NHS faces a double crisis this winter as financial day of reckoning nears
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Version 0 of 1. As the peak weeks for “winter pressures” in the NHS edge closer, the health care system is facing a second crisis – an imminent clampdown on overspent trusts. In a careful dissection of the evidence of why winter routinely causes serious problems, the Nuffield Trust tries to explain why an extra £250m over winter two years ago, and a huge £700m last year, failed to deal with the issue. Related: New NHS regulator has impossible task in face of spiralling funding crisis It stresses that the problems in winter are not caused by more people turning up at A&E – in fact, fewer attend in cold weather – but admission rates are relatively high and, among other factors, there is a growth in people with breathing problems who need to spend longer in hospital. But the underlying cause is that bed occupancy is too high – often above 90% – so systems soon topple over as more patients are admitted. Nuffield estimates that it would take another 14,000 beds to get occupancy down to the widely-accepted safe level of 85% and hit the four-hour A&E wait target. The alternative is to focus on that very small proportion of patients – less than 4% – who account for more than a third of the time in NHS beds. But this unshakeable logic slams straight into the desperate shortage of social care funding. Promises of more money are more sleight of hand than substance. Allowing councils to levy 2% on their council tax to fund social care means that the areas with the weakest tax base – generally the ones in most desperate need of more funding – will raise the least money, while as Local Government Chronicle revealed [subscription], little of the extra £1.5bn the chancellor announced for the Better Care Fund by 2019-20 will come on stream before the end of this parliament. In the aftermath of the spending review, organisations including the NHS Confederation and the Association of Directors of Adult Social Services have written to George Osborne asking for a meeting to discuss the crisis in social care funding, highlighting the usual litany of difficulties from growing demand and frailty to the cost of the national living wage. But the most pointed question they pose to the chancellor is: “What happened to the £6bn originally which was earmarked [sic] for the full implementation of the Care Act?” It says a lot about the ‘now you see it, now you don’t’ quality of recent spending settlements that such a question needs to be asked. Related: Addenbrooke's: why are internationally renowned hospitals struggling? But more money is highly unlikely to be forthcoming. Jim Mackey, who will be chief executive of new regulator NHS Improvement, has resorted to bloodcurdling language to ram home the point that the financial day of reckoning for overspent trusts is close at hand. He described the likely consequences if the Department of Health breached its spending limit for the current financial year as “fatal for a lot of people, on one level. More importantly it will really annihilate confidence in the service”. The clear implication is that senior people could lose their jobs. Mackey also disabused anyone who thinks that the shift from Monitor to NHS Improvement will mark any relaxation of financial stringency. On the contrary, he made clear that his overriding responsibility is to get the provider sector back into balance in the coming financial year. He told the Healthcare Financial Management Association conference [subscription] this will require some trusts “to go through a very painful process”. It is clear that the Treasury is about to reassert control over the NHS. The illusion of safety in numbers when it comes to running a deficit is about to be stripped away, and there must now be an expectation that trusts that cannot meet their financial obligations are going to be forced to make tough decisions about closing services, even at the risk of local controversy. For the government, that is a smaller political risk than losing control of its finances. Join our network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views. |