“Every little helps” is the tedious slogan of one supermarket: but it’s also true of the NHS. Yesterday’s announcement of an extra £250m towards the extra costs of “winter pressures” in the hardest-pressed Accident & Emergency units is better than not having £250m.
The fact that extra money is being made available is a testimony to the valiant campaigning efforts of local groups up and down the country who have challenged cutbacks and closures and ensured that any shortfall in services will be politically embarrassing major news next winter. But only continued public pressure can block further damaging cuts and the long-term risk of harm from under-funded under-staffed front line services.
The timing of the two £250m payments is significant, spanning as it does the two winters between now and the next election. David Cameron’s government is trying to buy a bit of peace and quiet to divert voters’ attention from their swingeing, unpopular “reforms” – notably the costly Health & Social Care Act that has siphoned more resources from patient care, further fragmented the NHS, and opened up even more services to competitive tender and privatisation.
For the NHS this ‘extra’ money is rather like being mugged and having £30 taken from your wallet, but a £1 coin and some small change handed back by a kindly thief, who promises to find you again next week.
Indeed the “extra” cash that’s being so generously handed out turns out to be money that’s already been milked out of the NHS budget through previous “cost savings” and micky ideas – such as the decision to punish inundated A&E units by paying them just 30% of the usual fee for repeat admissions or for where patient numbers rise above 2009 levels.
If ministers wanted to make changes that would ensure A&E services were more sustainable through peaks of demand, they should start by scrapping these counter-productive, stupid measures, and raise the tariff payment for A&E services to ensure busy hospitals can at least cover the costs of delivering properly staffed services, rather than seeing A&E as a huge financial liability.
Remember though, A&E is the part of the NHS the private sector doesn't want. And a bed shortage is good news for them too - NHS Trusts spending NHS cash on private hospital beds, and delayed patients “choosing” whether to wait longer or pay privately.
The claim has always been that any “savings” were to be recycled for investment back into the NHS: but in fact the past two years have seen £3 billion of NHS unspent ‘surpluses’ clawed back into Treasury coffers, while thousands of nurses have lost their jobs, beds have closed, and over a million NHS staff have suffered a hefty real terms cut in pay after years of pay freeze. Now it’s the Treasury that is graciously releasing back the £250 million, not the cash-strapped Department of Health.
We still don’t know exactly how the money will be paid out, or to whom: the Health Service Journal has heard that all spending will have to be signed off by a rag-tag army of bureaucrats: the Department of Health, Monitor, the Trust Development Agency and the “local area teams” set up by NHS England. If this is true, the sheer bureaucracy of obtaining money – and being told in detail what it can and cannot be spent on – is likely to add to the aggravation of managers and staff in the trusts under the greatest pressure.
Although David Cameron has said the extra money “will go to hospitals where the pressure will be greatest” there have also been hints that some of the money might not go to hospitals at all, but be funnelled into social care budgets that have been cut back for year after year along with the rest of local government spending. £3.8 billion of NHS money is already set to be carved out of the health budget to prop up social care from 2016, compounding the drive for NHS cutbacks.
This of course makes it possible that some of the extra millions could find their way into the coffers of BUPA whose care home division is touting for business from the NHS, offering to relieve the problems of “bed blocking” by frail older patients for whom there are no community-based services – at a price.
The shortage of beds and staff, the absence of viable community services to care for frail and vulnerable patients outside hospital – these are key problems that have been exacerbated by the cash squeeze. The threatened “reconfigurations”, closing more A&E units and hospital beds across the country, would drastically worsen the situation. The system itself is inadequate. As one exasperated manager wrote in a comment to the Health Service Journal:
“Last winter was a fiasco. Since then nothing has changed, there are no new staff, no improved facilities, no better systems or ways of working. We are heading into this winter with the same circumstances as last.”
Yet this reality is blithely ignored by those at the top. Indeed as campaigners protest, delays lengthen and chaos looms, the solution proposed to the widely-predicted “collapse” of A&E services is – closing more beds and hospitals, to concentrate services into fewer, more specialised units.
The whole senior tier of NHS management seems to be in denial, over the impact of cuts and closures, the realities of the cash squeeze – and the costs of privatisation. Every year the costs and consequences of the Private Finance Initiative contracts rise inexorably, milking even larger payments and profits from the shrinking NHS pot.
Twelve of the 30 trusts most challenged on emergency performance are saddled with large and growing commitments to service PFI bills for the next 20 years or more, with PFI hospitals that cost £2.7 billion to build, but which will cost upwards of £16.7 billion to pay back.
They aren’t the only ones with this problem. There are many more trusts with expensive PFI schemes are also struggling to make ends meet, their “turnaround teams” of accountants scrabbling around for cuts, as their capital costs gobble up an unaffordable share of trust income. Large schemes are in particular trouble - like Mid Yorkshire Hospitals Trust and Peterborough. The giant Barts Health, the biggest Trust in the country, is losing £2m a week while pretending this has nothing to do with the £115m a year and rising bill for a £1 billion PFI hospital scheme.
The high costs of some PFI hospitals are even driving “reconfiguration” and cutbacks in neighbouring non-PFI hospitals
– in Lewisham, where last week the High Court threw out plans to slash A&E and other services at (non-PFI) Lewisham and funnel their instead patients to nearby, struggling, South London, which had PFI bills to pay to investors).
– in NE London (King George’s, Ilford, threatened by the crisis in Barking Havering & Redbridge Trust, and the threat of cuts at Whipps Cross from the crisis in Barts Health),
– Yorkshire (Dewsbury Hospital losing services as the Mid Yorkshire Hospitals Trust struggles to cut costs)
– and in Staffordshire, where 1500 people turned out to a public meeting in Stafford to protest at moves to axe services at Stafford Hospital – that would force patients to trek 20 miles up the road to the PFI-funded £415m North Staffordshire Hospital in Stoke of Trent.
Against the backdrop of financial problems this huge, the “extra” £250m of NHS money refunded by Hunt and Cameron is a drop in the ocean.
Only public pressure got us this far: even more will be needed to keep services intact this winter and beyond.
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