NHS: Staffing crisis worsens

NHS waiting room

The NHS employs 1.5 million people in England yet still does not have enough staff to meet the needs of the working class. The NHS Long Term Plan does not show how this staffing crisis will be sorted despite its urgency. Across NHS hospitals, community and primary care settings, there are about 150,000 doctors and over 320,000 nurses and midwives, a third of the total workforce. One in 12 posts are vacant in hospital and community services. Between July and September 2018, there were 94,000 full time equivalent advertised vacancies in hospital and community services, nearly 40,000 of them in nursing and midwifery.


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Child health, poverty and poor performance in Britain

Children in Glasgow

Child poverty is one of the most significant factors in lifelong ill health and health inequalities. It raises the chances of early death from asthma, injury, infections and prematurity, and can lead to lifelong mental health problems. Recent Nuffield Trust data shows that 11% of children aged 15-19 years in Britain are living in severe material deprivation, the fourth-highest rate in Europe. Hannah Caller reports.


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NHS Long Term Plan – ignoring the immediate crisis

On 7 January, Prime Minister Theresa May launched what is called the NHS Long Term Plan, describing it as ‘a historic moment for patients across the nation.’ The Plan aims to base future care on ‘community care, population health and collaboration’. It claims that a redesign of outpatient services can replace 30 million appointments with online consultations by 2024, saving £1bn a year. Headline news includes DNA sequencing for all children with cancer, half a million lives saved by better disease prevention, a programme tackling health inequalities, better mental health and maternity care and better care for people with disabilities. The Plan also proposes legislative changes which will lead to the repeal of parts of the Health and Social Care Act 2012 dealing with procurement and competition. Behind the sound bites and the glossy packaging, however, the reality is a continued squeeze on NHS spending, and a staffing crisis for which the government has no solution. Hannah Caller reports.


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NHS funding: smoke and mirrors

NHS waiting room

The Tory government is claiming that the long-term financial crisis of the NHS is over: its Budget settlement of an extra £20.5bn in real terms above the 2018/19 level by 2023/24 now means that the NHS can meet the health care needs of its patients. As ever, the government use of figures is all smoke and mirrors: in real terms, the proposed funding increase falls way short of the minimum annual increase of 4% required to stand still, and shortages of trained staff are getting worse year by year. HANNAH CALLER reports.


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Maternal and reproductive healthcare services cut to the bone

Protest against the closure of Bridgenorth Maternity Unit

Longer waits, reduced access and a lack of staff have become the norm in women’s health care as services have been eroded. There is only so long apologies and sticking plasters can cover such wounds. Each cut, closure – and occasional victory – must be used to expose and oppose the depth of the care crisis.


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NHS: crisis in mental health services

Protestors march against NHS privatisation

170 years ago, the Public Health Act 1848 for England and Wales came into force, recognising the need for protection of all citizens from sanitary and social threats. After two more terrible cholera outbreaks, the 1875 Public Health Act made the 1848 Act part of local authorities’ powers. Thereafter, partly due to sanitation and clean water, housing, food provision, changes for the better were made to the living conditions and health of the population.

Now, since 2008, austerity Britain and savage capitalism have reversed the progress. Health inequalities are widening, life expectancy is levelling off, poor nutrition is evident by rising levels of obesity, while at the same time increasing numbers of people need food banks and many are going hungry, including children. Simultaneously, we are witnessing the decline of the health of the planet we live on.


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NHS at 70: a vital service under constant attack

Demonstration on the 70th anniversary of the NHS

Mawkish sentiments marked the 70th anniversary of the foundation of the NHS. Prince Charles, who has never used the NHS to our knowledge, preferring private queue-jumping and fawning luxury, was trotted out to pay tribute to ‘one of our country’s greatest treasures’. Celebrities recounted how their lives had been saved, how much they owed the service, in newspapers like the Daily Mail, otherwise renowned for undermining the NHS at every opportunity. Prime Minister Theresa May thanked ‘one of our nation’s most precious institutions’– although her government has been responsible for bringing the NHS to its knees. The Archbishop of Canterbury opined that the NHS was ‘the most powerful and visible expression of our Christian heritage’. The government, aware of the unpopularity of a decade of cuts in real-term funding for the service, used the occasion to offer an increased level of funding over the next three years – although still well below what the NHS needs. Hannah Caller and Robert Clough report.


