No cheap way to save cash starved NHS – John Listen, Health Campaigns Together

“Huge sums are being mis-spent. NHS England’s plan to spend up to £10 billion over 4 years sending NHS patients to private hospitals is short-sighted and inadequate.”

By John Lister, Editor of Health Campaigns Together and co-editor The Lowdown

Almost everybody but ministers and right wing Tory fundamentalists can see the NHS is on the edge of a major crisis on so many levels – exacerbated by the continuing Covid pandemic.

Complacent ministers claim to be ‘vigilant’ but do nothing, while 5 million adults are still not vaccinated. The shambolic roll-out of booster jabs, and premature scrapping of basic precautions of mandating mask-wearing in public places and social distancing, have contributed to 6,500 deaths since September and an 11% increase in Covid admissions to hospital in the past week.

IMF figures show the UK has fared worst in the world in terms of Covid death rates and economic damage. But warnings from the BMA, the NHS Confederation, public health experts and front line NHS staff are again being disregarded, and ministers have rejected all calls for ‘Plan B’ action to limit the new surge of Covid as it threatens to swamp the NHS.

Meanwhile demand for health care other than Covid-19 is sky high and rising. Ambulances, responding to record numbers of 999 calls, queue by the dozen for hours outside major hospitals across England to hand over patients, who will almost certainly wait many more hours for beds to become available: major A&Es treated over 1.39 million people during September – the highest ever for the month.

Waiting lists rise inexorably, at round 100,000 per month, to 5.7m. Tens of thousands face long waits of 1 year and even 2 years-plus for the first time since the 1990s. Delays are now forcing more frustrated patients to go private, with privately-paid hip and knee operations now close to outnumbering NHS-funded ops.

GPs delivered a record high number of consultations in September – despite fewer GPs in post than in 2015 – when they were first promised another 5,000 would be recruited.

NHS England also admits mental health services are vastly under-resourced, with 1.5 million people needing treatment but not getting it, and shortages of beds resulting in £100m a year being spent on sending patients private hospitals, often miles from their homes and family.

Staffing is perhaps the most crucial limit on capacity, with over 84,000 vacancies including up to 40,000 nursing posts. Add to that over 77,000 sickness absences in England, 16,000 of which are Covid-related.

Staffing is an even bigger problem in largely privatised social care, where pay and conditions are worse. NHS beds in many areas are filled by older patients who are fit for discharge … but for whom there is no social care support, with care homes reporting they cannot take more NHS patients for lack of staff.

NHS capacity is constrained. Almost 9,000 fewer beds were occupied in Quarter 1 of 2021 compared with 2019, as a result of social distancing and the reallocation to staff to deal with Covid. 6,300 more hospital beds in England are occupied by Covid patients, with admission rates rising.

This lost capacity adds up to 15% of England’s front line beds … but there is no capital to redesign and alter hospitals to restore the lost beds, and no plan to do so.

There is no capital even for backlog maintenance and renewal of clapped out equipment: that bill has risen to £9.2 billion.

But huge sums are being mis-spent. NHS England’s plan to spend up to £10 billion over 4 years sending NHS patients to private hospitals is short-sighted and inadequate, doing nothing to restore capacity and leaving the NHS chronically dependent on private beds.

All of the private hospitals together have only around 8,000 acute beds – and these are increasingly being used for more profitable insured and ‘self-pay’ private patients. Private hospitals are much smaller than NHS hospitals, and not equipped or suitable for emergencies – all of which are left to the NHS. They also rely on NHS-trained and often NHS-employed staff, so extra work for them undermines local NHS hospitals.

So on all fronts the NHS is suffering the impact of Covid combined with all the symptoms of eleven years of real terms cuts since 2010.

However, discounting the extra costs of Covid, the budget in March 2021 gave no significant new money to the NHS. September’s announcement of an extra £36bn over 3 years from April meant an extra allocation to NHS England of just £15.6bn – just half of the £10bn extra for 2022-3 called for by NHS Providers and the NHS Confederation. After general inflation and soaring energy prices there is little left.

However all of the problems will only get worse the longer investment is withheld. The staffing crisis calls for an immediate programme of action and incentives (including the possibility of flexible working) to win back many of the qualified staff who have left the NHS, and expand training programmes for doctors and health professionals.

Short term funding is also needed to cover increased costs of as many locum and agency staff as are needed to keep services going this winter. To stand any chance of tackling the workforce crisis, the NHS must also be funded to increase the woefully inadequate 3% pay award, already swallowed by inflation.

More funding above the recent tokenistic £250m hand-out is also needed to ensure GP staff and services, which handle 90% of first contacts with the NHS, can expand to meet local needs.

And the Public Health system that should have underpinned test and trace and the response to Covid has been undermined in England by cuts totalling £850m since 2015. An urgent programme of investment to rebuild and expand public health provision and preventative services to improve the health of the poorest is essential to protect our NHS.

The NHS needs a new decade of substantial, above inflation, annual increases in revenue, plus £9bn more in capital to tackle urgent backlog maintenance and upgrade of equipment, along with the funding to remodel and upgrade hospital buildings to restore the lost capacity.

It’s a lot of money – but it’s the cost of undoing the damage that’s been done since 2010.


Demonstration held in support of the NHS’s 70th birthday, and against austerity and privatisation. Photo credit: Health Campaigns Together

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