NHS: another winter crisis looms

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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.

The number of general and acute hospital beds available has fallen by 6,000 since 2010 to just over an average 103,000. Overall bed occupancy levels remain well above the accepted safe standard of 85%, standing at 89.1% at the end of June. This means that as emergency admissions start to climb during the autumn there will be insufficient beds available, trolley waits will rise along with A&E waiting times, and ambulance response times will deteriorate as more and more have to queue outside A&E departments because they cannot hand over their patients safely.

A&E waiting times have not improved over the summer period. Overall, 90.3% of patients were treated and discharged within four hours of arrival. This will be trumpeted as a success because the government reduced the target from 95% to 90%. But many hospitals have struggled to keep above 85%. In an effort to distract attention from the real cause of the problem – insufficient funding – the government is forcing hospital chief executives to fall on their swords.

The highest profile case is that of Matthew Kershaw who was asked to resign as head of East Kent Hospital Trust where only 70% of patients were treated and discharged within the target four hours during July and August. Kershaw was seen as such a safe pair of hands that he was appointed by Health Secretary Jeremy Hunt in late 2012 to manage South London Healthcare Trust when its operating deficit exceeded £60m a year. It was he who recommended the closure of Lewisham Hospital A&E department as part of a reconfiguration of hospital services in south east London. The head of North Middlesex Trust has also ‘resigned’. There are up to 25 hospitals where A&E performance is deemed to be a political embarrassment – the experience of the patients is a lesser concern.

Meanwhile behind the smoke and mirrors of publicly-announced financial performance, it is clear that hospitals are struggling in a year where there is a real-term cut of 2% in funding. 27 out of 233 hospitals have refused to agree their so-called control totals – financial targets which allow them to get money from the Sustainability and Transformation Fund. The reported cumulated deficit at the end of June was over £1bn, compared to £911m at the same point in 2016. Many hospitals have back-loaded their financial plans to make their projected savings late in the financial year – in a period when they may be completely derailed by winter pressures. The scale is formidable: projecting from the end of June, Barts and the London Trust will have a deficit in April 2018 of £207m (target deficit £85m); Kings College £109m (target deficit £38.5m) and Oxford University Trust £44.5m (compared to a projected surplus of £19m).

The average savings built into the control totals agreed for 2017/18 are an eye-watering 4.2%; for those 27 trusts which have not agreed them the expected savings are a ludicrous 6.4%. The best achieved in the past has been 2%. Clinical Commissioning Groups are being told to slash expenditure under the Capped Expenditure Process; the aim is to cut spending by £250m through rationing of treatment and will mainly be achieved by delaying referrals.

The favoured mechanisms for delivering the required savings, local Sustainability and Transformation Plans (STP), are hardly functioning. Hugely ambitious plans to remodel the NHS in each of the 44 local areas scarcely mask the real intention – to slash services. Cuts will anyway need to be implemented by existing statutory organisations – hospital trusts – so STP development will be put on the back burner while hospitals struggle to get through the winter and balance their books by April 2018.

The trade unions give no sign of offering any resistance: their demand for pay rises begs the question as to how such increases would be funded while they fail to organise determined opposition to staff shortages, ever-increasing intensity of work and service cuts. The Tory government has little to fear from this quarter.

Robert Clough

Fight Racism! Fight Imperialism! 260 October/November 2017