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NHS: Prospects for recovery are poor

NHS staff from abroad

After a winter crisis in which parts of the NHS almost collapsed, the service remains on the ropes. Normally the spring is when some semblance of an adequate service is restored. This will not happen: the chokehold on funding will mean that waiting lists and A&E waiting times will lengthen; the working class will suffer the most. The trade unions will have another national march for the NHS, this time on the 70th anniversary of the NHS’s foundation (30 June), but, as ever, it will be a substitute for real action.


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Health Crisis: Patients’ lives at risk

The winter crisis in the NHS has continued into the spring. Bed occupancy rates were at their highest levels in February, surpassing the 95% of December 2017. Waiting times in A&E were the longest since records began as were trolley waits for patients requiring a bed. One hospital reported the death of a man who had sat in a chair awaiting admission because all the A&E trolleys were in use. Conditions of work continue to deteriorate. More and more hospitals have been setting up private companies to employ non-clinical staff in a VAT scam which will mean new staff will be denied nationally-agreed salary levels. NHS unions had offered no effective opposition to this development, and now they are being presented with a pay offer which will amount to a further pay cut over the next three years. Robert Clough reports.


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King’s College Hospital in special measures

Kings College Hospital

‘The government and its regulator, NHS Improvement, are simply not facing up to the enormous challenges that the NHS is currently facing’. So said Lord Kerslake in The Guardian as he resigned as chair of King’s College Hospital Trust on 10 December. The next day, NHS Improvement placed the Trust in financial special measures. Of course the government is underfunding the NHS. But Kerslake was also part of the problem, boasting of the £80m yearly ‘savings’ he had agreed since 2015, ‘twice the average of other hospitals.’ His parting thoughts? ‘We could fight back, but this puts King’s future at even greater risk.’


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NHS in crisis: Worse to come

NHS protest capitalism

The NHS is going through its worst crisis since it was set up nearly 70 years ago. Years of underfunding have had their inevitable consequence. Newspaper headlines tell part of the story: thousands of patients each week having to wait in ambulances before they can be admitted into A&E; A&E departments designed to treat 350 patients a day that are seeing 500 to 700; wait times in A&E that are growing longer and longer while bed occupancy runs at 95%, way above the safe maximum of 85%. The government tells lies about how the service is coping: it does not care that 55,000 patients have had their operations delayed, including many thousands of cancer sufferers. Robert Clough reports.

Although the NHS is financed through taxation, taxes themselves are a deduction from the profits made through the exploitation of the working class. The ruling class is determined to ensure that such deductions are reduced to a minimum: hence the policy initiated by the ConDem coalition in 2010 and continued by the Tory government to choke off NHS funding, ensuring that it fails to meet the needs of the working class. The NHS budget needs to increase in real terms by 4% annually to meet the costs of new technology and drugs, but also because of an ageing population with more long-term health problems. But the average annual increase since 2010 has been just 1.2%, a level which the government intends to maintain until 2021. Whether it can will depend on the balance of class forces. So far the trade unions in the NHS have offered no meaningful resistance, despite a seven-year run of 1% pay caps or outright pay freezes, and constantly deteriorating conditions of work.


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NHS: back on the precipice

save our nhs

The NHS in England is again on the brink of a winter crisis. The extra money promised in November’s Autumn Budget has been calibrated to obtain electoral benefit for the Tories while keeping a chokehold on NHS spending. Key programmes to prevent the sort of disaster that threatened the health service last winter have failed. Bed occupancy rates are nowhere near safe levels. Reductions in delayed transfers of care – where a patient is medically fit for discharge but neither home care or social care are in place – are nowhere near target. Emergency admissions continue to rise. Hardly any A&E departments are meeting the 95% mark for treating patients within four hours of arrival; many are falling below 90%. Ambulance response times are deteriorating. Financial savings are nowhere near what is demanded despite a 1.7% improvement in productivity. 80% of Clinical Commissioning Groups (CCGs) are considering rationing operations. Behind this lies the determination of government to reduce real-term funding of the NHS as part of its overall attack on the working class. Robert Clough reports.


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NHS: another winter crisis looms

nhs rcg frfi
RGC supporters joined the Docs not Cops demonstration in London against racist checks and changes in the NHS on 30 September.

