Downing Street was accused by another former minister of “massaging” NHS cuts figures this week – just as locally NHS bosses propose more sweeping cuts that are beginning to look like the worst ‘reorganisation’ yet.
David Cameron and George Osborne “leaned on” NHS boss Simon Stevens to cut his NHS funding request in half before the election, former coalition minister David Laws alleged in a new book this week.
Laws sets out how Stevens said the NHS needed £16bn to plug a funding shortfall – and Number 10 responded “you’ve got to be joking”. Instead, Laws says, number 10 “massaged the figure down to £8 billion with higher and totally unrealistic efficiency savings”. The £8bn 'spending pledge' became the centrepiece of Tory election pledges and Jeremy Hunt’s mantra – fending off any criticism with the story that he’s merely implementing “the NHS’s own plan”.
Now it turns out that in fact this was Cameron and Osborne’s “own plan”. That far from “taking the politics out of the NHS" – the justification for the 2012 health act – the NHS remains deeply political, though less accountable now ministers can hide behind figures like Stevens.
Stevens denies Laws' claims – he could hardly admit that he’d caved to political pressure to mislead on the state of the NHS finances.
But Laws' comments back up what every NHS worker knows, what the Opposition is finally saying, what MPs on the Public Accounts Committee finally recognised earlier this month – and what OurNHS said before the 2015 election.
That taking an NHS black hole of £30bn and filling it with only £8bn, means in reality £22bn of cuts or 'efficiency savings'.
And that cutting £22bn can’t be achieved - unless there is to be a gouging out of what the NHS actually IS.
And on that note, worrying news has emerged this week from the Midlands.
Cash-strapped local health bosses there have suggested that they may in future no longer fund a wide list of procedures on the NHS for many patients, including hearing aids, cataract ops, vasectomies, and hip and knee operations.
Clinical Commissiong Groups (CCGs) in Wyre Forest, Bromsgrove and Redditch and South Worcestershire are currently consulting on the proposals, due to a £25million shortfall in government funding.
Worcestershire CCG says baldly: “We do not have enough money to continue to buy all the services that we currently do in the same way as we have done before.”
A couple of CCGs have already dipped their toe in the water of withdrawing such services – Essex announced in January it would no longer fund NHS vasectomies, and last October Staffordshire CCG started denying hearing aids for the first time in NHS history. The reductions in healthcare build on a longer tradition of short-term rationing fixes.
But the new midlands CCG proposals potentially suggest the most sweeping permanent reduction in the idea of comprehensive healthcare – at least since Devon tried and failed to introduce a similarly sweeping set of cuts, 18 months ago.
Most controversially, like Devon, the midlands CCGs also propose withdrawing treatment from patients with ‘unhealthy lifestyles’.
There was a huge backlash against such a move when Devon tried to ban smokers and obese people from routine NHS treatment, with Eric Pickles calling the move ‘unBritish’, and Devon backed down – but commentators at the time warned it was the shape of things to come.
So will there be a Devon-sized outcry this time?
Questions are being raised as to whose needs are served. Clive Peedell of the National Health Action Party pointed out all the services suggested for the chop “are services of choice for the private sector and people will have to pay to have them. It won't stop there once the principle is established."
For Osborne and his fellow travellers, the attacks on the welfare state are not – as IDS pointed out this week – in the interests of the national economy. Instead, a low tax, small state ideology, driven by the toxic narrative of the ‘undeserving’, meets the realpolitik of the demands of transatlantic healthcare investors.
Clare Gerada, former head of the Royal College of GPs, is worried. She told OurNHS "The idea of a comprehensive, universal healthcare service is now under sustained attack. Restricting access to these services is clinically short-sighted, economically unnecessary and politically calculating. The only people who'll benefit are the private healthcare companies keen to offer these services. It's also deeply worrying to see the language of the 'undeserving', creeping into healthcare - we've seen how much damage that's done in the benefit system."
To address the cash crisis, Simon Stevens has told the NHS to divide itself into 44 regional “Strategic Transformation Plans” (STPs) or “footprints” to make his 5 year plan happen, with local leaders including the star of Osborne’s northern powerhouse, Manchester council’s Chief Executive Sir Howard Bernstein and others.
Richard Vize writing in Guardian Professional Networks tells us what this means - “by the summer, we may well have some specific details on service cuts and closures…If […] not, this latest planning process will have failed…The financial crisis is now so severe that it is all but impossible to see a good outcome.”
Most of the political and NHS establishment seems keen to assure us that the last thing the NHS needs is more reorganisation.
But the cash crisis is resulting in some sweeping changes to what the NHS actually offers across the country, well off Westminster’s radar.
Guardian columnist Polly Toynbee suggested at a Kings Fund meeting yesterday that these politically imposed £22bn cuts plans (as set out in Stevens' Five Year plan and the 44 new STP ‘footprints’ set up to deliver them) “are beginning to look like a reorganisation so big you can see it from space” (as David Nicholson famously said of Lansley’s 2012 Health Act).
Mark Rogers, CEO of Birmingham City Council and recent appointee to the new team leading on NHS England's Sustainability and Transformation Plans, says the plans will give them the opportunity to make “pretty seismic changes”.
Meanwhile the NHS Bill - the main attempts to seriously address the mess and bring the NHS back towards the comprehensive, universal, tax funded NHS we’ve come to expect – was earlier this month talked out in parliament by Tory MPs (and enjoyed only lacklustre support from Labour backbenchers) who claimed the NHS couldn’t face another reorganisation.
Caroline Lucas MP, who presented the Bill, commented on the latest Midlands developments, saying “There is no doubt that our NHS is facing an existential threat. … The continued marketization of our NHS – with all the linked inefficiencies and costs – costs us dear.”
But the bill has been kicked into the long grass by MPs for another couple of months, at least. Can the founding principles of NHS last that long?