Read more: Stephen Bush on why the chlorine chicken row is only the beginning

The global food production genie is out of the bottle, it won’t go back in – nor should it. Global food security relies on diversity, and countries working and trading together. But this needs to be balanced with sustainability – both in terms of supply and the environment. We will never return to the days of all local produce and allotments, but there is a happy medium between freeganism and shipping food produce halfway around the world to prove a point to Michel Barnier. 

If shoppers want a dragon fruit, it will have to be flown in. If they want a chicken, it can be produced down the road. If they want a chlorinated chicken – well, who does?