As the pressures on the NHS grow as a result of funding cuts and staff shortages, it is likely that the crisis this winter will be even worse than that of 2016/17. A&E waiting times continue to increase, and hospital chief executives are being sacked where their hospital’s performance is deemed particularly bad. Plans to make more hospital beds available by reducing the numbers of patients whose discharge has been delayed by insufficient social support are way short of target. Although the government has signalled the end of the 1% pay cap for the public sector, there is no evidence that it will increase NHS funding to pay for even the very modest wage increases NHS unions are requesting – an average 3.9% plus a one-off payment of £800, estimated to cost £2.5bn a year. As it is, many hospitals are falling short of their financial savings targets as inflation hits 2.9% rather than the anticipated 2.3%, creating an extra £500m gap.

Performance figures released in mid-September show the intensifying pressures on the NHS:

  • The number of patients waiting for operations longer than the target 18 weeks, 382,000 out of a total 3.78 million on waiting lists, is at its highest level since September 2008.
  • Despite the focus on reducing emergency admissions, the number reached 486,669 in August 2017, 3.4% more than August 2016.
  • Although there was a slight drop in A&E attendances in August 2017 compared to August 2016, there is a year-on-year rise of 0.9%.
  • Ambulance response times continue to be below target, with 67.9% of Red 1 calls being met within the eight-minute target for 75% of calls, and only 60.1% of Red 2 calls meeting the same target.
  • There were 181,692 ‘delayed transfer of care days’ (the total number of days spent in a hospital bed by a patient whose discharge had been delayed) in July 2017, scarcely fewer than the 184,578 recorded for July 2016. This equates to 5,861 beds, only just below the figure of 5,954 a year earlier. Plans to free up an extra 2,000-3,000 beds by reducing the number occupied by patients whose discharge is delayed will not be met.


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Wearing away the NHS

nhs socialism

With the Tory victory in the June general election, the process of wearing down the NHS continues apace. An election promise of an extra £8bn means nothing: none of it is available for the current financial year when, with demand overall increasing at 4% per annum, the actual increase in funding is a mere 1.3%, or in 2018/19, when it will be even less, 0.4%. The consequences are clear: longer waiting lists for operations, longer wait times for consultations, reductions in services, ever-extending eligibility criteria for receiving health care. 14 out of 44 Sustainability and Transformation Programme (STP) regions have been told to ‘think the unthinkable’ to meet the demands of a ‘capped expenditure process’: rationing will become the norm. Matters are only going to get worse as the number of nurses in training falls and half the current cohort of nurses become eligible for retirement by 2020.


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Labour’s NHS promises are not enough

nhs march london

Seven years of Tory funding cuts have driven the NHS into the ground. Spending per patient has fallen, while training and hospital maintenance budgets have been raided in order to keep hospitals from going bankrupt. Rationing hospital services is becoming a norm.


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Defending the NHS: the real fight has yet to start

On 4 March, 250,000 people marched through London in defence of the NHS. Like so many other anti-austerity marches that have taken place since 2011, there was no idea what to do next. The extra money that came in the Budget the following week was a drop in the ocean: a paltry £100m for GP-led triage in A&E and £325m capital funding over three years for Sustainability and Transformation Plans (STPs) – and then only if they jump certain hurdles. The £2bn promised for social care over three years is non-recurrent and will not meet a growing annual funding shortfall estimated currently at £1.9bn. Social care will continue to be cut, and private care companies will reject more and more the minimal payment rates local councils offer for their services. And within days of the Budget, it was announced that £800m reserves earmarked for mental health services will be used to pay off this year’s hospital debts. Robert Clough reports.

The success of the 44 STPs across England is crucial for the process of re-organising the NHS. The long-term aim is to create an integrated management structure across each of the STP ‘footprints’ or regions which in the short term can slash services sufficiently to keep costs in line with savage funding cuts over the next three years. GP-led Clinical Commissioning Groups (CCGs), over 200 of which were set up under the 2013 Health and Social Care Act, will start to reduce in number. Harbingers of this development are the very recent merger of three CCGs in Manchester and three in Liverpool together with the publication of national guidance on the process in November 2016. That 11 CCGs in the West Yorkshire and Harrogate footprint have agreed to form a joint commissioning group is further evidence of this trend.


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Grinding down the NHS - An attack on the working class

womens hospital

The willingness of the Tory government to drive the NHS into the ground tells us how far the balance of class forces has shifted against the working class over the past decades. Prime Minister Theresa May and Health Secretary Jeremy Hunt are confident that they will face no significant opposition as NHS services are strangled by an unprecedented level of funding cuts. British Red Cross chief executive Mike Adamson has called the situation a ‘humanitarian crisis’ as staff have been called in to assist hospitals and ambulance services. Robert Clough reports.

