Under pressure: the Queen Elizabeth Hospital in Birmingham has seen a surge in patients at A&E. Photo: Getty
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Jacqui Smith: “The NHS model isn’t broken but it needs urgent attention and support”

The former home secretary on trouble in A&E – plus the triumph of all-women shortlists and the joys of summer caravanning.

You may remember the Queen Elizabeth Hospital in Birmingham as the splendid venue for the launch of Labour’s 2010 election campaign. It was also the place where Tony Blair was challenged by Sharron Storer over her partner’s cancer treatment in 2001 – but don’t let either of those events colour your judgement. I’m very proud to chair the NHS trust that runs it. However, like the rest of the health service, we’re facing unprecedented pressures.

A decade ago, the old emergency department at Selly Oak was seeing 60,000 people each year. The A&E at the Queen Elizabeth Hospital was built to accommodate 81,000. Last year, we saw 95,000 and the figure is rising. Our chief executive, Dame Julie Moore, describes A&E as the “canary in the mine” for the health service. This canary will soon need to be nailed to its perch.

We have found that when it’s harder to see a GP, people visit casualty, where the lights never go off; as social care is cut and social care workers are forced to make shorter visits, more people turn up at the door of a hospital. Mental health faces the biggest cuts in the NHS and we find that those in crisis come to our A&E or go into a police cell. When many are struggling to make ends meet, it’s not surprising that there are more people with malnutrition, scurvy and rickets needing our care.

Recent Commonwealth Fund research identified the NHS as the best system among 11 major developed countries for quality of care, access and efficiency. The NHS model isn’t broken but it needs urgent attention and support.

 

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Spending a lot of time on trains, I enjoy the eccentric pastimes of my fellow travellers. One woman got on to the early-morning train to London, pulled out a hairdryer, plugged it in and dried her hair. Last week, I sat next to someone rolling a cigarette and reflected on the transformation made by the smoking ban. Feel free to roll but thank goodness you can’t smoke it next to me.

The same Commonwealth Fund research that found the NHS to be the most effective health service also reported that we are one of the least healthy societies (the UK came tenth out of the 11 countries). We should learn from the success of the smoking ban. Governments of all persuasions have expected NHS providers to take tough decisions but avoided them themselves. At the Queen Elizabeth Hospital, we transplant livers for alcoholics but the government avoids minimum pricing for alcohol. More than one in ten of our patients have diabetes but action on healthier food is left to the willingness of food manufacturers and retailers to put different colours on their labels.

 

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As the dust settles on the reshuffle, it’s clear that there should be no let-up in the work to gain more equal gender representation in parliament and government. The appointment of two new women cabinet ministers, though welcome, still takes the total in the cabinet to only less than a quarter. In the Labour Women’s Network, we continue to train women to stand for parliament, but self-congratulation from any party on female representation is premature while we languish at 58th in the international league table – with Rwanda, Kazakhstan and Tunisia among those doing better than us. One answer is clear. Why do women MPs make up a third of Labour, while the Tories have less than 16 per cent and the Lib Dems only one in eight? It’s because Labour uses all-women shortlists. In recent weeks, both Nick Clegg and Ken Clarke have supported their use for their own parties. Why not just get on with it?

 

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Don’t hold your breath for the publication of this government’s review of the impact of immigration from the EU. A version recently leaked to the BBC gives a nuanced but largely positive view about immigration’s effect on jobs, pay and community cohesion. A previous version was ready for publication last December but the Home Office stopped publication because it considered it too positive. A much more sceptical, rewritten version was called propagandist by the Lib Dems. It’s clear now that this is a political stitch-up. Wouldn’t it have been better to ask an independent group comprising local government, industry, union and community representatives to consider the evidence? That’s what we set up when I was in the Home Office – the Migration Impacts Forum. This government has got rid of it. Apparently one of the effects of Ukip is the victory of anecdote over evidence.

 

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This summer, I will holiday in my caravan in north-west Wales. With little mobile-phone signal, this was a sanctuary in my ministerial years – though I did manage to speak to two prime ministers standing on a rock at the top of the site where you can just about get a connection. I was not the only caravanning minister: Margaret Beckett loved hers, too. Appropriately, as foreign secretary, she had a touring caravan that she took round Europe, while as home secretary I had a static caravan and stayed at home.

Wherever you are holidaying this year, I hope you have a happy and relaxing time. 

This article first appeared in the 23 July 2014 issue of the New Statesman, Summer Double 2014

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How Theresa May laid a trap for herself on the immigration target

When Home Secretary, she insisted on keeping foreign students in the figures – causing a headache for herself today.

When Home Secretary, Theresa May insisted that foreign students should continue to be counted in the overall immigration figures. Some cabinet colleagues, including then Business Secretary Vince Cable and Chancellor George Osborne wanted to reverse this. It was economically illiterate. Current ministers, like the Foreign Secretary Boris Johnson, Chancellor Philip Hammond and Home Secretary Amber Rudd, also want foreign students exempted from the total.

David Cameron’s government aimed to cut immigration figures – including overseas students in that aim meant trying to limit one of the UK’s crucial financial resources. They are worth £25bn to the UK economy, and their fees make up 14 per cent of total university income. And the impact is not just financial – welcoming foreign students is diplomatically and culturally key to Britain’s reputation and its relationship with the rest of the world too. Even more important now Brexit is on its way.

But they stayed in the figures – a situation that, along with counterproductive visa restrictions also introduced by May’s old department, put a lot of foreign students off studying here. For example, there has been a 44 per cent decrease in the number of Indian students coming to Britain to study in the last five years.

Now May’s stubbornness on the migration figures appears to have caught up with her. The Times has revealed that the Prime Minister is ready to “soften her longstanding opposition to taking foreign students out of immigration totals”. It reports that she will offer to change the way the numbers are calculated.

Why the u-turn? No 10 says the concession is to ensure the Higher and Research Bill, key university legislation, can pass due to a Lords amendment urging the government not to count students as “long-term migrants” for “public policy purposes”.

But it will also be a factor in May’s manifesto pledge (and continuation of Cameron’s promise) to cut immigration to the “tens of thousands”. Until today, ministers had been unclear about whether this would be in the manifesto.

Now her u-turn on student figures is being seized upon by opposition parties as “massaging” the migration figures to meet her target. An accusation for which May only has herself, and her steadfast politicising of immigration, to blame.

Anoosh Chakelian is senior writer at the New Statesman.

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