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NHS in England at 'tipping point' - hospital bosses Seven-day NHS 'impossible under current funding levels'
(35 minutes later)
NHS leaders in England say they have reached a "tipping point" and cannot maintain standards for patients on the funding they are getting. A seven-day NHS is "impossible" to achieve with the current funding and staffing levels, the chief executive of NHS Providers says.
Chris Hopson, chief executive of NHS Providers, said many hospital bosses wanted to "sound a warning bell" to political leaders. Chris Hopson told the BBC's Andrew Marr programme that "something has to give" and there should be a debate about which services to sacrifice "rather than pretend the gap doesn't exist".
It comes after latest figures showed record levels of delayed hospital discharges and patient waiting times. Figures show waiting times and delayed hospital discharges at record levels.
The government says it is giving NHS England the £10bn it asked for.The government says it is giving NHS England the £10bn it asked for.
NHS Providers, the organisation that represents hospitals in England, says unless urgent funding is provided it will have to cut staff, bring in charges or introduce "draconian rationing" of treatment. NHS Providers, the organisation that represents hospitals in England, says unless urgent funding is provided it will have to cut staff, bring in charges or introduce "draconian rationing" of treatment, for example, of non-urgent operations.
It highlights that 80% of England's acute hospitals are in financial deficit, compared with 5% three years ago - while missed A&E waiting time targets have risen from 10% to 90%.It highlights that 80% of England's acute hospitals are in financial deficit, compared with 5% three years ago - while missed A&E waiting time targets have risen from 10% to 90%.
'Unpalatable choices' Mr Hopson said the NHS was under the "greatest pressure that we've been for a generation".
Writing in The Observer Mr Hopson said: "Thanks to the dedication of staff, NHS performance rarely goes off the edge of a cliff. As the 1990s showed, instead we get a long, slow decline that is only fully visible in retrospect. He added: "Jeremy Hunt and others have made a very strong case for seven-day services, but it seems to us it's impossible on the current level of staff and the current money we have available.
"It's therefore difficult to isolate a single point in that downward trajectory to sound a warning bell. But NHS trust bosses are now ringing that bell. "If something has to give at the moment, when we're trying to do what we're currently doing, it can't cover important new policies like seven-day services."
"We face a stark choice of investing the resources required to keep up with demand or watching the NHS slowly deteriorate... Something has to give." Analysis
He added that trusts would "do all they can to deliver efficiency savings and productivity improvements" but "the NHS must make some quick, clear choices on what gives, however unpalatable these choices may be". By Nick Triggle, BBC health correspondent
Mr Hopson blamed cuts in social care and mental health services for causing "major problems" such as record numbers of healthy people not being discharged because of a lack of community care. On almost every measure, the last few years has seen a decline in performance in the NHS in England (although the rest of the UK is not immune to this either).
That should not come as a surprise. Overall the last five years has seen the tightest financial settlement in the history of the NHS.
To stem the decline, ministers agreed 2016-17 would see the biggest cash injection - nearly 4% above inflation - since the Labour years.
The jury is still out over whether that will have an impact. But even if it does the following years will see much smaller rises so the fear is any respite will only be short-term.
Yes there is a productivity drive, but it is the most ambitious one ever set. Most observers believe it would be amazing if it was achieved in full.
So that leaves the government with three choices: Put more money in, accept a further decline in standards or cut back on what the NHS does. None of them are particularly palatable for the government.
Is enough being spent on the NHS?
Mr Hopson also said the numbers of hospitals in deficit, and the missed waiting times for A&E, showed there was "clearly a system-level problem - it's not a problem of poor management".
And he said people on the front line in the NHS were saying that they "cannot provide the right quality of care, and meet the performance standards, on the money that's available, and something has to give".
Mr Hopson said he wanted to see the seven-day NHS idea abandoned, and more money put into the NHS through general taxation.
But he added that the NHS's chairs and chief executives were "absolutely signed up" to deliver "stretching savings targets, and stretching productivity".
"What they're not signed up to is being asked to deliver the impossible, and then being chastised when they inevitably fall short."
His warning comes days before the Commons Health Select Committee will decide whether to launch a special inquiry into the state of the NHS in England and two months before the government announces its spending plans in the Autumn Statement.His warning comes days before the Commons Health Select Committee will decide whether to launch a special inquiry into the state of the NHS in England and two months before the government announces its spending plans in the Autumn Statement.
In July more than 50 hospitals in England were given the go-ahead to miss key waiting time targets this year to help ease their financial problems.In July more than 50 hospitals in England were given the go-ahead to miss key waiting time targets this year to help ease their financial problems.
Fines for missing targets in A&E, cancer and routine operations have also been scrapped altogether and a new failure regime is being set up for the worst-performing trusts.Fines for missing targets in A&E, cancer and routine operations have also been scrapped altogether and a new failure regime is being set up for the worst-performing trusts.
The Vale of York trust considered suspending non-urgent treatment for obese patients and smokers for a year in order to ease financial pressures before bosses intervened.The Vale of York trust considered suspending non-urgent treatment for obese patients and smokers for a year in order to ease financial pressures before bosses intervened.
Chris Ham, chief executive of the King's Fund think tank, said NHS staff were increasingly unable to cope with rising demand for services.Chris Ham, chief executive of the King's Fund think tank, said NHS staff were increasingly unable to cope with rising demand for services.
"It is simply not realistic to expect hard-pressed staff to deliver new commitments like seven-day services while also meeting waiting time targets and reducing financial deficits."It is simply not realistic to expect hard-pressed staff to deliver new commitments like seven-day services while also meeting waiting time targets and reducing financial deficits.
"With winter approaching, the government should heed the warning signs rather than wait for a full scale crisis to develop.""With winter approaching, the government should heed the warning signs rather than wait for a full scale crisis to develop."
UK fundingUK funding
A government spokesman said: "On the back of a strong economy, we are giving the NHS the £10bn it asked for to fund its own plan for the future - including almost £4bn this year to transform services and improve standards of care.A government spokesman said: "On the back of a strong economy, we are giving the NHS the £10bn it asked for to fund its own plan for the future - including almost £4bn this year to transform services and improve standards of care.
"We know the NHS is under pressure because of our ageing population, but we rightly expect the service to continue to ensure that patients get treated quickly.""We know the NHS is under pressure because of our ageing population, but we rightly expect the service to continue to ensure that patients get treated quickly."
In June, Northern Ireland Finance Minister Máirtín Ó Muilleoir said its health service was to receive an extra £72m to help deal with pressures in the service, bringing the total additional funding for health to £200m in 2016/17.In June, Northern Ireland Finance Minister Máirtín Ó Muilleoir said its health service was to receive an extra £72m to help deal with pressures in the service, bringing the total additional funding for health to £200m in 2016/17.
Scotland's First Minister Nicola Sturgeon announced in June that minimum staffing levels in Scotland's NHS are to be enshrined in law.Scotland's First Minister Nicola Sturgeon announced in June that minimum staffing levels in Scotland's NHS are to be enshrined in law.
And Welsh Assembly Finance Minister Jane Hutt announced last December that the NHS would be getting a net boost of £278m under the Welsh government's spending plans for 2016-17.And Welsh Assembly Finance Minister Jane Hutt announced last December that the NHS would be getting a net boost of £278m under the Welsh government's spending plans for 2016-17.