CROYDON COMMENTARY: NHS bureaucrats try to deny that they are planning significant closures to south London’s hospitals, while working on a plan which offers two ‘hypotheses’, neither of which include maintaining all five of the current sites.
Here ANDY FORD, who works in the NHS, offers some background to the latest round of cuts
It is time for action.
There is a government plan which has the potential to transform the NHS into a largely privatised and fragmented version of itself, with A&Es all over the country under threat, maybe one-third of maternity units, and the loss of hundreds of thousands of jobs.
It is called STP – “Sustainability and Transformation Plan”. But the union Unite has more correctly named it as “Slash Trash and Privatise”.
The excellent Keep Our NHS Public has offered some useful background to what lies behind STP.
For a start, the NHS is not overspending.
The NHS is carrying out more treatments and providing more care than it is funded for. The plan by Simon Stevens, the chief executive of NHS England, the Five Year Forward View, estimated a £30 billion gap between resources and patient needs by 2020-2021. The government says the £22 billion gap has to be met by “efficiencies”, reductions in demand and slowing growth. And that means cuts in services and staff.
Fiddling the figures
In 2015, the then Chancellor, George Osborne, said the NHS would get £7.6 billion “extra”, that is, above inflation, over the five years to 2020-2021.
The government’s claim that the NHS has had £10 billion “extra” includes £2 billion from the previous year. It’s not just trades unions who are flagging this up as fiddling the figures: Conservative MP Dr Sarah Wollaston, who chairs the Commons health select committee, has also highlighted this sleight of hand with billions of public money.
Department of Health cuts to other budgets of more £3 billion – capital expenditure, pay, drugs, training and Public Health initiatives – reduced the total “extra” funding to £4.6billion. Because NHS inflation is higher than the economy average, that £4.6 billion is worth less than £900,000 in real spending terms.
Meanwhile, the funding to NHS Trusts has been cut by nearly one-fifth, 18 per cent, in the internal market’s “tariff” (the amounts they are paid to carry out treatments).
NHS Trusts, such as in Croydon, have already cut their costs by 13 per cent – often at the expense of staff working harder with fewer staff, and having suffered a real terms drop in wages of 16 per cent since 2010.
That still leaves a 5 per cent gap.
In 2015-2016 Trusts across England were in deficit by about £2.5 billion. That’s being reduced to nearly £0.6 billion in 2016-2017 because they are getting additional funds from the Sustainability and Transformation Fund. But that money was meant to be used for development, not to plug the deficit.
They are still faced with having to make £3 billion worth of “cost improvement” cuts – which is just not feasible given the increasing need for health services.
With needs increasing, if there isn’t more funding, it will mean more rationing of service provision – as is happening in Croydon, with the withdrawal of some treatments, such as IVF – or longer waiting lists, or charging for services. Or some combination of all of those.
NHS England (which oversees commissioning of services) wants to “slow demand” by 2per cent. They claim it’s possible by public health measures and by “transforming services” – such as transferring services out of hospitals. Again, this is something which has been suggested in the South-west London STP report and by the Croydon Clinical Commissioning Group’s plans.
Much of this is wishful thinking.
Public health measures are long-term. They won’t stop people having heart attacks, getting cancer, or suffering the illnesses of older age in a year or two. Even long-term, it may just delay the time when people do become ill or infirm and need health care.
It is dubious if care in the community is appropriate for many treatments, for example requiring urgent pathology tests or close monitoring, and community health services have not been developed to provide such care.
Hospital services are likely to be run down or closed in return for promises of investment in community care – for which there is little extra funding.
Sustainability and Transformation Plans – the STPs – are being rushed through secretively, with virtually no public consultation, and due to be signed by December 23 this year.
Now is the time for action.
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