Take to the streets! British Medical Association action 4 march 2017

The British Medical Association is encouraging its members to join the protest against NHS cuts on March 4th with this synopsis of damage done to the health service:

  • 2014/15 spend on NHS £135 billion = 7.3% GDP. By 2020/21 this will decrease to 6.6% amongst lowest of any OECD country
  • We have fewer beds, 2.8 per 1000 pop than almost all OECD (Germany 8.3, Poland 6.6) in 2011 and STP plans are to decrease this between 5 and 20%
  • We have fewer doctors, around 2.8 per 1000 than most of Europe (only Slovenia, Romania and Poland have less)
  • Current spend per head per year in England = £ 20657, lower than other European country
  • The Five Year Forward View estimates a funding gap of £30 billion per annum by 2020/21. To close the gap the government have proposed £10 billion extra funds and £22 billion efficiency savings. However, when the Health Select Committee (Chaired by a Conservative MP) examined the figures, for current year its actually £4.5 billion
  • The important fact to hold on to is the eye watering £22 billion “efficiency” savings = cuts.
  • Hospital deficits grew form £859 million in 14/15 to £2.54 billion in 15/16. PFI is a significant contributor to the deficits (eg Barts Hospitals Trusts, the biggest PFI in the UK, pays approx. £2 million a week in interest payments)
  • The 4 hour A&E target is now only 88.4% (target was 95%)
  • Delayed discharges are >25% up from last year
  • Number of emergency admissions have gone up by 2.9%  (this at a time when all efforts are being made to keep people out of hospital) suggesting that it’s the truly ill who are attending A&E

The great and the good
Sir Robert Francis QC delivered a stinging rebuke to health secretary Jeremy Hunt and the NHS’s senior management in a recent interview with the Health Service Journal, arguing that the NHS was facing an “existential crisis” and that “depressingly familiar” pressure on the NHS meant it was “inevitable” that mistakes that led to the Mid Staffordshire scandal would happen again. He warned that the Five Year Forward View and Sustainability and Transformation Plans were “unrealistic” and a “make do and mend” attitude was “neglecting adult social care”. Elsewhere Lord Carter, the efficiency tsar, likened NHS policy makers to a dog watching television, saying: “He can see it, but he doesn’t get it.” (www.hsj.co.uk 10th February 2017)

Stalled reform?
Sir David Dalton, chief executive of Salford Royal Foundation Trust and Pennine Acute Hospitals Trust, has ten solutions for the NHS’s inertia problem that make it clear where the problem lies.

  1. The organising scale for hospital services should change to serve a population footprint of around one million. Reducing the number of ‘sovereign’ providers allows quicker strategic decision making, pooling service-line workforce and better use of estate, across multiple providers/sites, to assure delivery of better and affordable care
  2. Decision making takes too long, with 238 trusts determining their strategy for their limited catchment area. Inertia prevails when providers put their own organisational interests ahead of the population they should serve. This ‘power of veto’ should be removed and the role of a provider should be reset to deliver operational excellence to agreed quality standards.
  3. We should quickly consolidate inpatient surgery, especially high risk surgery, into single surgical centres serving populations of around one million, with 24/7 consultant availability.
  4. The number of CCGs should reduce significantly.
  5. Primary care needs investment and support but it must become part of a single-governed and accountable system for neighbourhoods of around 50,000 people
  6. Safe and affordable social care must be found for our most vulnerable citizens and provided ‘free at the point of need’.
  7. Investment in ‘digital’ is a must.
  8. The sheer volume of performance targets distorts real priorities. Current targets should be replaced with locally selected key performance indicators (from a national thematic list)
  9. Staff satisfaction should become a principal metric for assessing a board’s performance.
  10. Many staff are showing signs of fatigue and helplessness. New workforce supply strategies that result in safer staffing levels are needed.  From the HSJ February 8th 2017

Funding the NHS
Research published by Price Waterhouse Cooper (PwC) suggests that half the general public would pay more national insurance to help improve NHS services. Only a quarter of people were opposed to the suggestion.

The research, commissioned by PwC recruited 2,000 nationally representative UK adults (aged 18+) to take part in an online survey. The research was conducted between 8th – 11th November 2016 and results were weighted to nationally representative criteria.

The public is clear that the ‘free at the point of use’ principle must be maintained:

  • Only 26% of people believe that treatment of conditions which are predominantly caused by lifestyle choices should be funded in part by the patient.
  • However, 29% believe that the NHS should not fund treatments that only benefit people by a small amount.

Overall the findings show that confidence in the NHS needs to improve:

  • Just 16% of members of the public surveyed believe the NHS has become more efficient in the past 5 years – 45% disagree that it has become more efficient.
  • The proportion of people who believe the quality of health services should take priority over balancing the books for hospitals has increased to 76%, up from 68% last year.

The PwC poll asked 2,000 people about their preferred options for easing financial pressure on the NHS including options around prevention and incentivisation – the most popular suggestion was immunisation becoming compulsory where it is known to prevent illness, except where the person is allergic to immunisation (66%). The second most popular suggestion from the members of the public surveyed, at 52%, was that people who are given advice to lose weight to help their condition should not receive any other treatment for that condition until they lose the weight.