As the NHS sinks into an ever widening financial crevasse, who is actually in charge?
Media attention in the last 10 days, especially from the Sheffield Telegraph’s sister papers, has highlighted the leadership vacuum.
The funding crisis is as real as the ‘black alerts’ for hospital admissions issued for much of December and January
Jeremy Hunt and his ministerial team have been depicted by columnists and cartoonists as asleep on the job – with Hunt sunning himself on a deckchair probably awaiting helicopter rescue by a healthcare multinational if the ship sinks too low.
Hammond and May are steadfastly looking in the opposite direction. Have bucks ever been passed so fast?
The funding crisis is as real as the ‘black alerts’ for hospital admissions issued for much of December and January.
Last year, thanks to a windfall and a major fudge, the Department of Health managed to avoid being called out by the Treasury as a defaulter over NHS Trusts’ £2.45 billion deficit.
This year the reserve is at full stretch. Next year there is no extra funding. The year end deficit projection is currently £280 million worse than three months ago. Capital funds have been raided, meaning that less is spent on essential maintenance, let alone touted service transformations.
Hospital bed numbers, already less than in other countries, continue to shrink. Pressure from the underfunding of social care will continue. The Department of Health announced this month that it was jettisoning 500 of 1,800 staff.
Ambitious so-called Sustainability and Transformation Plans (STPs) gloss over the impact of financial ceilings; label locally based services unsustainable, not just because of staff shortages, but because they have to cater for Hunt’s unrealistic commitment to a seven-day NHS; substitute cheaper staff for experienced clinicians; and talk up the role of non-hospital care.
Even locally it’s hard to know who is in charge. Despite some advances in wider partnership, South Yorkshire CCGs, Councils and NHS Trusts seem to be squabbling over their rights in the STP (5CCGs) and Working Together (8 CCGs) conglomerations, each anxious about being ganged up on and losing resources, knowing that individual CCGs remain the legally liable bodies.
These attempts to rationalise the chaotic structures created by the Coalition government are resulting in the parameters for our services being laid down by groups which have no statutory basis and no formal public accountability.
There has been no significant national channel for public voice because the STPs were deliberately developed in secret. The NHS citizen’s voice network was suspended as soon as STPs were announced (though it has now been restored in amended form). Up to 2002 we could have expected Sheffield Community Health Council to have provided clear information and a strong representation of public views.
Labour’s Alan Milburn and his then adviser Simon Stevens (now head of the NHS) abolished CHCs to bring public voice under control. Each replacement has proved weaker than before. The current Healthwatch organisations try to represent patient opinion and investigate service issues but are restricted by legislation, national management and limited resources. Although the themes of Sheffield’s Place Plan predate the STP, local ‘conversations’ about the STP itself are only now being launched – but are they after the event? NHS Staff & Public Conversations
So what’s likely to happen? Everyone wanting the NHS to work is hoping the government will relent over funding but this seems unlikely. May believes that extra money will only delay ‘sorting out’ the NHS.
In the worst scenario this will lead to significant cuts, starting with A&E and maternity services, carried out on behalf of obscure STP boards with no legal standing. In England 19 hospitals face closure and in South Yorkshire hospital services face independent review over their ‘sustainability’. The words ‘accountable care’ being canvassed across the country in STPs appear highly misleading.
Expect to hear more about outsourcing and charges, not to mention smokescreens such as health tourism. We will discuss these in future columns.
Last year junior doctors decided stopping work and going on the streets was the only action left open to them in resisting an oppressive and unreasonable contract. Widespread public support helped push ministers and NHS bosses into agreeing significant changes – although doctors remain formally in dispute.
This government’s determination to look the other way gives us little choice but to take our concerns for the NHS to the streets. The #OurNHS call for a national protest, started by an alliance of national campaign groups called Health Campaigns Together, is now supported not just by major health unions but the British Medical Association and the Royal College of Nursing. NHS staff, patients, and health groups from all over England will assemble in London on March 4 to march to Parliament Square. (View an appeal at #Our NHS Promo A demonstration of public opinion difficult for Hunt to ignore. Join it if you can.
Coaches from Sheffield have been organised by Sheffield People’s Assembly with support from Sheffield TUC. See Save Our NHS