- Created: Wednesday, 06 August 2014 14:54
- Written by Hannah Caller
The NHS budget has a £2bn shortfall for 2015-2016 and still there is the target of £30bn efficiency savings by 2020. In England between 2012-13 and 2013-14 the number of trusts in deficit rose from 45 to 66 and a £383m surplus in 2012-13 became a £100m deficit in 2013-14, despite emergency funding. This included £500m in summer 2013 to help prepare for the winter pressures, followed by another £150m in November. In June this year, a further £400m was provided to reduce the pressure on A&E and allow 100,000 extra operations in July and August when it emerged that waiting times for many operations, such as hernia repairs, cataract removal, tonsil and adenoid surgery, hip and knee replacements, are rising sharply. It is estimated that following three years of standstill funding, the NHS needs £15bn for the five years from April 2015 to avoid collapse.
While the media plays its part in prophesying doom and gloom, helping to soften the public up for more privatisation of services deemed to be failing, the reality is that conditions are reaching a tipping point. In April, the number of people waiting more than 18 weeks for an operation reached a six-year high of three million, with patients waiting up to 30 weeks in some places. In May, the cancer treatment target was missed for the first time since 2009 and the number of people unable to be discharged through lack of social services support reached the highest level yet. The number of people unable to get a diagnostic test, such as MRI or CT scan within the six weeks set out in the NHS constitution, has doubled in the year from 1% to 2.2%. In June 2014 figures showed the number of GPs has fallen since 2010 when the ConDem coalition took over, and the A&E four-hour waiting time target was missed nationally for the 49th consecutive week.
Private companies are steadily increasing their share of the £9.75bn annual budget for NHS community health services, up from 12 to 18% of the market, from £1bn in 2010-11 to £1.77bn in 2012-13. At a time when overall funding for mental health services has fallen by 2.5%, private companies have increased their provision by 12% over two years (£1.05bn to £1.17bn).
Cancer care is now next on the privatisation list, with the NHS looking at the biggest outsourcing of services worth £1.2bn. In Staffordshire, many private health care companies have expressed interest in securing the £689m ten-year contract for provision of cancer care for a population of 767,000 served by four Clinical Commissioning Groups (CCGs – responsible for distributing £66bn of the NHS’s £110bn budget). The same four CCGs are also seeking to outsource a separate £535m contract for end-of-life care. Macmillan Cancer Support is advising the four CCGs. These contracts add up to £1.22bn, over twice the previous record of £500m of Richard Branson’s Virgin Care to provide various community health services in Surrey. Virgin Care is currently a bidder along with Care UK for a contract worth £800m to provide older people’s services for Cambridgeshire and Peterborough CCG. The Staffordshire cancer services contract will require private companies not just to provide the service but after the first two years to assume the responsibility for designing the whole system.
GP services under threat
A study funded by the National Institute for Health Research showed that one in four people (26.5%) presenting to A&E did so as they could not get a GP appointment quickly enough – 5.8 million in all. A College of Emergency Medicine study says that anyway only 15% of A&E attendees could have been appropriately treated at a GP surgery. General practice share of NHS funding has fallen from 11% to 8.4% in recent years. Many surgeries cannot cope with the demands.
From April this year, budget cuts have begun to affect some GP practices with the phasing out of the Minimum Practice Income Guarantee (MPIG) over the next seven years. The government has decided to give less weight to deprivation and more to age. MPIG was introduced in 2004 to ensure that practices in socio-economically deprived areas with a big turnover of patients were adequately funded. Tower Hamlets in east London, one of the most deprived areas in England, will lose out to more affluent areas with a greater number of elderly people, even though in Tower Hamlets there are more people with serious long-term conditions at a younger age. An example is the highly-regarded Jubilee Practice which will lose nearly £1m over the next seven years. With MPIG being phased out, services will be cut and the surgery may have to close. There are 98 practices in England in this situation, many in London, five in Tower Hamlets alone.
As an additional threat to GP practices, in July, health secretary Jeremy Hunt announced plans to place GP practices in special measures if they are deemed to be failing their patients, just as he did with 17 hospital trusts in 2013. Proposals to ‘name and shame’ practices which are seen to miss cancer diagnoses are no more than a vindictive punishment which far from resolving existing problems may create additional ones with GPs referring unnecessarily to avoid stigmatisation.
In the run-up to the general election next year, Labour politicians will twist and turn to avoid any clear commitment to fund a decent health service. While they talk of repealing the Health and Social Care Act, they will not make any commitment to nationalise privatised services, let alone PFI contracts. The NHS will be as unsafe in their hands as it was when they were in government.
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