A detailed report from NHS Providers, which represents NHS and foundation trusts, has underlined the seriousness of the financial bind that has been created for managers in front-line services by six years of virtually frozen funding.
Since 2010 the population has increased rapidly. Falling real-terms pay and tougher working conditions have created predictable staff shortages and forced trusts to use costly agency staff to fill vacancies.
And costs have risen as well as demand for emergency and elective care. But real-terms funding has barely increased at all.
Now NHS Providers reports that in the first quarter of 2016-17:
The number of people waiting for elective treatment has reached a new record of 3.45 million.
A&E attendances rose to a record 5.34 million, with A&E admissions up 6.4 per cent on the same quarter last year
112,000 patients waited longer than four hours on a trolley for a bed — up over 60 per cent from last year
Calls to ambulance services increased by up to 15 per cent — but ambulance trusts could not meet performance targets for the most serious cases
Trust deficits for the first quarter of 2016 were reduced to £461 million — half last year’s record level at this stage — but only after millions were pumped into the most successful trusts from the £1.8 billion Sustainability and Transformation Fund, which was supposed to pay for investment in longer-term transformation of services.
Once that money is exhausted the NHS faces the grim reality of even meaner funding in 2017 and 2018, and real-terms cuts until at least 2020.
But NHS Providers warns that the apparent improvement this year is also misleading since almost half of trust finance directors say they will not be able to keep up the level of savings they achieved in the quarter to meet tough targets and access a share of the £1.8bn: things can only get worse — to reach the worst-ever situation.
“We anticipate that the level of financial challenge will surpass any that individual providers, and the sector as a whole, has encountered in previous years.”
This results from a political choice, taken initially by George Osborne, and currently enforced by Philip Hammond as Chancellor, to scale down public spending in general and reverse Labour’s decade of above-inflation increases in NHS spending from 2000 that increased health spending towards the EU average.
Six years of avoidable, imposed austerity — along with billions wasted on bureaucracy of a complex and costly competitive market system as a result of Andrew Lansley’s 2012 “reforms” — has left the NHS on its knees.
Massive cuts in funding for local government — which through social services is responsible for commissioning social care, from a motley network of underfunded private providers, have also made things massively worse for the NHS.
The key think tanks have been sounding alarms on this, while the right-wing fundamentalists of course want charges for care, health insurance and other horrors of a US-style system.
Now even prominent Tory MP doctors Dan Poulter and Sarah Wollaston are urging Theresa May to consider new devices to raise additional tax revenue to avert a collapse of the NHS, although any specific “health tax,” especially if raised from National Insurance, would begin to undermine the core principle that the NHS is funded in the fairest way through general taxation.
NHS Providers chief executive Chris Hopson has summed up the situation in stark terms. Even current levels of performance in A&E are now at risk: “There is now a clear and widening gap between what the NHS is required to deliver and the funding available. There is now a fundamental mismatch between what is being asked of our emergency services and the resources they have at their disposal.”
The same could be said of mental health services, primary care and community health services. For the NHS to stay within its inadequate budget, something has to give, and NHS England has recognised that to drive this process at local level a further reorganisation has been needed, establishing 44 new local area “footprints,” each of which is required to draw up a five-year Sustainability and Transformation Plan (STP).
Nigel Edwards at the Nuffield Trust, and now, following a report commissioned by 38 Degrees, the Guardian and other news media have finally highlighted the importance of this process, which Health Campaigns Together (HCT) has been flagging this up for the last six months. But there is still a lot more to come out as the process has been obsessively secretive.
Even the stolid management voice of the Health Service Journal is now urging NHS England to raise the shutters and publish draft STP plans that have been produced behind locked doors, with many of them not even shared with the boards of trusts and clinical commissioning groups or council cabinets.
So far — with speculation rife — only two of the detailed drafts have been published (North West London and Shropshire), while other leaks are either confidential copies, or relatively bland early drafts.
Indeed, even the 54-page north-west London STP draft, filled with extensive argument, skirts round one of the key proposals to balance the books — cutting beds and services at Ealing and then Charing Cross hospitals, bulldozing the buildings, flogging off part of each site, and replacing each hospital (if funding allows) with a glorified clinic with a few intermediate beds meaning a total loss over 590 beds.
The rapid closure of Ealing is reduced to a footnote and an added comment emphasising for the first time that this is a way to save money, not as claimed previously a way of improving services.
Shropshire’s STP also looks at axing an A&E (to “save” £22m, but at a cost of £300m) and cuts in orthopaedics — we also know that mental health services are being cut to save money.
Despite many of them seeking savings through reconfiguration, all of the STP drafts that have emerged are remarkably coy about the lack of any capital for investment in alternative services for the hospitals that are to be closed or downgraded; the Health Service Journal recently pointed out this embarrassing weakness undermining the credibility of service “reconfiguration.”
Nigel Edwards’s blog also underlines the point HCT has been making that many of the assumptions, assertions and cherished ideas underlying STPs are “best described as plausible hypotheses,” lacking evidence that they can deliver in practice.
“For example many STP leads we spoke to thought that hospital reconfiguration did not save very much and could actually increase costs, while others have put down significant savings.
“Similarly the assumption that integrated care, ACOs [accountable care organisations] and demand management can deliver savings is simply not supported by the evidence; and more caution is needed about bother scale and timing than some plans allow for.”
Many plans also seek to change models of primary care (GP services) despite the lack of evidence that the new models work.
There are plenty of nasty surprises for local people to be revealed as and when NHS England finally relaxes its rigid rule of secrecy. But in many areas it’s already clear that to cover claimed “gaps” between funding and health needs by 2020, STPs are pushing through plans for reconfiguration of hospital services — “centralising” A&Es, reducing local access, putting lives at risk.
Local NHS bosses have been bullied into signing up for cuts, realising they would be sacked if they refused. Local councils have been bullied and bribed into compliance by the promise of additional funding for social care — with hefty strings attached.
Too few council leaders have been prepared to speak out and stand up for their local communities. Ealing and Hammersmith have been bold exceptions to a miserable rule.
Every part of the country faces a major test this autumn and winter as a result of the ruthless spending squeeze. And with hard information a rare and precious commodity, it’s important for campaigners to collaborate together to build up a clear picture of the state of the NHS, the direction of Tory plans and the best way to fight back.
It’s now less than three weeks to the HCT conference in Birmingham on September 17. We called for this in the summer, before many people realised just how big the challenge was going to be.
Now the facts are beginning to emerge, health campaigners wanting to understand what’s involved, compare their problems and share lessons with others, and reach out to trade unions to build more powerful movements in defence of our NHS are urged to join us in Birmingham.
More details and registration at www.healthcampaignstogether.com.
By: John Lister
Watch Sell Off the film that tells the truth of the privatisation of the NHS, in graphic detail. Will easily offend lifetime supporters of the people’s health service, free at the point of use. Must be watched by children as soon as they can understand!
Additional Reporting: Mun Reporter with added applicable photographs and Film “SELL OF” Full Documentary of which Manchester User’s Network helped to Crowd Fund. Watch as a family this Easter remembers the NHS is the best Health System in the world. Do your own research upon this!