Health: Why city patients should be listened to before committing to change

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There are plenty of reasons to be proud of our local NHS – as well as plenty of good suggestions for improvement. But now it is in trouble.

Our NHS is caught between austerity budgeting and hostile ideology. The Coalition and Conservative governments since 2010 have squeezed the NHS between a hugely complex, expensive and ongoing reorganisation intended to put healthcare on a more commercial footing and continued reductions to healthcare spending while pretending to ringfence it.

Until now Sheffield’s NHS has managed to avoid the most damaging organisational effects of Government policy

Until now Sheffield’s NHS has managed to avoid the most damaging organisational effects of Government policy. Why? Partly because we’ve already had hospital closures and some restructuring of NHS community services; partly because of Sheffield’s long history of health partnerships; partly because the NHS here has been relatively efficiently-run and is well placed to attract and retain staff; and partly because of significant commitment from staff in all sectors to try and keep our local NHS on its feet.

Major privatisations have been avoided as yet although the two well-established private hospitals provide an increasing quantity of NHS treatments through local contracts or subcontracts.

Sheffield’s collective, radical and innovatory traditions must not be underestimated either – both in the dominant political commitment to keep the NHS as a publicly-owned and publicly-delivered service, and the commitment of many practitioners, particularly in primary care, to identify and address health inequalities in the city.

However, the financial squeeze has had severe and continuing effects. Nobody denies the need to reduce waste of increasingly scarce resources. The NHS, like all large organisations, definitely has its share of waste.

But when cost reductions are combined with a continuing rise in public expectations, the pressure increasingly lands on frontline staff whose levels of stress manifest in high levels of sick leave and increasing numbers who quit. So-called efficiency savings become counterproductive when they create new inefficiencies and costs, while service quality and availability are put at risk. For the first time, the NHS Sheffield Clinical Commissioning Group, which holds the main budget for the city, has to find £30 million savings this year. The Teaching Hospitals Trust reported its first deficit last year, to the tune of £7 million. Sheffield Health and Social Care Trust, which provides most of our mental health services, has seen its revenue income cut. Two Sheffield GP practices have closed this year while others have had their NHS income cut. The council’s social care budget was risking a £6 million deficit even at the start of the year. By 2020, if nothing changes, it is estimated that Sheffield’s health and social care funding gap will reach £235 million. Other areas may be even worse off.

To close these gaps NHS England has launched new Sustainability and Transformation Plans to deliver the £22 billion efficiency savings which its head, Simon Stevens, promised to the government by 2020. Sheffield has to link up with the NHS and other councils in South Yorkshire and Bassetlaw to produce an STP within a strict spending limit fixed from the centre.

STPs have been prepared under wraps because of the potentially radical changes which may be introduced, particularly to hospital services, although Sheffield partners have initiated some discussion with other local organisations. The role of the private sector remains clouded. Campaigners across the country are asking partners, especially councils, not to sign up to STPs which involve significant service closures.

Emerging themes of our local STP include ‘Care out of Hospital’; ‘Equal access to high quality specialist care wherever you are’; and increased practical commitment for organisations to work together.

The stated intentions are about improving services but details of the plan and its financing remain vague. Sheffield citizens will not see much of the STP until shortly before its final submission on October 21. We are promised consultation but this will be limited.

Linked to the STP are two proposals produced by a separate NHS partnership called Working Together covering Wakefield and Chesterfield as well as South Yorkshire. These will introduce radical changes to urgent care for stroke and to children’s surgery. A consultation will be launched this month and should provoke vigorous debate.

Sheffield Save Our NHS is a cross-cutting and politically unaffiliated group formed in 2011 to campaign against NHS cuts and privatisation and to reject changes which, for example, mean the loss of services without adequate replacement; handing more of the NHS to private hands, and the potential introduction of charges. We call on the Government to restore proper funding levels and on local NHS and council leaders not to cover up for national cuts; to provide full public explanations of the implications of their plans and other savings measures; to engage in proper consultation; and to heed the results before committing to contracts which will affect all NHS patients in Sheffield and the wider region.

n A public debate on the future of the health service, organised by Sheffield Save Our NHS and the Festival of Debate, is happening on November 22 at the Quaker Meeting House in the city centre from 7pm. Visit www.sheffieldsaveourNHS.co.uk or email team@sheffieldsaveournhs.co.uk for more information.