NHS Plans: A Portsmouth Doctor Questions the Cuts

‘Your Big Health Conversation’ seeks to engage Portsmouth residents about the 5 year plan for Hampshire and Isle of Wight NHS Services, as set out in the controversial Sustainable Transformation Plan, or STP. Here a Portsmouth NHS doctor questions the assertions being made in the STP and survey to justify cuts of £577 million to NHS services across Hampshire and Isle of Wight. Editor in Chief Sarah Cheverton provides additional reporting.

Back in December, we reported that controversial plans for Hampshire and Isle of Wight NHS services were set to pass without consultation:

For those who don’t know – and there are a lot of us – STPs are 5 year plans for all aspects of NHS spending in England. 44 plans have been drawn up by health services, local authorities and health providers across the country, each one covering geographical areas known as ‘footprints’, and representing an average population of 1.2 million people. As well as covering NHS spending, each plan also has to show how NHS services can better integrate with local authority services such as adult social care – ‘known as place-based planning’ – and is expected to cover the period from October 2016 – March 2021.

Nationally, STPs have proved highly controversial with activists often referring to them as ‘Slash, Trash and Privatise’ plans.

Last month saw the launch of an online survey as part of ‘Your Big Health Conversation’, an engagement process run by the three clinical commissioning groups (CCGs) serving Portsmouth, Fareham and Gosport, and South Eastern Hampshire. The closing date for responses is 24th March 2017.

A local NHS doctor who has been working with S&C since the plans were passed last year responds to some of the assertions being used by local NHS organisations and leaders within the survey process, particularly the central assertion that it will be possible to ‘make services better’ and ‘drive up services’ while cutting NHS funding in the region by over £570 million.

Your Big Health Conversation says:

The local NHS faces a twin challenge – living within its means in the short-term, and also making services better and affordable in the longer term. The NHS always makes year-on-year savings and has had considerable success in keeping spending under control. That process continues, but it is no longer enough – more fundamental changes must be considered.

The Portsmouth NHS Doctor says:

The NHS doesn’t ‘always’ make year-on-year savings, it has been forced to since 2010.

S&C says:

The Chartered Institute of Public Finance and Accountancy estimate that the NHS and social care face a funding gap of between £8.5 and £15bn by 2020.

The graph from the Kings Fund  below illustrates that since 2010, the UK has seen “the largest ever sustained reduction in UK NHS spending as a percentage of GDP”. The Kings Fund – an independent health charity – has also highlighted that funding to the NHS has fallen in comparison to health spending in other countries: “the United Kingdom has slipped further into the bottom half of the Organisation for Economic Co-operation and Development (OECD) health spending league – overtaken by Finland and Slovenia.”

Source: The Kings Fund, NHS spending squeezed as never before, [2015]

Your Big Health Conversation says:

The challenges are well-known – an ageing population living with more long-term illnesses, rising costs, the need to drive up standards, and all at a time when resources are limited.

The Portsmouth NHS Doctor says:

This is an oft repeated mantra but that doesn’t make it true. These issues are NOT the main problem, ideological Tory opposition to a fully public NHS is the problem.

S&C says:

Economist and columnist, Paul Krugman wrote a lengthy examination of austerity for The Guardian that concluded austerity was not only an ideology, but one with no evidence of success.

The Guardian, The Austerity Delusion by Paul Krugman [2015]

Your Big Health Conversation says:

These challenges have been set out in the Hampshire and Isle of Wight Sustainability and Transformation Plan. This document also describes how the NHS in different parts of the county has already begun to develop its own solutions – locally, through Health and Care Portsmouth, and Better Local Care in south east Hampshire.

The Portsmouth NHS doctor says:

STPs are imposed from above, using local CCGs and other NHS organisations and leaders as fig leaves and fall guys for imposed cuts from central government. The Hampshire and IOW STP aims to address cuts of £577m from the NHS and £192 million from social care budgets in the region, including by removing up to 300 hospital beds.

S&C says:

According to the IPPR, in an article examining potential benefits of reforms within the STPs as well as criticisms, the government has not yet given ‘NHS leaders real powers to intervene in their local area, as well as devolving functions currently undertaken by central government’.

Your Big Health Conversation says:

Those initiatives set out a broad vision of the future – more community-based support, removing boundaries between staffing groups to stop people being passed around the system – but there are big questions to be considered: What staff are needed? At what cost? Where? What quality of care can be provided? How quickly can care be delivered?

The Portsmouth NHS doctor says:

My belief is that the language used in the STPs hides the reality of the likely impact of the cuts it aims to address. For example, ‘more community based support’ points to hospital cuts.

‘Removing boundaries between staffing groups’ may actually refer to using cheaper, less qualified staff to undertake roles e.g. using nurses to do doctors’ jobs, using nurse associates (a role that doesn’t require a degree) to do work currently undertaken by qualified nurses, or using volunteers and helplines where a service was previously provided by trained staff.

