NHS‘Reset’ into chaos

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The Conservative government has now made it clear that the NHS is to be allowed to descend into chaos with the NHS Improvement (NHSI) instruction that NHS organisations will have to ‘reset’ their finances to ensure that there is no repeat of the 2015/16 overspend of £2.45bn. Waiting time targets – such as the four-hour target in A&E – are to be abandoned. Waiting lists will soar: the historical way of rationing essential health services for those who cannot afford to buy them privately. Services will be cut and hospitals will close. All this will be overseen by the richest Cabinet member, Health Secretary Jeremy Hunt, who received a £972,000 dividend from his education company in 2014/15 on top of his £135,000 Cabinet member salary. There were many who hoped that Hunt would be sacked for overseeing the worst financial crisis in the history of the NHS. It was not to be: his arrogance makes him ideally suited for bringing the NHS to its knees and dealing with resistance such as that shown by junior doctors.

The ‘reset’ letter, sent by NHSI chief executive Jim Mackie on 21 July, states that individual trusts and Clinical Commissioning Groups (CCGs) must agree and must meet ‘financial control totals’. Those that fail will be placed in ‘special measures’. Five hospital trusts and nine CCGs will immediately enter ‘special measures’ because their deficits are so huge; 13 more hospitals are waiting in the wings. Among the first five hospitals is Barts Health NHS Trust in east London, the biggest health trust in the country and the biggest over-spender, which despite receiving £91.9m on top of its £1.5bn annual budget, recorded a deficit of £135m in 2015/16. Under the ‘reset’ rules, Stepping Hill hospital in Stockport is closing a surgical ward and cutting 350 posts in an effort to reduce a deficit of £40m.

Mackie states that £1.8bn will be made available to help hospitals reduce their total deficit from £2.45bn in 2015/16 to about £250m in 2016/17, saying ‘This plan is intended to restore financial discipline and ensure ongoing financial sustainability across the whole NHS.’ This is just wishful thinking which plays with peoples’ lives. The chief executive of the Nuffield Trust thinktank has concluded that ‘With almost nine out of 10 acute hospital trusts in deficit at the last count, the idea that this is a problem caused by “a few bad apples”, where the management simply doesn’t try hard enough to balance the books, is long gone.’ He continued: ‘I fear that in order for hospitals to virtually eradicate their debts, as NHS Improvement and NHS England want, the next steps could be a series of brutal service reductions and bed closures – which will shock an unprepared public.’ Stepping Hill is the first example.

Financial balance in 2015/16 was only achieved by raiding capital budgets and the fortuitous ‘discovery’ of £417m overpaid national insurance contributions. Yet one in five acute hospitals reported deficits greater than £20m, with 11 over £50m. King’s College Hospital in southeast London posted a deficit almost as large as Barts: £135m. Since 2010, the number of hospitals in deficit has grown from 21 to 157. To meet demand and pay for advanced treatments, NHS spending must increase by 3-4% a year in real terms. Under the ConDem Coalition, NHS spending increased by 1% per annum. The Tories said they would put in £10bn a year by 2020, again about 1% per annum; the balance of £22bn needed to keep pace with demand would have to be met by savings – staff cuts.

In order to find money to pay for acute hospital services, CCGs have reduced spending on mental health services. The King’s Fund reports that ‘44.8% of mental health trusts experienced a reduction in income between 2012/13 and 2013/14 and 38.6% between 2013/14 and 2014/15.’ The result has been a staffing crisis in acute mental health services, reduced access for patients who receive ‘poor experiences due to service responses that fail to meet their needs and lack basic respect, warmth and compassion’. In general practice, the number of consultations grew by 15% between 2010/11 and 2014/15 while funding fell by 0.4%.

With a falling number of GPs, waiting times for GP appointments have risen. It is now so bad that one practice has resorted to putting up a notice on its front door saying ‘Please do not bring a chair with you when you are waiting for the surgery to open’ because of the queues that form in the morning to get an appointment – they start so early and are so long people have been bringing camping chairs.

A decision to abandon the system of fining hospitals for failing to meet service targets, such as waiting times in A&E, shows that the cost of meeting financial pressures will be measured in ever-longer ambulance queues outside emergency departments, longer queues for treatment within, and longer queues waiting for a bed. Deaths will be inevitable. Hospitals had been forking out £600m a year because they had failed to meet these targets. As a first step, 52 of the 139 trusts with A&E units, five cancer hospitals and three hospitals will be exempt; soon all will be.

Junior doctors

Following a protracted struggle between junior doctors and the government over a new contract during which there were five strikes, the government and the BMA negotiated a revised version. However, when this was put out for agreement, 58% rejected it in a ballot involving 68% of eligible junior doctors and medical students. Democracy is irrelevant to Hunt who has pledged to impose the contract anyway. The BMA junior doctors’ committee chair Johann Malawana, who had recommended acceptance of the offer, has resigned. Jeremy Hunt continues to insist the new contract is necessary to deliver a seven-day service – although he has never explained what a ‘seven-day service’ is, given that hospitals are open seven days a week anyway. Junior doctors have always worked weekends and a truly seven-day service across the board would require a huge raft of other investments. Hunt’s ‘seven-day service’ is just a smokescreen for cutting clinical costs and making junior doctors work harder with longer hours. It will add to the chaos the government is imposing on the NHS. Resistance is the only option.

Hannah Caller and Robert Clough

Fight Racism! Fight Imperialism! 252 August/September 2016