Storm warning for the NHS

It was difficult to miss the early warnings to people in the vulnerable areas that Hurricane Ophelia was headed for Britain and Ireland. The storm signals were taken seriously, writes John Lister.

But health ministers have closed eyes and ears to all the danger signals that the NHS is facing a major crisis this winter as a result of the continued, relentless cash squeeze imposed since Tory-led governments took office in 2010. It’s hard to avoid the conclusion that they are happy with the way things are going … downhill fast.

Waiting lists have soared above 4 million, targets for waiting times are increasingly being missed – whetting the appetites of private hospital bosses for increased numbers of paying patients seeking to escape long delays.

Desperate letters have been written to hospital trust bosses urging them not to give up on achieving the increasingly unreachable target of admitting or discharging A&E patients within 4 hours. Despite endlessly repeated plans to divert patients into alternative services that have still not been put in place, emergency admissions have risen by 14% since 2010 – while nursing staff numbers have risen by 0.7%, and are now beginning to decline.

Before the 2017 election the Royal College of Emergency Medicine argued the need for an extra 2,200 beds to give A&E departments any chance of reducing the waiting times towards the 4-hour target. But up and down the country the only plans on offer are looking to cut even more beds – plunging even further below the levels of provision in comparable countries.

Far from acting on the warning signs, everything ministers have done, from a brutal cap on pay increases to scrapping bursaries for NHS professional education, and failing to offer any pre-Brexit guarantees to thousands of EU nationals working in the NHS has made things even worse.

Now even the normally timid King’s Fund has echoed warnings from the Royal College of Nursing that nurses are feeling the strain of 40,000 unfilled vacancies and rising pressure to deliver “productivity” improvements.

Staff shortages have also been flagged up by the Royal College of Radiologists, noting that consultant numbers have increased by just 3% since 2013, while the numbers of CT and MRI scans have risen by ten times as much. Two thirds of vacant posts have been unfilled for over a year.

It’s not just acute hospital services stretched to breaking point: professional bodies representing psychiatrists and mental health nursing staff have exposed the mounting problems of both adult and child and adolescent services – and the fact that while ministers promised increased spending, many local Clinical Commissioning Groups have been planning and implementing cutbacks.

The Care Quality Commission’s latest report itemises many of these issues and concludes with a warning: “We are also seeing a whole health and care system

that is at full stretch, not just social care.”

NHS Providers, the body representing hospital and mental health trusts, has also been voicing increasingly forceful ‘Winter Warning’ demands for more resources to avert a crisis even worse than last winter’s disastrous shortages of beds and services that hit news headlines. Indeed some hospital trusts have remained at crisis point throughout the summer of 2017, with some declaring ‘Black Alert’ status for lack of beds in August and September.

To bang the point home even Baroness Dido Harding the (privately insured) Tory peer hand-picked to take the chair of the regulator NHS Improvement, told a pre-appointment hearing of the Commons Health Committee that even she has noticed that “Everything I have read, everyone I have spoken to tells me the system is at full-stretch.”

But what has been the response from health ministers? A combination of stupid, transparent lies, claiming increased spending, staff and improved services despite all the evidence, with absurd and impractical new ideas such as trying to prevent ‘walk in’ patients accessing A&E departments without an appointment – negating the very idea of an emergency service.

If anyone was daft enough to implement this it would have the effect of increasing pressure on GP and ambulance services, but would also require bouncers and penalties to deter worried people seeking emergency treatment without first being “referred”.

Meanwhile behind the scenes NHS managers are being pressed to move ahead with unpopular and potentially dangerous cuts and plans for “savings”: clinical commissioning groups are looking for ways to ration or exclude various services, while NHS trusts seek mergers, downgrades of services, closures of beds and whole hospitals and sale of land and property assets.

NHS England recently conducted a ritual bullying session, summoning top managers from 60 trusts with poor A&E performance to a telling-off, part of which involved the regional director of Midlands and East of England Paul Watson forcing one group to repeat louder and louder the meaningless mantra “we can do it.”

No they can’t. But what can happen is bullying and bad management lead to catastrophic failures of care. In Basildon, one foundation trust financial director has been effectively forced out when the board voted to overrule him and sign up for an extra £5.5m of cuts.

The danger is that where managers prioritise such cash savings over patient care it could lead to one or more repetitions of the disastrous failures of care in Mid Staffordshire Hospitals a decade ago, where chronic staff shortages were made worse by a bullying culture that suppressed concern over quality of services to patients.

None of this has to happen – the problems are all based on the real terms freeze in funding imposed since 2010, which flowed from a political and ideological choice by George Osborne to impose an austerity regime constricting public spending, with the NHS freeze coupled with outright cuts in local government funding and social care.

Theresa May’s weak and wobbly government with its wafer thin majority has clung to the same policies – but having suffered humiliating losses in previously safe seats many Tory MPs are now vulnerable to pressure by a determined and broad-based campaigns. Now is the best-ever opportunity to pile pressure on them to demand a change of course from chancellor Philip Hammond in next month’s budget.

Already there are signs of retreats from planned cuts – in Essex and Devon – and from the ridiculous plan to privatise NHS Professionals, the body that saves the NHS £70m a year in fees for agency staff.

The chances of forcing retreats and a rethink on funding can be increased by the building of a broad-based, united effort by campaigners, linking up with health unions and demanding local politicians of all parties stand up and fight for proper funding and quality health care and an end to the savage cap on pay that is undermining recruitment and retention of staff.

That’s the goal of the campaigners’ conference called on November 4 by Health Campaigns Together, with top speakers from UNISON, Unite and BMA and film director Ken Loach and many more, as a step on the road to a stronger and sharper campaign. Join us in Hammersmith Town Hall, and book your place and free lunch here.


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