S&C says:

Similar complaints have been made by Bristol campaigners about their STP:

The STP includes references to developing an ‘accountable care organisation’, to ‘demand management’, to reduction in ‘hospital admissions’, and to enabling the use of ‘personal care budgets’. This is all code for the restriction of treatments and the reduction of patient numbers. Moving to this kind of model (with its US-health insurance connotations) undermines the basic principle of the NHS to provide free treatment to all based on ‘clinical need’, a phrase, incidentally, that doesn’t appear once in the STP.

Your Big Health Conversation says:

The reality for the local NHS is that:

Without change… there will not be enough GPs and other key staff groups, as the current shortages get worse.

The Portsmouth NHS doctor says:

STPs and further ‘re-dis-organisation’ is actually driving out staff, it doesn’t help retain them. In reality the government want to run the NHS on a cheap, privatised basis, with more support workers and ‘physician assistants’ instead of doctors and nurses who have been pushed out of the NHS.

S&C says:

Health writer Margaret McCartney raised similar concerns in a recent article for The New Statesman, highlighting research from the British Medical Journal that found:

…professionals wasting time over poorly designed IT systems, conflicts between different teams (even within single organisations), heavy workloads and staff shortages, with multiple external agencies creating mess about where time and effort should be spent.

Your Big Health Conversation says:

Without change… there won’t be enough staff or resources to run a “seven-day NHS”.

The Portsmouth NHS doctor says:

There has always been a 7 day NHS where needed. The 7 day NHS spin is – I think- in part designed to push the NHS towards weekend consultant appointments where workers lose their weekend to go to the doctor.

S&C says:

The Nuffield Trust has said that “Implementing a seven-day NHS will mean significant changes to the way services are run, it will require a critical mass of specialist staff to be recruited, and it may mean closures or mergers of local services”.

A similar point has been made by Britain’s top GP, Dr Helen Stokes-Lampard, who told The Guardian that surgeries will have to stop seeing patients during the week unless ministers abandon their drive to guarantee access to family doctors at weekends.

Your Big Health Conversation says:

Without change… the demands on A&E staff, ambulance crews and other urgent care services will keep on growing.

The Portsmouth NHS doctor says:

The government is closing and downgrading A&Es, so of course this drives up the need at the remaining A&Es. The govt needs to extend existing A&Es in line with the growing population, not shut them.

S&C says:

A report published in February in The Guardian (citing related reports from The Telegraph and BBC) found that:

One in six A&E departments face being closed or downgraded in the next four years, according to an analysis of NHS proposals.

About 33 casualty departments in hospitals in 23 areas of the UK are facing either complete closure or being replaced with minor injuries units.

Your Big Health Conversation says:

We know that changes are needed in the way we run GP services, community NHS teams, and hospitals. The ambition is to make these services better, but the reality is that change is necessary.

The Portsmouth NHS doctor says:

The change that is necessary is to increase funding to around 10% of GDP and stop privatisation/outsourcing. The administration of the ‘market’ in the NHS costs between £3.5 to £10 billion, I think per year.

According to FullFact – an independent UK fact-checking charity – estimated costs of the NHS marketplace are difficult to pin down, but vary between £4.5 to £10 billion per year.

Your Big Health Conversation says:

The details of how the local NHS will work in the future are not decided – that is why we need to hear the views of local people, so that they can be considered before any decisions come to be made. Please take a few minutes to let us know your views on the future of the local NHS.

The Portsmouth NHS doctor says:

Nonsense. STPs for the first two years from April 2017 were signed off on 23rd Dec 2016, so it has been decided, albeit with precious little detail e.g. where hospital beds will be cut, or where the £577 million cuts will be made. If I made a treatment plan for a patient like this, and asked the patient to sign it off without knowing much detail of what’s in it, I would get a massive complaint, and rightly so!

According to national health campaigners, 31 local authorities have already lodged objections to, or pledged to oppose, the STPs in their area, including the Isle of Wight Council, whose Chief Executive John Metcalfe wrote to NHS England stating:

The Committees were disappointed, the timescales to produce the plan, dictated by NHS England, did not give sufficient weight to the democratic process allowing it the opportunity to consider the final plan, or debate the issues it raises in a public forum, and did not appear to conform to the best practice guidance (for example Engaging Local People -NHS September 2016).

Star & Crescent would not have been able to publish this report without the assistance of a local GP, who has worked closely with us to help us understand the implications of the STP and the local campaign attempting to prevent it. This is part of S&C’s renewed focus on investigative, critical journalism and our exploration of how it can be funded without compromising editorial independence through advertising or ‘advertorial’ (articles that have been paid for by businesses for promotional purposes).

 

Find out more

Hampshire and Isle of Wight STP – read it for yourself and share it with your friends, colleagues and families

Health Campaigns Together – crowd-sourced information on all STPs across the 44 ‘footprints’

Take Action by 24th March 2017

Complete the Your Big Health Conversation online survey by 24th March 2017 and let local NHS leaders know what you think

Support campaigns calling for public information and involvement in NHS cuts

In Portsmouth

  • Contact your councillors and/or your MP to ask what they think – and what they’re doing – about the STP

Nationally

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