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.
In 2014, Public Health England put the cost of the NHS staff absence at £2.4bn a year and agency staff bills at £3.3bn. By December 2015, hospitals estimated they were spending £2.72bn on agency and contract staff, £1bn more than planned. While the NHS is crying out for more staff on the ground, Monitor and the Trust Development Agency in January 2016 told the 241 Trusts under their watch to use ‘headcount reduction’ to reduce their deficit for 2015/16. Put this in the context of the 2013 Francis Enquiry into the Mid Staffordshire events of 2005 to 2009 where between 400 and 1,200 people died unnecessarily in a district general hospital. Its conclusion was that the main causes were inadequate staffing levels and subsequent inadequate care that was to blame.
The government says it is committed to a fully-staffed seven-day NHS. Such services will require thousands more doctors, nurses, support staff and additional investment in hospital and community care. A seven-day NHS cannot be created simply by stretching the current workforce even further. A leaked government document states that 4,000 extra doctors will be needed to achieve a seven day NHS. The document outlines how community and social services would be currently unable to deal with increased weekend discharges, and that 11,000 additional clinical staff would be needed. Of the extra 4,000 doctors, there would have to be 1,600 consultants, 1,500 registrars and 900 additional junior doctors. The government is lying when it portrays junior doctors’ contracts as a block to a seven-day NHS: they are already working to cover 24 hours a day, seven days a week delivering health care in acute and mental health hospitals. In a speech to the British Medical Association consultants’ conference in March, committee chair Keith Brent said that improving care at weekends is not a question of contract change but one of proper resourcing. The consultants’ conference gave their support to the junior doctors and passed a vote of no confidence in Hunt, NHS England chief executive Simon Stevens and NHS England national medical director Bruce Keogh. Keogh has since rowed back and is critical of the government’s decision to impose a new contract.
All the froth about the seven-day NHS covers up for the reality. 46% of GP practices report they have GPs who are planning to retire or leave the NHS. The pressure of increasing demand is making new graduates turn their backs on careers as a GP. With one in ten practices also reporting that their finances are so weak that they are financially unsustainable, almost 300 practices are facing possible closure.
As junior doctors continue their strike action with four days in April, many are threatening to leave the NHS and their training. There has been a huge surge in applications to the General Medical Council for the certificate usually required to apply for posts overseas. On 11 February when Hunt announced in the House of Commons that he would impose the new contract, an unprecedented 298 doctors applied for a Certificate of Current Professional Status and a further 106 the next day. Other doctors in training are taking time out or leaving medicine all together.
Meanwhile, overseas students who graduate from British medical schools could be denied the opportunity to continue their NHS training. The Migration Advisory Committee (MAC) proposal restricts the link between the Tier 4 visas given to overseas students studying in Britain and the Tier 2 (skilled worker) visas they require to progress onto speciality training. They can only take this up if there is no suitable candidate from the European Economic Area. The MAC also recommended setting the immigration skills charge at £1,000 per year of the visa applied for; this upfront immigration charge could cost Health Education England, who sponsor doctors in training in England, £800,000 per year. MAC’s proposal to increase the minimum salary for Tier 2 applicants to £30,000 could penalise doctors earning less than this or working less than full time, who would then be forced to leave.
Adding insult to injury, NHS England and Health Education England have launched Britain’s first national clinical entrepreneur training programme. Under the guidance of international entrepreneurs and health innovators they will develop their ideas for the market. The doctors will take a year out from their clinical duties to be part of the training on how to run a business, attract investors, apply for funding and build a start-up. It is claimed that this will help them deliver health improvements in all sorts of innovative ways. In reality it is to provide a core of doctors committed to privatisation.
The responsibility for the future of an NHS open to all and free to use lies with us all and while doctors in training take industrial action, they must not do so alone or the workforce will be further divided and the message obscured. We want universal health care, free at the point of delivery and the end of privatisation of the NHS.
