JAMES KILLDARE, our health correspondent, reports on some of the hard choices being made about NHS services locally
If you live in Croydon and have expectations of using NHS services, then hard luck, because you have lost out in a postcode lottery where the booby prizes are closed beds, axed services and another round of millions of pounds’ worth of cuts.
IVF fertility treatment will no longer be available in most cases in Croydon, older patients requiring orthopaedic treatment will be provided with cheaper, less long-lasting equipment, a care facility for women with mental health issues is to be closed, and milk will no longer be prescribed for any infants growing up in Croydon.
Croydon’s main hospital, Mayday, and the Croydon CCG – clinical commissioning group, the body which manages funding for the area’s GPs – have both been placed on special measures by NHS England for over-spending. No matter that, according to the CCG’s latest report to the council, “Funding for healthcare in Croydon for 2016/17 reflects underfunding of -3.71% circa £18m… No additional funding outside of growth funding is expected.”
And after years of making “efficiency savings” to what are self-evidently already over-stretched services, government officials are insisting that Croydon CCG makes additional cuts of £5.7 million by next April.
“In April 2016, NHS England advised the CCG that we were required to reach recurrent financial balance more quickly by 1 April 2017 and with a deficit control total of £4.2million for 2016/17. This is an additional £5.7million savings, on top of the £13.7million we already had planned,” stated the written report to Tuesday’s meeting of the council’s health scrutiny committee.
The Town Hall meeting heard Paula Swann, the chief officer of Croydon CCG, confirm that a number of elective procedures will no longer be available. And the message to stunned councillors was that there could be worse to come.
The previous council meeting on the health service crisis on our doorstep had kept much of the hard detail of what is to be axed in the secret, Part B of the report. This time, the CCG’s report was a little more forthcoming, though not everything which might get cut was necessarily revealed this week.
“There are a lot of sacred cows we are looking at,” Antony Brzezicki, a practising GP and the chair of the CCG, told the meeting. “Nothing is off the table.”
The withdrawal of IVF treatment for “most people” in Croydon, Swann told the meeting, “is quite a significant change”.
What the local health officials referred to as “changes in tariffs”, meaning increased costs from service suppliers in the NHS’s internal market, is one of the reasons for Swann to predict further cuts in 2017, too.
“We face additional challenges next year,” was the euphemism of choice from Swann.
Dr Brzezicki spoke of the CCG saving nearly £1 million by reducing the referral of patients to a wide range of what are called “intermediate services” – other practictioners who specialise in areas such as dermatology, diabetes and opthamology.
“They don’t fill a need,” the CCG chair said, somewhat bluntly. “They fill a want.”
Asked whether the cuts proposed in Croydon represent a form of postcode lottery, with residents in other parts of London and the rest of England being able to access some of the health services being withdrawn in this borough, Dr Brzezicki said, “There will be a uniform level of service. Sadly, it will be at a lower level than now.”
Croydon CCG justified the ceasing of IVF treatment in the majority of cases by pointing to a similar cut having already been implements by 13 other CCGs.
The CCG said it will be “Re-commissioning services to gain better outcomes and experiences for patients and better value for money for the NHS” – in other words seeking cheaper options within the internal market that is so beloved of Jeremy Hunt and the Tory government’s privatising agenda.
At Prime Minister’s Questions yesterday, Jeremy Corbyn, the leader of the opposition, highlighted how 80 per cent of the country’s hospitals are operating a financial deficit. In 2010, the NHS had been in financial surplus.
“NHS Trusts are in the worst financial crisis in the NHS’s history,” Corbyn said. The government, Corbyn said, is “leaving the NHS on its knees”.
In Croydon, it’s beginning to look like the NHS is on life support.
The CCG officials delivered their report, and its wide-ranging cuts, not without some degree of reluctance.
“Croydon, as a borough, has one of the most diverse populations both in London and nationally,” their report states. “While Croydon has slightly lower levels of deprivation than the England average, it has a higher than average number of children living in poverty; higher levels of homelessness; higher rates of teenage pregnancy and a greater prevalence of diabetes than the England average. These are all key indicators of serious health inequalities.”
Nonetheless, they have been forced by NHS England to find another £5 million-worth of cuts, and quickly.
The Croydon CCG officials told of how in future, older patients requiring orthopaedic surgery will be treated, but they will have less expensive equipment used on them in the procedures. The implicit message was that while this equipment is adequate, it may not be as long-lasting as the higher quality, more expensive kit used until now. But as the patients are elderly, they are unlikely to need the equipment to last so long. Welcome to Theresa May’s caring Britain.
A facility at Foxley Lane, which provides residential care for women patients with mental health issues, with some patients referred there after being in abusive relationships, is to be closed. That will provide an estimated saving of £700,000. Some of that resource will be used elsewhere in Croydon, for young black men with mental health problems, as “a matter of equity” the committee was told. Nothing was mentioned about the potential income from the sale of the Foxley Lane property.
A whole range of more expensive medicines will no longer be available to be prescribed by GPs in Croydon, who will also be instructed to no longer prescribe powdered milk for infants with certain digestion complaints.
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