The financial crisis of the NHS is now so deep that Tory Health Secretary Jeremy Hunt has been forced to concede its existence. Typically, however, he has blamed it on factors beyond the government’s control: ‘There’s a triple whammy of the ageing population which means there will be a million more over 70s by the end of the parliament than there are today – that’s a massive impact; the financial pressure which means that the government is not able to increase spending in real terms on the NHS by the amounts it has done historically – that’s something we’ve had to get used to over the last five years; and raised expectations from people who use the NHS about accessing it more easily but also raised expectations post Mid Staffs in terms of the quality and standard of care.’ The underlying message is that capitalism will not provide a decent health service for the mass of the people. There was an £822m deficit in the NHS last year and the NHS is facing a £2bn deficit this year. Had the Department of Health and NHS England not put in £350m, the deficit would have been bigger.
A typical example of the crisis is the world-leading Addenbrooke’s Hospital in Cambridge, now losing £1.2m a week, and which has become the 26th NHS Trust in England to be put into special measures. A Care Quality Commission (CQC) inspection, costing about £1m, concluded in September that serious staff shortages were putting patient safety at risk, alongside difficulty recruiting staff, cancelled operations, long waits for elective procedures and outpatient eye care and too few midwives to cover the number of births. Ironically one of the CQC concerns was the high use of agency and bank (supply) staff to try and maintain adequate staffing. Addenbrooke’s chief executive announced he was leaving the trust after three years in the job, criticising the CQC for stating the obvious. It will cost the hospital tens of thousands of pounds to recruit a replacement. The average length of stay of a Trust chief executive is about 21/2 years, 7% of CEO posts are vacant and, in 33 Trusts, the chief executive post is held by an acting postholder. The job is impossible.
Lack of permanent nurses and midwives, use of agency staff and recruiting abroad is a vicious circle that contributes to the financial problems and compromises the care that can be given. Between May 2010 and May 2013, the number of nurses, midwives and health visitors fell by 3,200. In London at the end of July 2015, Barts Health, which runs five hospitals, had 1,200 nursing and midwifery vacancies, one in five of the staff. Figures from the Royal College of Nursing show that while in the three months April to June 2012, hospitals spent £400,000 on agency nurses, from July to September 2014 this had shot up to over £1m.
In 2014, one in four nurses in the NHS were recruited from abroad. This follows a cut in the training places in Britain year on year. The Royal College of Nursing estimates that there are 54,000 applicants for 20,000 places. It costs about £2,500 to recruit a nurse from the EU before wages even start. Aintree University Hospital Foundation Trust spent £46,000 on a trip to Madrid to recruit 20 nurses and one year later, only 11 were still in the job. United Lincolnshire Hospitals Trust spent £100,000 on a trip to Athens and recruited 39 Greek nurses.
In a letter sent out on 3 August by the regulator Monitor to NHS Foundation Trusts, hospitals have been told that financial forecasts for 2015/16 are ‘simply unaffordable’ and are urged to take a range of actions to bring down costs, and in particular to fill vacancies only where essential. Since 70% of NHS staff are nurses, this will mean that nursing numbers will be hit hardest. The CQC inspections, which can cost trusts up to £1m to prepare for, will become even more of a waste of time: they will be telling hospitals that they are inadequately staffed – which the hospitals already know – and that they have to recruit staff – which Monitor is ordering them not to. There is no point to the CQC, and unions should be calling for its boycott.
Monitor chief executive David Bennett, the highest paid boss in the NHS on £250,000, is now moving on to make way for a single leader of Monitor and the Trust Development Authority (TDA). Ed Smith has been appointed joint chair on a £108,000 starting salary. His other jobs are NHS England’s Deputy Chairman; Chair of its Audit Committee; Pro-Chancellor and Chairman of Council at the University of Birmingham; Non-Executive Chairman of the Crown Commercial Service; lead Non-Executive Director for the Department for Transport; a member of the Competition & Markets Authority and Treasurer of Chatham House. Clearly he will not be expected to do much for his £108,000. Previously he was Global Assurance Chief Operating Officer and Strategy Chairman of PricewaterhouseCoopers.
Five years of 1% funding increases on top of the last Labour government’s £20bn savings programme have brought the NHS to its knees. The Conservatives’ promise of £8bn in the future does not address the crisis now and anyway leaves a £22bn gap in the NHS budget by 2020. The consequences are with us now. Adequate health care is being undermined across the board. GP practices are closing for lack of GPs or because of threats from the CQC. Monitor is advising hospital trusts to not meet their staffing quotas. Hospital departments and whole hospitals are facing special measures or closure. 77 of 153 Foundation Trusts and 43 of 99 Trusts lost money in 2014/15 and are in a worse financial situation this year. Many Foundation Trusts are financially broken by huge Private Finance Initiative repayments. Clinical staff numbers are completely insufficient. The internal market, PFI, the Health and Social Care Act – a mixture of Labour and Tory policies – are completely destroying the NHS. Defend it now!
Hannah Caller
FRFI 247 October/November 2015
