Last week’s general election was being called a political earthquake. The Conservatives were forced to retreat and most commentators had to eat their words. Nevertheless a few days later the same old faces are being wheeled out in government, including, probably to his surprise and even regret, Jeremy Hunt.
Outwardly the landscape looks much the same. But we must surely expect there has been worse damage to May’s government than the current cowboy repairers can cover up. Strength of feeling about the NHS crisis certainly fed the opposition to Theresa May.
It was clear from the various manifestos that Conservative proposals for the NHS stood in isolation. All other parties (including the DUP) wanted more NHS funding and had other proposals both for health and social care.
The uneasy status quo which will be the result of May’s current tactics does the NHS no favours. Undoubtedly we will be told by Hunt that previous plans remain on track.
Unless any concession to the DUP means more NHS funding across the board, there will be no additional resource this year at least. Resistance to closure and cutback programmes being introduced through Sustainability and Transformation Plans (STPs) will increase and it’s unlikely the Tory minority government can withstand a proper Parliamentary challenge on any serious social issue.
The Labour Party has a huge opportunity to demonstrate its capabilities by leading an alliance of all opposition parties against austerity budgeting and in particular on the NHS. I would hope that Labour consults and then tables its own more detailed plans for the NHS (and social care) .
Without clear and open debate, both nationally and locally, more resource-driven decisions about NHS provision may be taken initially behind closed doors in order to forestall opposition.
Unfortunately this could already be happening here in South Yorkshire, despite assurances from the NHS about transparency. Health and care is being fast-tracked into an accountable care system (with the help/reward of some extra funding).
Indeed NHS managers claim that an Accountable Care Partnership (ACP) is already in place for Sheffield – though it meets in private, with convoluted and bureaucratic accountability and has only shaky statutory basis.
What’s at stake? A review of hospital provision is being undertaken. Mental health services are being reconfigured under the Quality Improvement, Productivity and Prevention procedure. Sheffield Teaching Hospitals Trust is taking an increasingly proactive role in social care, working with consultants Newton Europe who claim to improve service levels while delivering a 10% to 30% reduction in staffing requirements. Meanwhile decisions will be taken (in public) later this month (June 28 at Doncaster CCG) about hyper-acute stroke and children’s surgery at a joint CCGs committee in which a 75% majority decision is supposedly binding. The issue which will most immediately affect the most people in Sheffield is Urgent and Emergency Care. A long-promised consultation was postponed to September because of the election though details of the proposals may become available earlier.
On funding, the bad news is that South Yorkshire is one of the five English areas which are highest above its funding allocation target under criteria brought in by the Coalition Government which gave more weight to the number of older people in an area rather than social deprivation.
This means that we will get the lowest proportional funding increases in the country from an already inadequate pot, that flexibility (e.g. for winter pressures) will be reduced and that cuts could be on the way. (Remember that the STP currently demands a budget saving of over 14% by 2020.) Slightly better news is that some of the good and pioneering work being undertaken here is being recognised by additional funding, like the £1.8m for Improving Access to Psychological Therapies. Staffing is also a problem with Sheffield feeling recruitment pressure for perhaps the first time. In a recent recruitment drive, half the candidates offered posts by Sheffield Health and Social Care Trust turned them down. Shortages of junior doctors, GPs and community nurses are increasing.
Against these resource problems the Sheffield and South Yorkshire NHS does have skills, commitment, interest in innovation and public loyalty which must be built on.
The election of Labour MPs across Sheffield and South Yorkshire (including Hallam’s newly elected Jared O’Mara, a disability campaigner) plus Labour majorities in local councils (which are part of ACPs) means the Labour Party has a key role to play in ensuring that local NHS decision making is genuinely based on patient need rather than austerity budgeting.
They need to be proactive both locally and in Parliament and to demonstrate this publicly, building credibility and helping to stimulate the public vigilance which will be necessary to counter the pressures of top-down efficiency and savings targets and the risks of piecemeal privatisation as long as these are on the agenda.
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