At a time when there needs to be a massive and militant mobilisation of working class people to defend a service vital for their well-being, Labour-led councils are implementing cuts in social care which will make the crisis worse, and the trade unions are all but invisible. All that is on offer by way of opposition is the ritual of a national demonstration on 4 March – an event that will be tightly managed to ensure it presents no real challenge to the government. Meanwhile more and more people will suffer and die as they are unable to get the care that they need.


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NHS cuts round-up

Save NSH

The wide-ranging attack on NHS services is documented by FRFI supporters from around the country.

STPs and Grantham A&E

Lucy Roberts

In August 2016, it was announced that Grantham and District Hospital Accident and Emergency unit would be closed between the hours of 18:30 and 09:00. United Lincolnshire Hospital Trust (ULHT) has said it does not have enough doctors to staff the department safely while also maintaining services in Lincoln and Boston.


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Fight to save free health and social care

Save the nhs protest

There was no extra money in the Autumn Statement on 23 November for the NHS, despite the fact that it is so obviously in a catastrophic financial crisis, we must now expect savage cuts, with an escalation in rationing services and tightening of eligibility to those that remain. These will be set out in the local Sustainability and Transformation Plans (STPs) that are now being published and whose purpose will be to show how £22bn can be cut from the NHS budget over the next four years. Robert Clough reports.

What is happening to the NHS cannot be explained by Tory ideological hostility to state provision of health care alone. A nationalised health service is the cheapest and most efficient way of meeting the health needs of the working class under capitalism. The ruling class is not opposed to the NHS in principle: it simply regards its level of health care provision as far too generous for the working class. Although it seems that the working class pays through its taxes for the NHS as with any other state service, in fact the worker never sees this money nor has any choice about its deduction. The process obscures the underlying reality: that state expenditure is paid for by part of the surplus value extorted by the ruling class. Taxation is the means by which this transfer to the state takes place, and it reduces the surplus value available for profitable capital accumulation. Furthermore, since most of state health care is directed towards the maintenance of workers who do not produce surplus value for the capitalists, either because they are employed unproductively or because they do not work at all through retirement or disability, there is an added reason for the ruling class to axe it (for a thorough discussion of these issues, see Revolutionary Communist No 3/4: Inflation, the crisis and the post-war boom). The pressure is therefore on: the cost of the NHS must be slashed and slashed again. What will determine the outcome will be the extent of resistance both within and outside the NHS, and this presents a political problem for the ruling class: the popularity of the NHS is likely to generate serious opposition to A&E or hospital closures.


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Hospitals as border control – no to racist checks and charges!

‘Women forced to show passports.’ ‘Photo ID to access care’. The media reported with interest on St George’s NHS Trust’s October board papers,[1] which propose that all women should show their passports at their first midwife appointment in order to prove their eligibility to receive care. Condemned by Labour leader Jeremy Corbyn in Prime Minister’s Questions, the proposal received support from Theresa May, who stated: ‘Where there are people who come to this country to use our health service – and who should be paying for it – the health service identifies those people and makes sure it gets the money from them. I would have thought that would be an uncontroversial view.’ Accompanying editorials and articles argued for the need to ‘crackdown’ on ‘health tourism’ to limit the NHS’ growing debt. The financial crisis in the NHS is not the fault of people needing care. Measures such as those proposed by St George’s Trust will be harmful to the people who do need care, and will ultimately cost more. Even more importantly, they strengthen racist arguments about who should be cared for and who should not, and begin to normalise the NHS charging for care.  


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Health Matters fight the cuts

The crisis in the NHS is now so acute that Chris Hopson, chief executive of NHS Providers, which represents NHS hospitals, has warned that the years of underfunding have left hospitals facing ‘impossible’ demands, and that if there is no extra money in the November budget statement, it will have to face what he calls ‘unpalatable choices’, adding: ‘The logical areas to examine would be more draconian rationing of access to care, formally relaxing performance targets, shutting services, extending increasing charges, cutting the priorities the NHS is trying to deliver or, more explicitly, controlling the size of the NHS workforce.’ (The Observer 10 September)


