Pastygate, Leveson and the local election results have kept the NHS out of the headlines. For now.
With the Health and Social Care Bill limping over the finishing line to enter the statute book, “Pastygate”, Leveson and local election results have kept the NHS out of the headlines. For now.
Yet, look closer and in places, the strain is showing. Not everywhere, not to the same extent. But the impact of public sector austerity, and the financial squeeze on both NHS and local authority budgets, is already feeling its way through to services.
Inflation undermined the Tory claim of a real terms increase in NHS budgets, with £500 million of NHS funding recently clawed back by the Treasury.
Locally though, financial squeeze is concentrated in two areas. The first is staff wages, with most staff looking at 2-3 years wage freeze, probably longer. The second is hospital Trusts, through cuts to patient treatment payments.
Another pressure is the selective but growing influence of the private sector in running hitherto NHS services, in which price is a key factor in awarding the tender. Two major community services tenders, in Norfolk and Surrey have been won by Serco and Virgin respectively.
In Surrey, Virgin beat off the Tories’ poster-boy for NHS social enterprise, Surrey Community Health, whose chief executive previously graced the Tory conference platform with Andrew Lansley.
The financial terms of these tenders are usually kept secret – but one recently uncovered (discovered by a journalist in the Commons’ library) is the franchise deal for a private health company, Circle, to run Hinchinbrook Hospital in Cambridgeshire. Circle’s reward will be £30 million of public money if it eliminates the hospital’s debt of £40 million.
For many hospitals however, making ends meet is a struggle: the government has been busy doling out subsidies for a growing list of hospitals – over 31 shared over £400 million in 2011/12.
So what might be the main “crisis” signs in your local NHS services? Here are five things to look out for:
• Long trolley waits in A&E. Long trolley waits for A&E treatment were a familiar story in the Major years. Labour set a target of 98% of patients to be seen and moved on from A&Es within 4 hours. This standard has a strong safety angle: in essence, overcrowded accident departments mean things are missed. Andrew Lansley reduced this to 95% but there is growing evidence that Trusts are struggling to meet this, and, as nursing unions highlighted recently, excessive trolley waits are on the rise to reach an 8 year high.
• Waiting times increasing. Waiting times went up by an average of 6 per cent from 2010 to 2011, with patients requiring a new knee having to wait 99.2 days, the Patients Association report found.
• Savings programmes dominate. Savings programmes are driving the hospital’s priorities to unprecedented degree. This will get worse next year, with Foundation Trust regulator Monitor setting an eye-watering 5% “downside“ cuts requirements for hospitals over the next three years, acknowledging these “will have to be delivered on an even more ambitious scale going forward”.
• Nurse staffing levels being cut. A consequence of tough savings programmes is that nurse staffing, as the biggest single expense, is being gradually targeted in many places, with less frontline staff and senior grades stripped out. Though no central figures are kept, the Royal College of Nursing estimates that 26,000 posts were lost from frontline services over the last two years.
• NHS impact of local authority cuts. The NHS relies on local authority social services to help discharge its elderly patients in particular. Under Labour these discharge delays fell rapidly, but they are creeping back. A joint survey carried between Nursing Times and charity Age UK found 85% of respondents believed more patients had experienced delayed discharge from hospital compared to the previous year. The majority, 82%, said cuts to council social services had contributed. With local authority cuts of around 28% over the next few years, NHS and local authority staff know this will only get worse.
The NHS has just wasted two years dealing with an ever changing top down reorganisation that many experienced NHS staff are grappling to understand fully – at a cost of between £2-3 billion. But these early warning signs are alarming, given we almost certainly face another 4-5 years of austerity, courtesy of their Spending Reviews.