Thursday, 13 February 2014

NHS financial squeeze unsustainable in face of increasing demand

NHS financial squeeze unsustainable in face of increasing demand It's time the health service admits it is unlikely to meet future demand with ongoing funding crunch.

The NHS is now at a more pivotal stage than it has ever been since I became a GP more than 30 years ago. The financial squeeze on health services will get much tighter over the next five years, with spending per person on the NHS falling by 9%. The Institute for Fiscal Studies said that even if the NHS budget remained protected from cuts, the growth in population would lead to big real terms cuts. The truth is that the NHS protection myth is over. Even if health spending continued to rise with inflation, as it has since 2010, age-adjusted spending per person would be 9% lower in 2018 than in 2010.

A third of NHS trusts have reported themselves in deficit. Sir Robert Francis QC, looking at the year since he reported on Mid Staffs, called for health services to be "frank" about their funding crunch: lack of resources was rooted in the nursing care scandal. He's right. It's time every part of the health service was honest that no more efficiency saving blood can be drained from it, as £2.1bn more is extracted to shore up council care budgets.

The Health and Social Care Act has introduced competition at every level, between primary care providers and secondary care services, from NHS providers to private providers, and even at clinical commissioning group level where there is an imperative to privatise commissioning support units. This is causing fragmentation.

The overall effect of all these measures on healthcare is set to be a declining share of gross domestic product, which is unlikely to be enough to keep pace with the demand for services, fuelled by the spiralling costs of managing diseases such as obesity, care of older people, depression and diabetes. Cuts in expenditure in other areas, such as welfare benefits, will also have a knock-on effect on demands on the NHS.

Following the Health and Social Care Act, considerable financial resources are being used to stimulate the private sector and transfer or outsource large numbers of healthcare initiatives and jobs to the private sector. Using public money to help the private sector and introducing market forces into healthcare are anathema to everything the NHS stands for. There is also the wide-scale pay decrease that NHS staff have to contend with at a time of rising family expenditure, as well as a reduction to pensions.

The NHS has not faced this level of challenge in its history. The universal healthcare provided by the NHS is in serious danger of becoming unsustainable.

To deal with the increasing demand on the health service, the government must allow NHS staff to use their own clinical judgment in order to make workable improvements. It's about doctors having the freedom to make change for the benefit of the health service away from politically motivated interference.

The profession wants modernisation of the NHS and to provide quality care to patients, not its destruction. If the coalition truly wants to reduce waste and inefficiency, it should abandon the mantra of competition, market forces and choice of provider and instead work towards developing a co-operative and integrated healthcare system, with collaborative commissioning at the heart of how precious resources are utilised. The risks of longer waiting times, the clogging up of primary care services, cancelled operations, instability in some major hospitals, and sinking staff morale looms closer. Acting now ensures that some of the damaging effects of the reforms might be reversed. Guardian Professional.

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