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NHS ‘Reset’ into chaos

The Conservative government has now made it clear that the NHS is to be allowed to descend into chaos with the NHS Improvement (NHSI) instruction that NHS organisations will have to ‘reset’ their finances to ensure that there is no repeat of the 2015/16 overspend of £2.45bn. Waiting time targets – such as the four-hour target in A&E – are to be abandoned. Waiting lists will soar: the historical way of rationing essential health services for those who cannot afford to buy them privately. Services will be cut and hospitals will close. All this will be overseen by the richest Cabinet member, Health Secretary Jeremy Hunt, who received a £972,000 dividend from his education company in 2014/15 on top of his £135,000 Cabinet member salary. There were many who hoped that Hunt would be sacked for overseeing the worst financial crisis in the history of the NHS. It was not to be: his arrogance makes him ideally suited for bringing the NHS to its knees and dealing with resistance such as that shown by junior doctors.


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NHS in financial meltdown

In a significant retreat, Health Secretary Jeremy Hunt has agreed to talks with the junior doctors on their proposed new contract. Since they started their strike action, the doctors have received widespread public support. They have refused to back down in the face of government intransigence and lies, and instead have linked their struggle to the need to take action against the government’s deliberate running down of the NHS and the associated privatisation of its services.

Starting with the 2010 ConDem coalition government, the NHS has faced an unprecedented squeeze on its finances. This will continue until 2020/21, by which time NHS spending as a proportion of GDP will have fallen from 8.8% (2009) to 6.6%. GDP is forecast to grow in real terms by around 15.2% between 2014/15 and 2020/21, but NHS spending will grow by only 5.2%. The annual real-term increase in NHS spending between 2009/2010 and 2020/21 will be a mere 0.9%; it needs to be 4.5% to keep pace with rising need and the costs of advances in medical technology. This represents the difference between government lies that it is protecting NHS funding and a reality of insufficient staffing at every level and collapsing services.


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NHS maternity services up for sale

NHS for sale

‘We are all trapped in a marvellously pure ideology, the ideal socialist dream.’ So said Tory peer Baroness Cumberlege in 2000 of the NHS, as she advocated for an injection of private companies, competition and profit-making to improve ‘freedom of choice’. Cumberlege is the ‘independent’ chair of the 2016 NHS Maternity Review ‘Better Births’, and it seems her interests remain the same. The review recognises some maternity service problems, but offers a solution which would pave the way to further undermining of free, accessible, universal care.


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Unite in struggle to save the NHS

The NHS grinds steadily towards a government-engineered financial collapse. After five years of flat-line funding, spending on health has dropped from 11% of GDP in 2007 towards 6.6%.  Chancellor George Osborne may have announced £10bn investment in NHS England last November, but only £8bn of that represents new funding, and most of this is to paper over the fact that NHS spending must expand at 4% per annum to keep pace with demand.

In February 2016, the NHS provider sector recorded a deficit of £2.26bn, £622m worse than planned. A report to the joint meeting of Monitor and the National Trust Development Authority boards showed that as of 31 December 2015, 179 (75%) out of 240 NHS providers reported a deficit, of which 131 were acute hospitals; providers had made £1.94bn of savings, £257m less than planned. Hospitals as a whole missed the A&E waiting time target of seeing 95% patients within four hours between October and December 2015, and the size of the waiting list for routine operations reached 3.14 million as they failed the referral to treatment 18-week health care standard for the first time.


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Starving the NHS of staff and money

An adequate system of health care needs people to deliver it and the funding to sustain and develop it. In Britain, both are severely threatened, despite this being the fifth richest nation in the world. Services are being closed or handed to the private sector, poorer working conditions are being imposed on the remaining staff, and increased zero-hour contracts and job losses introduced for the already lowest-paid, tendered-out hospital staff, such as domestics, porters and caterers, vital members of any health care team.

The NHS employs more than one in 20 of the working population in Britain and nearly 80% of its workforce are women. Across the country there are tens of thousands of unfilled doctor and nurses’ posts, while training places are cut and student nurses, midwives and others are about to have their bursaries axed. Thousands of pounds are spent recruiting abroad for short-term gain in the NHS.

In 2013, Britain spent 8.5% of its total GDP on health care, ranking it 13th out of the 15 original EU members. For NHS spending to match the average European country’s level of expenditure by 2020 would require a 30% increase, equivalent to £43bn a year. The government has promised a mere £8.4bn extra, little more than 1% more a year. In the past five years, the average increase in NHS spending has been 0.8% per year. Yet annual spending on the NHS has to increase by 4% just to keep up with the annual increase in costs of treatments and running services. The future is one of yet more cuts, with the NHS facing continuing financial crises.


