NHS: back on the precipice

save our nhs

The NHS in England is again on the brink of a winter crisis. The extra money promised in November’s Autumn Budget has been calibrated to obtain electoral benefit for the Tories while keeping a chokehold on NHS spending. Key programmes to prevent the sort of disaster that threatened the health service last winter have failed. Bed occupancy rates are nowhere near safe levels. Reductions in delayed transfers of care – where a patient is medically fit for discharge but neither home care or social care are in place – are nowhere near target. Emergency admissions continue to rise. Hardly any A&E departments are meeting the 95% mark for treating patients within four hours of arrival; many are falling below 90%. Ambulance response times are deteriorating. Financial savings are nowhere near what is demanded despite a 1.7% improvement in productivity. 80% of Clinical Commissioning Groups (CCGs) are considering rationing operations. Behind this lies the determination of government to reduce real-term funding of the NHS as part of its overall attack on the working class. Robert Clough reports.

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NHS: another winter crisis looms

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RGC supporters joined the Docs not Cops demonstration in London against racist checks and changes in the NHS on 30 September.

As the pressures on the NHS grow as a result of funding cuts and staff shortages, it is likely that the crisis this winter will be even worse than that of 2016/17. A&E waiting times continue to increase, and hospital chief executives are being sacked where their hospital’s performance is deemed particularly bad. Plans to make more hospital beds available by reducing the numbers of patients whose discharge has been delayed by insufficient social support are way short of target. Although the government has signalled the end of the 1% pay cap for the public sector, there is no evidence that it will increase NHS funding to pay for even the very modest wage increases NHS unions are requesting – an average 3.9% plus a one-off payment of £800, estimated to cost £2.5bn a year. As it is, many hospitals are falling short of their financial savings targets as inflation hits 2.9% rather than the anticipated 2.3%, creating an extra £500m gap.

Performance figures released in mid-September show the intensifying pressures on the NHS:

  • The number of patients waiting for operations longer than the target 18 weeks, 382,000 out of a total 3.78 million on waiting lists, is at its highest level since September 2008.
  • Despite the focus on reducing emergency admissions, the number reached 486,669 in August 2017, 3.4% more than August 2016.
  • Although there was a slight drop in A&E attendances in August 2017 compared to August 2016, there is a year-on-year rise of 0.9%.
  • Ambulance response times continue to be below target, with 67.9% of Red 1 calls being met within the eight-minute target for 75% of calls, and only 60.1% of Red 2 calls meeting the same target.
  • There were 181,692 ‘delayed transfer of care days’ (the total number of days spent in a hospital bed by a patient whose discharge had been delayed) in July 2017, scarcely fewer than the 184,578 recorded for July 2016. This equates to 5,861 beds, only just below the figure of 5,954 a year earlier. Plans to free up an extra 2,000-3,000 beds by reducing the number occupied by patients whose discharge is delayed will not be met.

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Wearing away the NHS

nhs socialism

With the Tory victory in the June general election, the process of wearing down the NHS continues apace. An election promise of an extra £8bn means nothing: none of it is available for the current financial year when, with demand overall increasing at 4% per annum, the actual increase in funding is a mere 1.3%, or in 2018/19, when it will be even less, 0.4%. The consequences are clear: longer waiting lists for operations, longer wait times for consultations, reductions in services, ever-extending eligibility criteria for receiving health care. 14 out of 44 Sustainability and Transformation Programme (STP) regions have been told to ‘think the unthinkable’ to meet the demands of a ‘capped expenditure process’: rationing will become the norm. Matters are only going to get worse as the number of nurses in training falls and half the current cohort of nurses become eligible for retirement by 2020.

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Labour’s NHS promises are not enough

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Seven years of Tory funding cuts have driven the NHS into the ground. Spending per patient has fallen, while training and hospital maintenance budgets have been raided in order to keep hospitals from going bankrupt. Rationing hospital services is becoming a norm.

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Defending the NHS: the real fight has yet to start

On 4 March, 250,000 people marched through London in defence of the NHS. Like so many other anti-austerity marches that have taken place since 2011, there was no idea what to do next. The extra money that came in the Budget the following week was a drop in the ocean: a paltry £100m for GP-led triage in A&E and £325m capital funding over three years for Sustainability and Transformation Plans (STPs) – and then only if they jump certain hurdles. The £2bn promised for social care over three years is non-recurrent and will not meet a growing annual funding shortfall estimated currently at £1.9bn. Social care will continue to be cut, and private care companies will reject more and more the minimal payment rates local councils offer for their services. And within days of the Budget, it was announced that £800m reserves earmarked for mental health services will be used to pay off this year’s hospital debts. Robert Clough reports.

The success of the 44 STPs across England is crucial for the process of re-organising the NHS. The long-term aim is to create an integrated management structure across each of the STP ‘footprints’ or regions which in the short term can slash services sufficiently to keep costs in line with savage funding cuts over the next three years. GP-led Clinical Commissioning Groups (CCGs), over 200 of which were set up under the 2013 Health and Social Care Act, will start to reduce in number. Harbingers of this development are the very recent merger of three CCGs in Manchester and three in Liverpool together with the publication of national guidance on the process in November 2016. That 11 CCGs in the West Yorkshire and Harrogate footprint have agreed to form a joint commissioning group is further evidence of this trend.

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