‘We might owe you £8.7 million – but you’ve got to make NHS cuts anyway’.
This is the brutal message from NHS England, as it takes over the running of Shropshire’s NHS. In February this year, the Interim Accountable Officer of Shropshire Clinical Commissioning Group (CCG) reported a ‘spending gap’ – a gap between income and expenditure – of £19 million[i]. She talked openly about making the cuts that were necessary to close the gap. At last week’s CCG Board, a paper was approved that proposed £18 million ‘efficiency opportunities’ and an overlapping programme of £10.1 million savings. The figures are dizzying. The cuts plans from local NHS bosses haven’t been enough. NHS England has intervened to ensure that ‘financial recovery’ is achieved.
Shropshire CCG was placed under ‘Legal Directions’ today. This means that the organisation than buys NHS care for the people of Shropshire is effectively run now by NHS England. There will continue to be a pretence that local GPs are in charge – but every single key decision will be scrutinised by bureaucrats from NHS England, senior members of staff will be appointed by NHS England, and, most seriously of all, deep cuts will be demanded by NHS England. The decisions on local NHS care for Shropshire will be made by NHS England bureaucrats.
The cuts that are coming Shropshire’s way are particularly outrageous when Shropshire’s NHS is owed £8.7 million – by NHS England! A report from the CCG explained last week that Shropshire is deemed to be funded at 2.3% below its ‘fair share target’ – and that amounts to £8.7 million[ii].
It’s no secret that Shropshire’s NHS is failing. The reports are hitting the local press practically on a daily basis. Ambulances are off the road – because they’re parked up outside A&E waiting for patients to be allowed in. A&Es don’t have enough cubicles to treat patients – so patients are left waiting outside, or on trolleys in the corridor, or sitting on the floor. A&E is full because there aren’t enough hospital beds for patients to be transferred into. And, in the final strand of chaos, patients can’t be transferred out of those acute hospital beds because there aren’t the community services there to look after them, and the number of community hospital beds has already been cut.
Those of us who go to NHS Board meetings know of the other problems. It’s obvious that there’s a CCG Board that’s firefighting – muddling through and desperately seeking ways of making cuts. It’s also plain that the working relationships between the CCG and its ‘partners’ (particularly Shropshire Community Trust and the hospital trust) have broken down. The CCG has tried to solve its own financial problems by passing them on to other organisations, without bothering too much about negotiation and agreement. Last Thursday, the Community Trust was set to reject the cuts demanded by the CCG, and to seek mediation instead.
So NHS England is right to worry – but the solutions do not in any way take us towards an NHS that’s working better. The directions[iii] about leadership, capability and capacity are fine in principle; of course the CCG needs people who are up to the job. A Turnaround Director imposed by NHS England is more worrying. ‘Turnaround’ in the NHS is about cutting costs and cutting standards of care to do it. And the overwhelming emphasis in the Directions document is on ‘Financial Recovery’ – with detailed requirements to operate with no deficit this year, and to make sure a deficit never recurs. How many millions of cuts does that actually require? We are not told.
The challenge is that there isn’t enough money coming into Shropshire’s NHS in the first place. It’s not just the £8.7 million withheld by NHS England. There’s also the NHS England allocations policy that discriminates against rural areas and areas with an older population – a dreadful double whammy for Shropshire’s NHS. We’ve been hearing informal reports today from senior NHS staff who are terrified about what today’s developments will mean. They expect the cuts discussed by the CCG last week to be implemented quickly, and without public consultation. That means deep cuts to community hospital beds (up to £5.1 million), to mental health and learning disability services (£3.8 million), to hip and knee replacement surgery (over £1 million)[iv]; there are even cuts planned to palliative care and end of life care[v].
There are very grave fears now for our local NHS; particularly for the future of our community hospitals, and even for the viability of Shropshire Community Trust itself. When cuts get as deep as this, organisations cannot simply absorb them and carry on regardless.
Gill George, Chair of Shropshire Defend Our NHS, said:
“This is incredibly serious. We’ve now got NHS England running our local health services. That means remote bureaucrats – with no knowledge of our area and its needs – will be making decisions on which services to cut.
“Our expectation is that the deep, deep cuts to community hospital beds will now be implemented quickly, and probably with no pretence at all of public consultation. We think we could be looking at closure of one or more community hospitals if these cuts are imposed, and that’ll be alongside many other NHS cuts. At a time when we have an ageing population and rising demand, this is desperately concerning. And with the Future Fit project cutting acute hospital services as well, we need investment in community services, not cuts. This is a disaster for patients, and of course for the nurses and other staff who will lose their jobs.
“Our MPs have got a responsibility to wake up to the threats to Shropshire’s healthcare. It would be nice to have Shropshire Council taking a bit of a responsibility too. They’re meant to scrutinise local healthcare on our behalf, and they’re nowhere to be seen. The biggest problem here is that there isn’t enough money coming into Shropshire’s NHS to provide decent healthcare – and this is what needs sorting out.”
[i] Verbal report to meeting. Interim Accountable Officer of Shropshire CCG; Chief Officer of Telford and Wrekin CCG; SDON representatives. 26th February 2016
[ii] Operational Plan 2016/17. Page 13. 30th March Board meeting. http://www.shropshireccg.nhs.uk/governing-board-meetings-2015
[iii] www.england.nhs.uk/commissioning/ccg-auth/con-review/ (and joint CCG statement: http://www.shropshireccg.nhs.uk/news/joint-statement-from-shropshire-ccg-and-telford-wrekin-ccg-3519/ )
[iv] Operational Plan Page 14. Op. cit.
[v] Operational Plan. Page 18. Op. cit.