Wednesday, 8 July 2015

Not safe in his hands

Most people – including those who voted for him – knew that the NHS was never going to be safe in David Cameron and the Conservatives’ hands. Far from creating safety, they have created an NHS crisis. Services are going backwards and patients are paying the price

Starting with a damaging top-down reorganisation (broken promise) which wasted £3bn and harmed patient care, they have made it harder to see a GP and sent demand for A&E soaring.

Whilst promising to protect the NHS, the government has stupidly cut social care under the guise of efficiency savings in local government funding. 300,000 fewer older people are now getting home care help, meaning that too many older people are ending up in hospital. Emergency hospital admissions for elderly people increased by 22% to 2.2m a year between 2005-06 and 2012-13, while spending on social care has plunged by almost a third to £5.46bn.[1] It’s no surprise that delayed discharges at a record high.

This week, Age UK said that more than one million elderly people are not receiving the home social care they need.[2] The charity’s analysis showed that more than half of the 1.1m people who said they struggled to wash had no help, as did more than a third of the 400,000 who had difficulty using a toilet unaided, and 210,000 out of 650,000 who found it hard to leave bed alone.
Yet the government is already cutting a further £1.1bn in social care this year, described as ‘absurd’ by the Association of Directors of Social Services.[3] They predict that this will mean shorter home care visits and even fewer people benefitting from care. 

As I write, the Conservative-led County Councils’ Network is predicting a £1bn gap in the care home market, caused by the last coalition government’s Care Act[4]. The research, by health market consultancy Laing Buisson, said this would mean councils having to pay higher fees for each care place and a scarcity of care homes into which the NHS could discharge elderly hospital patients.[5]

As a result of this analysis, the Conservative chair of the Local Government Association’s  Community Wellbeing Board has said that the rollout of the second phase of the Care Act should be postponed and the £590m earmarked to fund the reforms should diverted to help plug the gap in social care funding.

Last week, she told the government that it would be “deeply damaging” to press ahead with the reforms, including a cap on care costs, in the face of a funding gap that is increasing by £700m a year.[6] She said the approach councils had taken to date to manage shrinking budgets – including cross-subsidising social care through cuts to other services – was no longer sustainable.
But it isn’t just health and social care for the elderly which is increasingly getting worse and failing to cope.

Last year over a million people waited over four hours in A&E. Over one in four people now wait a week or more to see or speak to a GP, or don’t get an appointment at all. The waiting list for treatment is at a seven-year high. The vast majority of NHS staff say David Cameron’s reorganisation harmed patient care – is it any surprise that clinical negligence claims are up 80 per cent since 2010?

The Conservative/Liberal Democrat coalition government cut nurse training places, which has created staff shortages – forcing hospitals to recruit from overseas or spend vast amounts on expensive agency staff. It simply won’t do for Mr Cameron to blame the NHS for recruiting agency or overseas staff when he took the decisions which have caused the problem.

David Cameron was not straight with people at the election on the NHS. He promised to protect the NHS but refused to set out where a single penny of the extra money it needs would come from. He was not open about the scale of the deficits that hospitals face this year – which could require staff cuts, bed reductions and even service closures.

Last year, NHS Trusts in England reported a total deficit of £822m in 2014-15, compared with £115m the previous year.[7] This year, More than 80% of NHS acute trusts are reporting that they will be running at a deficit this year – estimated to be more than £2bn in total.[8]

Mr Cameron told us that cancer services were improving, but then tried to sneak out a document admitting the two-month waiting-time target won’t be met for another year

He has also committed to £22bn “efficiency savings” but refused to spell out whether this will involve staff cuts or service closures. Yet Norman Lamb, who was the Health Minister until May this year, says that the plan for £22bn efficiency savings outlined in the NHS Five Year Forward View are ‘virtually impossible’ to achieve. He said the document’s financial assumptions were “completely heroic”.[9] Followers of Yes Minister will recall that “completely heroic” actually means “wildly optimistic; well beyond any realistic expectation of delivery.”

In Sheffield, we are very fortunate – I say fortunate, but actually it’s due to the tremendous hard work and professionalism of NHS staff at all levels – to have high-performing acute hospital trusts. Although this month the Care Quality Commission gave a wake-up call about some services to the Health and Social Care Trust, it also found other of its services to be outstanding.

However, Mr Cameron is determined to press ahead with his plans to make a massive shift in NHS resources from the poorest areas with the lowest life expectancy and highest morbidity to the wealthiest areas with the highest life expectancy and the lowest morbidity. It’s simplest to understand this as shifting £40m a year from Sheffield to Surrey’s health services.

Further, I anticipate that the proposed changes in primary health care funding will bring major problems for some GP practices in Sheffield. Stories about particular GP practices – for example, Devonshire Green[10] and Beighton[11], in which I was heavily involved - have already appeared in the local media, but these only reflect the opening skirmishes.

I predict that in the next few weeks we will publicly learn that some GP practices will announce that they are no longer going to be financially viable or capable of delivering the quality of service they think is essential for the resources available.  This will herald a damaging shake-up of primary care services in the city with areas with some of the biggest health challenges taking the biggest hit.
The NHS is simply not safe in Mr Cameron’s hands.