In 2009, NHS chief executive David Nicholson was set a challenge by Gordon Brown to find £20 billion in “efficiency savings” by 2015, as the NHS’ contribution to bailing out the banks and paying off the national debt. It was dubbed ‘the Nicholson Challenge’ by Brown, a tag enthusiastically embraced by the Conservatives to signal where the buck would stop if it failed. Nicholson was clear this was a one off, drastic squeeze in NHS funding that he hoped could be achieved by improving quality and productivity without affecting patient care. The fact that it was enforced as the horrors of the Mid Staffordshire scandal were unfolding, and yet were repeatedly ignored and denied by government, showed the dangers of prioritising savage savings over safe staffing of the NHS.
Nicholson’s failure to meet Mid Staffs campaigners and to act earlier on widespread concerns about appalling care contributed to his retirement, but his replacement Simon Stevens fell into exactly the same political trap. In promising to make a further £22 billion of fantasy efficiency savings by 2020 to fund his ‘Five Year Forward View’, the NHS is now facing over a decade of static funding in the face of rising demand and – coupled with massive cuts in social care budgets – parts of the service are in meltdown. The initial bail out of the banks in 2008 could have funded the NHS for eight years, but Theresa May and Philip Hammond still insist no more money can be found for the NHS, and that it has been given ‘more than the £8 billion extra over 5 years’ that Stevens asked for. The true figure is £4.6 billion, and NHS managers are once again prioritising financial savings over patient care.
The Mid Staffordshire Inquiry concluded that the NHS must introduce safe staffing levels for nurses in hospitals. Research has repeatedly highlighted the link between nurse numbers and patient safety, and the benefit of nurse to patient ratios below 1:8. The skill mix of the staff is also important. And yet the Health Service Journal has just published the culmination of a two year investigation into nurse staffing levels. It found 96% of acute hospitals in England are failing to meet their own planned level for nurse staffing during the day and at night, and that the situation is getting worse. It is not uncommon for a nurse to have to care for 16 patients on a night shift, and the HSJ found one nurse on an acute ward looking after 24 patients. 4 in 10 hospitals have declared a major alert in the last month because they were not able to safely cope with demand, and there are at least 24,000 nursing vacancies across the NHS. There has also been a 23% drop in the number of applications to study nursing at English universities in the wake of the government’s cuts to the bursary scheme. And under Jeremy Hunt’s leadership, the number of junior doctors progressing directly into specialty training has fallen from 71.6% in 2011 to 50.4% in 2016, its lowest ever level.
Despite the government’s boast to increase GP numbers by 5000, there was a reduction last year in the number of ‘whole time equivalent’ GPs, meaning any new recruits are thin on the ground and the job so stressful many are choosing not to work full time. Meanwhile, Simon Stevens has challenged Theresa May and Jeremy Hunt over their claims that the NHS has received £10 billion of new money but is still trapped into trying to enforce harsh financial controls without harming patients. The English NHS has been carved up into 44 ‘footprints’ which each devised a Sustainability and Transformation Plan in secret to balance the books by June 2016. Most have now been published and many are laughably deficient, particularly in their plans for safe staffing levels. NHS England will doubtless try to pass the buck for their failure down to local commissioners. Kent CCG has already had to ban routine operations from December 20 to April 1 to try to make £3.2 million savings.
STPs do radically increase opportunities for private companies to take over entire NHS services as well as buildings, but Theresa May was still parroting the Alan Milburn lie that ‘the NHS is not for sale’ on the same day that Care UK took over out of hours services in Gloucestershire. The business opportunities of a £120 billion NHS market will not be lost on Donald Trump, and given the desperation to achieve a trade deal with America, it seems very unlikely the UK would have the muscle to protect the NHS from an ‘America First’ policy and the might of their predatory private health corporations, one of whom (UnitedHealth) Simon Stevens worked for. But maybe that’s part of the plan. When politicians say they love the NHS, they mean they’d love it to be off the balance sheets and no longer their responsibility. Extra charges, insurance and top up fees aren’t far away.
MD is taking his health revolution on tour. Dates here