The Autumn Statement’s proposal to increase NHS funding by £3.8bn in 2016/17 is the minimum required to avoid financial disaster over the next 18 months, but may be too late to avoid a crisis this winter. The NHS needs £30bn by the next general election just to stay still; however, the government has only promised £8bn. The health service will have to find the balance of £22bn through ‘efficiency savings’ – about 20% of its current budget. This is an impossible target: but the government pretends not only that it can be achieved, but also it will be sufficient to meet what it defines as a 24-hour, seven-day-a-week service. The savings require productivity improvements at twice the rate of the past five years, during which time the increase in health spending has averaged 0.8% per year, the smallest five-year rise since the NHS was introduced in 1948. In reality, annual spending has to increase by 4% to keep up with increasing need and escalating costs of new drugs and treatments.
Two years ago, 25% of hospitals ended the financial year with deficits. Last year (2014/15) this rose to 50%; this year the Healthcare Financial Management Association has predicted that all of England’s 155 acute hospital trusts will end up in deficit by April 2016. Half the promised £3.8bn will be used just to pay off these deficits. When a hospital is in deficit, regulators put on the pressure, job vacancies are not filled, there are fewer staff on the ground and investment in new equipment is reduced or halted altogether. This has a direct impact on the quality of care hospitals provide, with longer waits for treatment in A&E and longer waiting times for diagnostic tests and operations. These have targets which, when missed, trigger fines, further deepening the financial mess for that hospital.
In England, 15 hospital trusts are in special measures; 71% of inspected trusts are rated as requiring improvement or as inadequate; 33 of 156 acute hospital trusts have a vacant chief executive post and 75% of trusts are receiving money from the Trust Development Authority (TDA). The TDA has the responsibility for overseeing almost half of the country’s hospital sector. David Flory, its first chief executive, resigned in May this year and on leaving received £410,000 on top of his £210,000 salary.
At this time of financial crisis, Greater Manchester, with a 2.8 million population, is about to be the first region in England to have its £6.2bn health and social care budgets brought together and removed from central government control. There are grave concerns about the speed of the process in Manchester, where 37 organisations will be coming together (12 clinical commissioning groups, 15 NHS providers, 10 local authorities and NHS England) with no clarity on who has ultimate responsibility if anything goes wrong. Health devolution bosses are negotiating with Greater Manchester, health regulator Monitor and the NHS Trust Development Authority. A group of surgeons have formed a limited company Keep Wythenshawe Special and are applying for a judicial review regarding decisions made about Wythenshaw hospital and emergency surgery services. The fragmentation of a national health service will be disastrous.
Workforce planning is in chaos, with thousands of unfilled posts, inadequate permanent staffing in key areas and insufficient training places. For example, a recent report by the charity Bliss, which supports services for premature babies, found that 2,140 more neonatal nurses are needed to meet national standards and two-thirds of hospital neonatal departments need more doctors.
The NHS spent £3.3bn on agency staff in 2014/15, an increase of almost a billion pounds on the previous year. Around £1bn per year is spent on locum doctors filling vacancies for permanent positions, with the top ten highest paid locum consultants costing a total of £3.4m per year. The last six months has seen an increase in payment for locums of 18.6%. In the first three months of 2015, Trusts booked over 3,500 locums at a cost of £33m in pay and commission to agencies.
While there are nursing shortages, there is not a shortage of applicants for training. However, the Treasury is now stopping bursaries for nurses in training and forcing them to take out loans. The DoH currently spends £826m per year to help pay for approximately 60,000 student nurses in England through a three-year degree. Another £3.5bn of Health Education England (HEE)’s £5bn budget is to pay the salaries of junior doctors in training. This money, which includes tuition fees, bursaries and work placements, comes from the money the DoH gives to HEE. HEE’s budget is to be removed from NHS budget ring-fencing, to be cut at will.
The three one-day strikes in December planned by junior doctors are a measure of the depth of the NHS crisis. Health Secretary Jeremy Hunt’s attempts to impose a new contract on 37,000 doctors have hit a brick wall. Support for strike action in a ballot organised by the British Medical Association was 98% on a turn-out of 76%. The new contract will extend working hours and reduce pay despite government claims to the contrary. The BMA wanted to negotiate on 23 of the proposed changes to the existing contract; Hunt said 22 were non-negotiable. He has continually talked of an 11% pay rise but this only applies to basic pay and working hours will now be extended and will include Saturday working. Hunt has repeatedly tried to deceive the public that there are excessive deaths because of insufficient on-duty doctors in hospitals at the weekend. However, this is a wilful misinterpretation of very limited data presented in a paper published in the British Medical Journal in September 2015. Hunt has been forced to concede to negotiations through ACAS. The stand taken by the junior doctors is essential for defending the NHS. They deserve our support.
Hannah Caller and Robert Clough
On the NHS frontline
In the Autumn Statement, George Osborne announced massive cuts to bursaries for nursing and midwifery students, to be replaced by loans. To read this at the end of a 12-hour shift, after doing as much as possible to ensure good care – even just adequate care at times – was galling. Mostly, it provoked incredible anger. Working-class students will be unable to train with the prospect of £40,000 of debt at the end of the course. The £2.30 per hour my student bursary works out at is already not enough to survive in London, made up for by part-time jobs between night-shifts and exams when possible. It of course will affect a mainly female workforce, many of whom also have children or caring responsibilities.
But it is not just about bursaries – it is part of the wider dismantling of free, quality health care; of an NHS which can meet people’s needs.
To try to provide even the basic care is hampered by staff shortages, as posts are cut and not re-advertised when people retire. The gaps are filled by staff missing breaks and doing unpaid overtime, as the desire on the part of staff to provide adequate care is exploited. All of this, however, is just a part of the main issue – that this creates conditions ripe for privatisation. Already, it is creeping in at every opportunity, such rooms that were once for specialist care being turned into rooms for private care only. The prices charged by corporations for drugs is never questioned. People are simply not getting the care they deserve to have because the NHS is being knowingly destroyed. Without a bursary I could not have started my training. Knowing that it is because private companies and profit is being put before people’s health care and health care services makes it entirely unacceptable. How dare they!
Student at a London hospital
Fight Racism! Fight Imperialism! 248 December 2015/January 2016
