NHS cuts round-up

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The wide-ranging attack on NHS services is documented by FRFI supporters from around the country.

STPs and Grantham A&E

Lucy Roberts

In August 2016, it was announced that Grantham and District Hospital Accident and Emergency unit would be closed between the hours of 18:30 and 09:00. United Lincolnshire Hospital Trust (ULHT) has said it does not have enough doctors to staff the department safely while also maintaining services in Lincoln and Boston.

Initially this closure was projected to be for three months, but the closure was predictably extended and as part of the Sustainability and Transformation Plan (STP), the accident and emergency centre at Grantham is now proposed to be downgraded to an 'Urgent Care Centre'. Major trauma care would then have to take place at hospitals outside the county.

For the moment, Lincoln Hospital A&E is filling the gaps in the hours when Grantham is closed, but it is already failing to meet patient waiting targets. Relying on other hospitals to provide major trauma care is also likely to put extra pressure on the East Midlands Ambulance Service, requiring them to drive longer distances to get patients the care they need.

Grantham A&E is used by residents from Lincolnshire, Leicestershire, Nottinghamshire and even Rutland, meaning that the STPs are undermining the A&E network for the wider area. The plans will put pressure on many services in the local area and this is just a small part of what is going on nationwide.


Nottingham NHS in crisis

Seamus Padraic

In the last three months Queen’s Medical Centre (QMC), the second largest hospital in Britain, has issued three ‘black alerts’, meaning long waiting lists and no beds available. Two of these were in the same week in January. To save beds, the QMC has cut back on the number of routine operations it books in. In December NHS Improvement published its performance report on Nottingham University Hospitals NHS Trust (NUH), which includes the QMC. NUH is treating or admitting 75% of patients attending A&E within four hours. The national target is 95%. 49,168 patients visited the trust's A&E departments between 1 July and 20 September. Over 12,600 of those patients waited for longer than four hours to be seen, treated or discharged. In September, 714 (4.4%) of attendances at NUH left A&E before being seen for treatment. This is 85% more than the 387 (2.4%) in September 2015.

NHS Digital figures published in November found that 40% of patient occupied space at the QMC was deemed not functionally suitable in 2015/16. The QMC reported that it needed to spend £4.8m to tackle the “high risk maintenance backlog” of urgent repairs/replacements needed to prevent major disruptions, failures or safety deficiencies likely to cause serious injuries and/or prosecution. A further £71.8m is needed to eradicate significant risk issues.

Red Cross volunteers have had to step in to help East Midlands Ambulance Service get people home from hospital in order to free up the desperately-needed beds. The charity has called the situation a ‘humanitarian disaster.’ In 2015/16, East Midlands Ambulance Service had a deficit of £11.9m, over 23 times the overspend prediction at the start of the financial year. On New Year’s Day, paramedics’ meal breaks were cut from 45 minutes to 20 to deal with call volumes. There are reports of ambulances taking four hours to arrive at incidents.


Worcestershire Royal Hospital Crisis

Tom Vincent and Paul Mahoney

Three deaths at Worcestershire Royal Hospital over the New Year period prompted a public outcry – two patients died on trolleys in A&E while the third person hanged themselves on a ward. This is the outcome of a longstanding funding crisis. The hospital was built in 2002 through one of the Labour government's PFI deals, with an initial loan of £82m in exchange for payments to private companies that will total at least £852.1m by 2032. In 2014/15 the annual payment was £29.5m, amounting to 8.6% of the Trust's budget for that year. The Trust had to be bailed out by NHS Worcestershire in 2011 and was put into special measures in December 2015. Its target deficit for this year is £34.6m, but it was already on course to exceed this before the latest crisis. The Trust’s A&E department has not met its 4-hour wait target for over a year. In November 2016, there were 37 cases of patients spending more than 12 hours on a trolley; over the Christmas period there were 109 cases. The hospital has 200 vacancies for qualified nurses.

Providing health care to a largely rural area with an aging population requires significant resources, but instead further cuts are planned: Worcestershire clinical commissioning groups were already consulting on £25m of proposed cuts in summer 2016. The Strategic Transformation Plan for Worcestershire and Herefordshire published in November includes additional cuts of £34.6m, of which £11.8m is to be taken from urgent and emergency care. In the likely event that reductions in demand via 'demand mitigation' and 'efficiency gains' fail to materialise, further cuts will take place.


The doublespeak of the NHS Sustainability and Transformation Plans

Hannah Caller

The Sustainability and Transformation Plan (STP) for the North East London area includes some of the poorest authorities in London such as Hackney and Newham, and well as major hospitals such as Barts, the Royal London and the Homerton.

Published at the end of 2016, the STP claims that the changes it plans will not be fewer services or reduction in quality, but more preventive care and more efficiency. It declares that its aim is ‘to measurably improve health and wellbeing outcomes for the people of North East London and ensure sustainable health and social care services, built around the needs of local people; to develop new models of care […] focused on prevention and out of hospital care.

However, almost simultaneously, Homerton hospital published documents that reveal it is axing a fifth of its community nursing team. This follows City and Hackney CCG budget reductions which end funding of the One Hackney Initiative. The One Hackney Initiative focuses on over 75-year-olds with complex needs, to help reduce inappropriate hospital admissions and facilitate discharges.

The results of the funding cut will be the loss of 14 district nurses, the addition of two patients to each remaining nurse’s caseload meaning less time each nurse can have with their patients and so a reduction in quality of care. These cuts go against both national and local STP policy of shifting activity into the community and will not reduce admissions nor help with discharges. Tellingly, the CCG says that the One Hackney Initiative was a pilot which didn’t achieve all its aspirations nor ‘realise the savings in hospital spend we were hoping for’.

Find out about your local STPs, expose their plans and build the resistance!