At a first glance, the notion of an NHS “reset” conjures up images of Jeremy Hunt as an inexperienced IT technician, examining your faltering piece of equipment studiously but having absolutely no idea what the problem with it might be. Rather than admitting any shortcomings, the technician instead confidently tells you to “turn it off and on again” in the vague hope of a miraculous solution emerging, leaving his lack of knowledge unexposed.
The truth about the reset, revealed in a document entitled, Strengthening Financial Performance & Accountability in 2016/17, slipped out on the last day of term to avoid Parliamentary scrutiny doesn’t quite fit in with this simplistic image, but it isn’t far off.
The document is effectively an admission of failure from the Government, one more lengthy than that of the NHS Improvement Chief Executive, Jim Mackey, who recently acknowledged that “the NHS is in a mess“ but it is no less frank or astonishing for that. So while the scale of the problems facing the Health Service is now finally being acknowledged, there is a critical failure from the Health Secretary about the causes of the current crisis and some of the solutions mooted risk exacerbating the situation.
The problems facing the NHS have never been more serious. Trusts currently face a £2.45 billion deficit and the Department of Health only avoided busting its £118.3 billion budget in 2015/16 through what the Health Committee called “accounting devices to balance the books“ and the good fortune of receiving £417 million more than planned in extra national insurance receipts because of an “administrative error” for which it will not be punished.
So what of the solutions offered? Many of the actions in the Report appear to offer only a short-term focus, which it is difficult to square with Tory rhetoric about long-term plans, while others seem to continue the failed policies which got us into this mess.
The short-term focus is exposed on page nine of the Report, which calls for measures for “tackling excessive paybill growth” which any NHS worker who has has year on year pay freezes will struggle to recognise. As the Health Committee found only a matter of weeks ago, “a long-term pay squeeze has unintended consequences for recruitment and retention, which may drive higher costs.” Some of these higher costs include the surge in spending on agency staff, which has been found to be one of the key drivers behind the record NHS deficit. It is therefore impossible to see how further pay restraint will actually help reduce costs. It will certainly do little to improve staff morale which is already suffering hugely.
The short-termism of the Health Secretary is made even clearer by the very next bullet point, which calls for implementation of Lord Carter’s recommendations on efficiency savings, “with a particular focus on quick wins.” After six years in charge of the Health Service, the Government really ought to have moved on from “quick wins”.
The Government also continues to expect Trusts and CCGs to make efficiency savings by asking them to agree lower spending totals. In a demand led system where demand increases year on year, reducing the amount spent will be a false economy, creating greater cost further down the line. It also fails to acknowledge the systematic under funding of the service over the last six years-the truth is that in a system where the vast majority of providers are in deficit, missing spending targets can no longer be deemed only to be a local management issue. As the Head of NHS Clinical Commissioners, Julie Wood, put it, “The simple truth is there is no spare money in the system – we urgently need a cross-governmental review into the overall financial position of the NHS and an open debate about what can be realistically delivered with the current level of funding.”. The debate is therefore artificially framed by the financial parameters rather than the kind of service I believe most of the public want to see and would, in the main, be prepared to pay for.
The Report continues the recent obsession with failure regimes, introducing new measures to be applied to Trusts and CCGs who are not meeting the new financial commitments that they have been required to sign up to. Given the unrealistic nature of these targets it’s probably only a matter of time before we’ll see the Secretary of State announcing grandiose new plans to introduce a failure regime for failing failure regimes. The most worrying savings suggestion to many people though will be what is euphemistically termed “the consolidation of unsustainable services,” which will go well beyond the usual efficiency savings to be found from back office consolidations and could well mean front line closures. These “consolidations” are being driven through the Sustainability and Transformation Plans (STPs), about which I have previously written. They represent a hidden reorganisation with rocket boosters on and we are only months away now from seeing the impact.
Now that the Tory claim that an additional £10billion was being invested into the NHS has been exposed as a myth by the Health Committee, it is clear that the Health Service simply does not have the money required to continue to provide services as it does. This means one of two things, either more money needs to be invested to meet the shortfall or the NHS will not be able to continue to provide services as it does. Whatever is happening in the Labour Party, we cannot lose our focus on fighting for the investment that the NHS needs and tackling any attempts to use the current financial crisis as a Trojan horse for privatisation.