Saving money not safeguarding services
The end of the financial year is fast approaching and the emphasis in the NHS is to ensure that the books are balanced. Health Secretary Patricia Hewitt announced at the beginning of 2007 that the NHS is on track to break even within three months, but that jobs would have to be cut. Such job losses are being described as ‘natural wastage’ whilst Hewitt claims that jobs aren’t being filled because the NHS is ‘becoming more efficient’. However, 20,000 nurses and other NHS staff will have lost their jobs by the end of this March, and a further 40,000 jobs will go in 2007/08.
Workforce chaos
The NHS will not have the clinical staff it needs to deliver an effective service. This is the message from the draft of the government’s NHS pay and workforce strategy for 2008-2011 leaked to the Health Service Journal in early January. The document predicts shortages of 14,000 nurses, 1,200 GPs and 1,100 junior doctors by 2010, but a surplus of 3,200 hospital consultants and 16,000 allied health professionals, healthcare scientists and technicians. Cuts in nurse training posts coupled with the retirement of a large number of nurses will be the cause of the nursing shortfall.
Market-driven health policy
Hewitt reassures us that ‘the NHS has been saved, but it still needs to be transformed to ensure that it will survive for another generation’. This transformation involves more private sector healthcare provision with guaranteed profits where competition replaces cooperation between departments and services. Planning and allocation of resources based on need does not even come into the picture as short-term measures predominate.
Independent Sector Treatment Centres (ISTC) are making profits by taking the most profitable and least risky cases off waiting lists. With the ‘payment by results’ system this means that the ISTCs take money out of the NHS. ISTCs have preferential long-term contracts guaranteeing them full payment regardless of how few people they actually treat. Now the government is proposing Integrated Clinical Assessment and Treatment Services (ICATS), private companies delivering clinical assessment, diagnostics and even treatment. The claim is that these will cut waiting times for referral, but the ICATS will send patients to treatment providers run by the same company to maximise their profits. Meanwhile hospital referrals by GPs are being reduced in an attempt to cut expenditure. Almost 70% of GPs are having their referrals to hospitals cut, with some facing cuts of up to 20%.
In the world of ‘payment by results’, NHS financial advisers are warning that hospitals may ‘deliberately’ carry out too much work to generate extra income. In a development that beggars belief, a system of fines is proposed for hospitals which treat too many people too soon. Recently, Ipswich Hospital Trust aimed to improve its economic situation by treating people faster, but the Primary Care Trust (PCT) refused to pay up and the hospital found itself £2.5m worse off. Under the new regulations, PCTs will be able to fine hospitals up to 2% of the value of their contract for treating more than the agreed number of patients. However, from 2008, PCTs will also be able to fine hospitals if they don’t treat people fast enough and miss the government target of treating people within 18 weeks of referral from their GP.
A healthcare system cannot provide healthcare to all on an equitable basis if it is run for profit, with decisions about service provision being financially driven. Current cutbacks are demoralising staff, driving wedges between departments in hospitals, between hospital and community-based services, and are beginning to affect people’s trust in those taking clinical decisions about their care. Now is the time for collective action by all those on the frontline of delivering health care.
Hannah Caller
FRFI 195 February / March 2007
