NHS‘Reset’ into chaos

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.

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NHS in financial meltdown

In a significant retreat, Health Secretary Jeremy Hunt has agreed to talks with the junior doctors on their proposed new contract. Since they started their strike action, the doctors have received widespread public support. They have refused to back down in the face of government intransigence and lies, and instead have linked their struggle to the need to take action against the government’s deliberate running down of the NHS and the associated privatisation of its services.

Starting with the 2010 ConDem coalition government, the NHS has faced an unprecedented squeeze on its finances. This will continue until 2020/21, by which time NHS spending as a proportion of GDP will have fallen from 8.8% (2009) to 6.6%. GDP is forecast to grow in real terms by around 15.2% between 2014/15 and 2020/21, but NHS spending will grow by only 5.2%. The annual real-term increase in NHS spending between 2009/2010 and 2020/21 will be a mere 0.9%; it needs to be 4.5% to keep pace with rising need and the costs of advances in medical technology. This represents the difference between government lies that it is protecting NHS funding and a reality of insufficient staffing at every level and collapsing services.

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NHS maternity services up for sale

NHS for sale

‘We are all trapped in a marvellously pure ideology, the ideal socialist dream.’ So said Tory peer Baroness Cumberlege in 2000 of the NHS, as she advocated for an injection of private companies, competition and profit-making to improve ‘freedom of choice’. Cumberlege is the ‘independent’ chair of the 2016 NHS Maternity Review ‘Better Births’, and it seems her interests remain the same. The review recognises some maternity service problems, but offers a solution which would pave the way to further undermining of free, accessible, universal care.

Maternity Review

In 2000, Cumberlege argued against the NHS remaining free at the point of use for all, calling for an NHS insurance premium and private insurance. In 2001 she set up Cumberlege Connections, now Cumberlege Eden & Partners, to deliver training to NHS and private provider staff about health sector ‘development’, including a course on ‘politics, power and persuasion’. Whilst profiting from this venture, in 2012 she voted for the Health and Social Care Act, legislation which furthers private interests in the NHS. Her company’s partnership with the PricewaterhouseCooper Alliance, set up to bid for new contracts to develop Clinical Commissioning Groups (CGCs), put them in a position to profit directly from the law she voted for.1

Cumberlege has had a long relationship to maternity services, chairing ‘Changing Childbirth’ in 1993. The latest maternity review aims ostensibly to make care for women and babies safer and more personalised. It recognises that women generally want a familiar midwife to care for them, that women and health professionals should work in partnership and that longer appointments are needed for better care. None of this is new – the arguments for continuity of care have long existed with excellent evidence. The care already exists to a limited extent within the NHS, and has shown improvements to health outcomes and equity. However, rather than call for more resources to develop this care within the NHS, the report has its own proposal – a new system of funding incorporating personalised budgets. ‘NHS Personal Maternity Care Budgets’ would give women £3,000 to ‘spend’ on a provider of their choice, covering antenatal, labour and postnatal care. The details are still vague and funding for complex cases is yet to be worked out; a trial is proposed for 2016-17, with certain service providers to be approved by the Care Quality Commission (CQC).

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Unite in struggle to save the NHS

The NHS grinds steadily towards a government-engineered financial collapse. After five years of flat-line funding, spending on health has dropped from 11% of GDP in 2007 towards 6.6%.  Chancellor George Osborne may have announced £10bn investment in NHS England last November, but only £8bn of that represents new funding, and most of this is to paper over the fact that NHS spending must expand at 4% per annum to keep pace with demand.

In February 2016, the NHS provider sector recorded a deficit of £2.26bn, £622m worse than planned. A report to the joint meeting of Monitor and the National Trust Development Authority boards showed that as of 31 December 2015, 179 (75%) out of 240 NHS providers reported a deficit, of which 131 were acute hospitals; providers had made £1.94bn of savings, £257m less than planned. Hospitals as a whole missed the A&E waiting time target of seeing 95% patients within four hours between October and December 2015, and the size of the waiting list for routine operations reached 3.14 million as they failed the referral to treatment 18-week health care standard for the first time.

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Starving the NHS of staff and money

An adequate system of health care needs people to deliver it and the funding to sustain and develop it. In Britain, both are severely threatened, despite this being the fifth richest nation in the world. Services are being closed or handed to the private sector, poorer working conditions are being imposed on the remaining staff, and increased zero-hour contracts and job losses introduced for the already lowest-paid, tendered-out hospital staff, such as domestics, porters and caterers, vital members of any health care team.

The NHS employs more than one in 20 of the working population in Britain and nearly 80% of its workforce are women. Across the country there are tens of thousands of unfilled doctor and nurses’ posts, while training places are cut and student nurses, midwives and others are about to have their bursaries axed. Thousands of pounds are spent recruiting abroad for short-term gain in the NHS.

In 2013, Britain spent 8.5% of its total GDP on health care, ranking it 13th out of the 15 original EU members. For NHS spending to match the average European country’s level of expenditure by 2020 would require a 30% increase, equivalent to £43bn a year. The government has promised a mere £8.4bn extra, little more than 1% more a year. In the past five years, the average increase in NHS spending has been 0.8% per year. Yet annual spending on the NHS has to increase by 4% just to keep up with the annual increase in costs of treatments and running services. The future is one of yet more cuts, with the NHS facing continuing financial crises.

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