Danger! NHS at risk from cuts and political inertia: Despite myths that health budgets are growing, NHS spending will be cut as funds are redirected towards social care
The NHS is in danger of being crushed between a funding cut and political inertia over the need to reconfigure services.
While the outcome of the chancellor's spending review will no doubt contain some financial sophistry to maintain the fiction that health spending is growing in real terms, in reality NHS spending is going to be cut as money leaches out to social care. Whatever George Osborne says on 26 June, the cuts will catch up with the NHS after the general election.
In the bloody battle between Whitehall departments over where spending cuts will fall, the Department of Health's case is not helped by others exploiting the NHS's embarrassing secret – there is a lot of waste. Avoidable prescription of expensive branded drugs, inefficient use of operating theatres, delays in pathology services keeping people in hospital and a lamentable record in exploiting IT are just some of the examples of where the NHS can make substantial savings. This is not lost on other ministers, and it certainly isn't lost on local government.
The £1.4bn clawed back by the Treasury from last year's underspend, at a time when dozens of trusts were finding it tough, has already softened up the NHS to the prospect of a tougher spending review.
But the government is now heading towards squeezing NHS funding while refusing to be honest with the public about the need to reorganise services.
This failure of leadership will mean that, instead of planning service changes to meet local needs, there will be a disorderly retreat as the money in some hospitals runs out. If this happens, reconfigurations will be determined by some Darwinian process of which trusts adapt best rather than through a rational process based on clinical needs and evidence.
At the launch of the Guardian Healthcare Innovation Awards two weeks ago, NHS Confederation chief executive Mike Farrar pointed out the simple truth about how an industry becomes more efficient. It consolidates production, changes the way it uses its labour costs and drives innovation.
But the NHS is struggling with all three of these. NHS England, clearly frustrated at the slow pace of service reconfigurations, has said it is going to make driving such changes the focus of its QIPP (quality, innovation, productivity and prevention) programme. But there are two risks here.
First, these changes will never be delivered in a political vacuum. The constitutional niceties of the mandate, separating politicians from the day-to-day running of the service, are irrelevant in this circumstance. Health secretary Jeremy Hunt is going to have to get his hands dirty by generating public debate about the NHS facts of life.
Second, NHS England's approach is in grave danger of looking like a nationally planned economy. Reconfigurations will be driven by its local area teams, NHS England policy director Bill McCarthy told HSJ. Clinical commissioning groups are in danger of being reduced to a hub for public consultations.
NHS England's anxiety about lack of progress is justified, but it needs to embrace the reality of the new commissioning system and make great efforts to do reconfigurations with CCGs rather than to them. This is not just because CCG support is one of the four tests for reconfiguration (along with safety, patient choice and engagement and clinical evidence). Public rows between different parts of the health service undermine public confidence – as the dispute over children's heart surgery in Leeds demonstrated.
There is something about the tone of NHS England's approach in its first few weeks which is troubling. It would require a particularly impressive scanner to detect any difference from the way the old regime behaved. If GPs feel they are being sidelined over the big decisions there will be trouble.
So every part of the system has to move its position if the inevitable funding squeeze is going to spur planned improvements rather than unplanned crises.
The health secretary has to have the courage to speak out, NHS England needs to embrace and empower local commissioners, and the commissioners themselves need to show leadership in making change happen.
The closing date for entries for the Guardian Health Innovation Awards is 28 June. Guardian Professional.
The NHS is in danger of being crushed between a funding cut and political inertia over the need to reconfigure services.
While the outcome of the chancellor's spending review will no doubt contain some financial sophistry to maintain the fiction that health spending is growing in real terms, in reality NHS spending is going to be cut as money leaches out to social care. Whatever George Osborne says on 26 June, the cuts will catch up with the NHS after the general election.
In the bloody battle between Whitehall departments over where spending cuts will fall, the Department of Health's case is not helped by others exploiting the NHS's embarrassing secret – there is a lot of waste. Avoidable prescription of expensive branded drugs, inefficient use of operating theatres, delays in pathology services keeping people in hospital and a lamentable record in exploiting IT are just some of the examples of where the NHS can make substantial savings. This is not lost on other ministers, and it certainly isn't lost on local government.
The £1.4bn clawed back by the Treasury from last year's underspend, at a time when dozens of trusts were finding it tough, has already softened up the NHS to the prospect of a tougher spending review.
But the government is now heading towards squeezing NHS funding while refusing to be honest with the public about the need to reorganise services.
This failure of leadership will mean that, instead of planning service changes to meet local needs, there will be a disorderly retreat as the money in some hospitals runs out. If this happens, reconfigurations will be determined by some Darwinian process of which trusts adapt best rather than through a rational process based on clinical needs and evidence.
At the launch of the Guardian Healthcare Innovation Awards two weeks ago, NHS Confederation chief executive Mike Farrar pointed out the simple truth about how an industry becomes more efficient. It consolidates production, changes the way it uses its labour costs and drives innovation.
But the NHS is struggling with all three of these. NHS England, clearly frustrated at the slow pace of service reconfigurations, has said it is going to make driving such changes the focus of its QIPP (quality, innovation, productivity and prevention) programme. But there are two risks here.
First, these changes will never be delivered in a political vacuum. The constitutional niceties of the mandate, separating politicians from the day-to-day running of the service, are irrelevant in this circumstance. Health secretary Jeremy Hunt is going to have to get his hands dirty by generating public debate about the NHS facts of life.
Second, NHS England's approach is in grave danger of looking like a nationally planned economy. Reconfigurations will be driven by its local area teams, NHS England policy director Bill McCarthy told HSJ. Clinical commissioning groups are in danger of being reduced to a hub for public consultations.
NHS England's anxiety about lack of progress is justified, but it needs to embrace the reality of the new commissioning system and make great efforts to do reconfigurations with CCGs rather than to them. This is not just because CCG support is one of the four tests for reconfiguration (along with safety, patient choice and engagement and clinical evidence). Public rows between different parts of the health service undermine public confidence – as the dispute over children's heart surgery in Leeds demonstrated.
There is something about the tone of NHS England's approach in its first few weeks which is troubling. It would require a particularly impressive scanner to detect any difference from the way the old regime behaved. If GPs feel they are being sidelined over the big decisions there will be trouble.
So every part of the system has to move its position if the inevitable funding squeeze is going to spur planned improvements rather than unplanned crises.
The health secretary has to have the courage to speak out, NHS England needs to embrace and empower local commissioners, and the commissioners themselves need to show leadership in making change happen.
The closing date for entries for the Guardian Health Innovation Awards is 28 June. Guardian Professional.
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