Friday, 13 December 2013

The real NHS 'crisis' this winter is the constant threat of unrealistic cuts | Colin Leys

The real NHS 'crisis' this winter is the constant threat of unrealistic cuts | Colin Leys Hospitals are overwhelmed this winter, that is true, but they are being run down to make room for private healthcare.

Before the invention of email, the Post Office took on thousands of students every December to help deliver the predictable spate of Christmas mail, but it was never called "the Post Office Christmas crisis". So why should the equally predictable winter spike in illness be an annual "winter crisis" in the NHS? Why should opening extra wards and hiring more nurses from abroad be a drama? After all, since 2000 well over 100,000 nurses have come from abroad. Don't hospitals plan for fluctuating levels of need over the annual cycle?
The short answer is that they do, but they no longer have sufficient funds to implement the plans. Since 2010 the government claims to have protected the NHS by keeping its real income stable. Even if this were true the rising healthcare needs of a growing and ageing population unmatched by any increase in resources would by now have brought it close to breakdown. But the real income of NHS hospitals is not being kept constant. It is being cut by 4% year on year, the theory being that this will make hospitals more efficient by forcing them to do more with less. But unlike most commercial businesses, where annual efficiency gains may be achieved by replacing labour with labour-saving technology or by outsourcing work to cheap labour countries, in healthcare the room for either kind of saving is narrow. Most NHS hospitals are at the limits of good practice with the staff they now have, often with bed occupancy rates well above safety levels. On top of this, in 2015 £2bn is due to be transferred from hospitals to non-hospital providers – who, it is safe to predict, will mostly be private – pushing many hospitals towards financial collapse.
Various parties pretend to have solutions to the problem. Jeremy Hunt intervenes to replace A&E departments in two London hospitals, and hopes to shut another in Lewisham, effectively closing three full-service hospitals. NHS England's medical director Sir Bruce Keogh proposes closing up to 70 A&E departments across England, with unforeseeable consequences. Health watchdog Monitor, many of whose senior staff are from consultants McKinsey and KPMG, has published proposals to close the NHS funding gap, accompanied by 349 slides purporting to demonstrate big savings opportunities across the whole NHS. It is on the same lines as McKinsey's controversial 2009 report, commissioned by the Department of Health, Achieving World Class Productivity in the NHS, which is equally full of unrealistic assumptions about how billions could be saved by doing things differently.
In addition, Monitor also proposes to set next year's NHS tariff – the list of prices for NHS treatments – at a level which it acknowledges is liable to push an additional 37% of hospitals into deficit if sufficient cuts aren't made, while maintaining in its impact assessment that the overall effect will have "positive impacts for patients".
All these interventions in the name of improving or even "saving" the NHS are pathological symptoms of a basic truth which no one in authority is willing to admit: if providers' revenues continue to be cut for another year, let alone another parliament – as Monitor says we must assume – comprehensive high-quality care for all will begin to be seriously eroded. No genuinely realisable savings are going to avert this. A&E departments are under siege. Hospital wards are understaffed. GPs are overwhelmed. In some areas you can now only get cataract surgery for one eye and no client commissioning group now pays for treating varicose veins. Community health services are going the way of social care, withcontracts awarded to private companies, which cut staff and service quality.
The NHS is being run down to make room for private healthcare companies. Anyone who believed that NHS trusts would be free to compete on a fair playing field must now realise that this was never the idea. Voters have now begun to grasp this, with a sharp shift in opinion against private providers. People are now beginning to see for themselves what the Health and Social Care Act really means. The reality is displacing the spin. The Guardian

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