The Government says it’s ‘liberating the NHS’. That’s liberating the NHS of adequate funding and a workable structure, maybe. Locally, we’ve got an NHS that’s sliding deeper and deeper into crisis. Health bosses have gone to war with one another, as they try to shift the blame and the cuts onto someone else. Who loses? We do.
So what goes on?
Shropshire and Telford Hospital Trust runs the PRH and the Royal Shrewsbury. They finished the last financial year £4 million in deficit and had to be bailed out by the NHS nationally. In March, hospital bosses refused to set a budget for the new financial year from 1st April – because of a £6.2 million gap between what patients need and the income the organisation is expecting to get. Their financial crisis explains why they want to close one of our two A&Es, and turn one of the two District General Hospitals into a local community hospital instead. Neat way of saving money, that.The Hospital Trust is at war with Telford and Wrekin CCG, the GP committee responsible for buying healthcare. They’ve been fighting about the cost of treatments provided by the hospitals, and about whether or not the CCG has to pay for rehabilitation services that they say the Hospital Trust didn’t provide. NHS England has just ruled in favour of the Hospital Trust, so the CCG now has to cough up £3.2 million. This means they have £3.2 million less to spend on patient care this year, and – because of the way NHS finance works – a strong risk of central government giving less money to the CCG in the next financial year too. That’s even less money for patients.
It’s not all win-win for the Hospital Trust. Government cuts mean that the amount of money they get in has gone down and down (with something called the ‘national tariff’ falling by 12% since 2010). They lost a slice of their income when SpecSavers muscled in on adult audiology services in 2012. There are also plans to move healthcare away from hospitals and into community settings. This could be a really good idea in principle, but it means the Hospital Trust will be starved of funds and risks bankruptcy – a disaster for patients. It gets worse. There’s something called the Better Care Fund: existing NHS money, creamed off hospital budgets to bail out social care (already clobbered by government cuts). So this means even more cuts ahead for our local hospitals. Less money means worse patient care.
The Shropshire Community NHS Trust, providing local community-based services, should be riding high. It picks up new ‘business’ – sorry, but that’s the right word these days – as NHS services are moved out of hospitals. It also gets to bid for slices of the Better Care Fund.
Sadly, it’s not all plain sailing for the NHS Community Trust either. Telford and Wrekin CCG has decided that school nursing services will be put out to tender. This is core business for the Community Trust. Their income will fall if the contract is lost. If an organisation like Virgin or Serco gets the contract, then this is used as a ‘foot in the door’ to grab other NHS services. Every time the Community Trust loses a contract, its long-term viability is threatened, and NHS services get more and more fragmented – which is bad news for patients.
The Community Trust has a new competitor, too. Shropshire GPs have just grouped themselves into a ‘GP Federation for Shropshire and Telford’. No, not the Shropshire CCG or the Telford and Wrekin CCG; this is a different GP organisation, although it represents the same GPs. One of the things the ‘Federation’ wants to do is bid to provide a wider range of NHS services – and each time they win, that’s a slice of income taken away from the Community Trust (or just possibly the Hospital Trust). A conflict of interests here, maybe? GPs put the NHS service out to tender, GPs bid for the work, GPs award the contract… It’s just not right for GPs to do this. Long-term, patients lose out.
So surely the ambulance services are OK? Well, no. Ambulance services have been missing target response times for a long time, with patients in rural areas sometimes facing catastrophic waits for an ambulance. West Midlands Ambulance Trust says this is because it doesn’t get enough money, and Shropshire CCG has said, ‘Nonsense, of course you do’. This particular battle was only resolved when the Ambulance Trust announced it would no longer drive seriously ill patients to a hospital offering more specialist care, but would drop them off at the nearest hospital instead – and would do that until the CCG gave them more money. The CCG seems to have caved in. What a way to run a health service!
Shropshire CCG is close to broke itself, which might explain its fights with the Ambulance Trust. Bosses are currently planning for a 10% reduction in the CCG running cost allocation for 2015/16, and announced in March that they’ve missed the year-end financial target required under NHS business rules. So that’s another local NHS organisation set to cut spending on patient care.
All of this is a perfect illustration of how not to run the NHS. We’ve got a bunch of organisations that should be collaborating to provide the best patient care – and instead, they bicker with one another over a shrinking pot of NHS money.
It’s time for Shropshire, Telford and Wrekin NHS bosses to stop the squabbling and come clean with the public. There isn’t enough money being given to the NHS. Services cannot survive the cuts now being thrown at them. Competition and privatisation make a bad situation much, much worse. We need our local NHS bosses to go back to MPs and tell them this needs sorting out.