As the NHS descends into chaos, the government knows who to blame: uncaring nurses, greedy doctors, poor management, negligent hospitals, patients who do not look after themselves, old people, inaccessible GP services – anything but the tightening squeeze on the NHS budget and the burden of the Health and Social Care Act. In an orchestrated campaign to denigrate the NHS as a public service, the Department of Health leaked a report into the quality of care and treatment provided by 14 hospital trusts in England to the press in advance of its publication. The result was hysterical and lying headlines claiming that ‘13,000 died needlessly at 14 worst NHS trusts’ (Sunday Telegraph).
In fact the report, by NHS England medical director Bruce Keogh, was very careful in presenting its findings. The hospitals it reviewed had been selected because they had higher Hospital Standard Mortality Ratios (HSMRs) than expected. HSMRs are measurements of the death rates which take into account patients’ age, illness severity and place of residence in terms of affluence or poverty. HSMRs allow the predicted number of deaths to be compared to the actual number who died. Keogh referred to the ‘complexity of using and interpreting aggregate measures of mortality, including HSMR and Shmi’ (Summary Hospital-Level Mortality Indicator), and pointed out that the two different measures of mortality gave two different lists of hospitals to investigate. He warned that ‘however tempting it may be, it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths’. This did not deter either the press or the government from abusing Keogh’s figures, and ignoring his point that ‘It is important to understand that mortality in all NHS hospitals has been falling over the last decade: overall mortality has fallen by about 30% and the improvement is even greater when the increasing complexity of patients being treated is taken into account.’
Keogh did find poor and unsafe services in these hospitals. He also found that seven of them had shed 1,117 nursing jobs since the 2010 general election. Several of them are in parts of the country where it is difficult to recruit clinical staff and so the hospitals have to rely on expensive agency staff and locums. The bottom line is that underlying unsafe or inadequate services is a shortage of staff, and underlying the shortage of staff are the £20bn cuts in NHS spending. The government says it will step up the inspection regime for hospitals: yet this requires more money and more clinical staff, which it will of course not fund. The Keogh report required a £2.8m contract with Price Waterhouse Cooper. No amount of inspection can deal with the problem that 80% of A&E departments do not have consultant cover for the minimum 16 hours a day regarded as essential for safety, and the situation is worse at weekends.
Even prior to the current round of £20bn cuts, the NHS in England had one of the lowest ratios of beds and staff per head of the population in the OECD. In 2010, there were three hospital beds per 1,000 population in England compared to the OECD average of 4.9 per 1,000. This is set to get worse. NHS England’s information director Tim Kelsey has said that there will be a funding gap of £30bn by 2020, while Mike Farrar, chief executive of the NHS confederation representing health service managers, puts it at £50bn. The government says it has ring-fenced NHS funding, and that it will be maintained in line with inflation. This ignores the fact that funding has to increase by 4% per annum to keep pace with medical and pharmaceutical advances, as well as with the requirements to provide adequate health care to an ageing population.
The lack of money will encourage a well-spring of reactionary solutions. A survey of GPs in July 2013 found that 51% now think it’s a good idea to introduce patient charges of up to £25 per visit – up from 34% in 2012. All this will do is penalise the poor. Punishment is the name of the game when targets drive the NHS. East Midlands Ambulance Service has been fined £3.5m for missing a 95% target of reaching life-threatening emergencies within 19 minutes by 3%. That fine will just make the service worse.
Hospitals throughout the country are facing bankruptcy. Barts in London is one example. Saddled with a ruinous PFI debt of £1bn costing £115m a year, the trust, which runs six hospital sites, has to find £77m savings this year. It is £15m behind schedule. Price Waterhouse Cooper has been parachuted in and proposes to cut up to 1,600 jobs as the solution. Meeting minimum ward staffing levels will become an impossibility. In south London, Lewisham hospital is threatened with partial closure to help bail out the South London Hospital Trust which has PFI schemes consuming 18% of its income. Local services are being sacrificed for the interests of bankers, shareholders and corporate stakeholders.
No to the cuts! No to PFI!
Hannah Caller and Robert Clough
Fight Racism! Fight Imperialism! 234 August/September 2013