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Crisis in mental health services

On 25 January 2016 The Guardian exposed the collapse of NHS mental health services, citing figures from the NHS’s Health and Social Care Information centre showing that the number of registered mental health nurses (RMNs) working in psychiatry has decreased by 10.8% since 2010 as funding for the service has been slashed. The following day the paper revealed that the number of unexpected mental health patient deaths had risen by 21% over the last three years. This was inevitable given that mental health service budgets fell 8% in real terms under the last government. Claire Wilkinson reports on the crisis engulfing NHS mental health services.

Working on an acute psychiatric ward for the last four years, my experiences certainly correspond with this data. The North West mental health trust I work for is increasing its training and employment of Assistant Practitioners (APs), a relatively new role where a healthcare assistant is trained to take on many of the duties of a nurse while remaining unregistered in a professional capacity. APs are employed on a Band 4 in the NHS pay scale, whereas an entry-level RMN is employed on the more highly-paid Band 5. There is an obvious financial incentive for trusts to employ fewer RMNs and replace them with the cheaper APs, who are unable to progress past Band 4 or register with a professional body.


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NHS under-funded and under pressure

The Autumn Statement’s proposal to increase NHS funding by £3.8bn in 2016/17 is the minimum required to avoid financial disaster over the next 18 months, but may be too late to avoid a crisis this winter. The NHS needs £30bn by the next general election just to stay still; however, the government has only promised £8bn. The health service will have to find the balance of £22bn through ‘efficiency savings’ – about 20% of its current budget. This is an impossible target: but the government pretends not only that it can be achieved, but also it will be sufficient to meet what it defines as a 24-hour, seven-day-a-week service. The savings require productivity improvements at twice the rate of the past five years, during which time the increase in health spending has averaged 0.8% per year, the smallest five-year rise since the NHS was introduced in 1948. In reality, annual spending has to increase by 4% to keep up with increasing need and escalating costs of new drugs and treatments.


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No solution but to fight for health care

The financial crisis of the NHS is now so deep that Tory Health Secretary Jeremy Hunt has been forced to concede its existence. Typically, however, he has blamed it on factors beyond the government’s control: ‘There’s a triple whammy of the ageing population which means there will be a million more over 70s by the end of the parliament than there are today – that’s a massive impact; the financial pressure which means that the government is not able to increase spending in real terms on the NHS by the amounts it has done historically – that’s something we’ve had to get used to over the last five years; and raised expectations from people who use the NHS about accessing it more easily but also raised expectations post Mid Staffs in terms of the quality and standard of care.’ The underlying message is that capitalism will not provide a decent health service for the mass of the people. There was an £822m deficit in the NHS last year and the NHS is facing a £2bn deficit this year. Had the Department of Health and NHS England not put in £350m, the deficit would have been bigger.


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NHS: More fragmentation, privatisation and rationing

During the election campaign the Conservatives made great play of their commitment to put an extra £8bn into the NHS. This was their response to the Stevens Report from 2014 which identified a £30bn gap in NHS funding by 2020, and which argued that £22bn of this could be met with ‘efficiency savings’. Meeting such a target was always fanciful, and now senior NHS managers are stating openly that it is impossible, and that achieving even £15bn of savings is unlikely. Health Secretary Jeremy Hunt has seized the opportunity to express his doubts about the long-term viability of funding the service through taxation. Further fragmentation, privatisation and rationing are inevitable as part of undermining a universal service free at the point of use.


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The NHS: facing a financial nightmare

As the financial crisis engulfing the NHS deepens, Conservative promises to create a ‘seven-days-a-week’ NHS by 2020 already ring hollow. Its election commitment to invest an extra £8bn a year by 2020 will at best keep the NHS standing still: more likely, it will involve further cuts to an increasingly threadbare service.

Desperate pleas for an immediate cash injection of £1bn into the NHS demonstrate how close it is to a financial abyss. Hospital, mental health and community services collectively ended 2014/15 £821m in deficit, nearly eight times the 2013/14 figure of £107m. The total deficit for acute hospitals was just over £1bn, with Barts £80m overspent and foundation trust Kings College £47m overspent. On current trends, the projected NHS deficit for 2015/16 is in excess of £2bn.


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