Every time you think it can’t get any worse – it does
Shropshire CCG has now been placed under ‘Legal Directions’ by NHS England. This means what it says, basically. NHS England is now telling local NHS bosses what they can and can’t do. The Directions have been imposed because the cuts to our local NHS weren’t fast enough or deep enough to satisfy the bureaucrats at NHS England. The Directions aren’t about patient care or high quality services; they’re primarily concerned with ‘financial recovery’. The NHS England takeover is about driving through deep cuts to spending on NHS services. It’s particularly outrageous that these cuts are happening at a time when NHS England owes Shropshire £8.7m as part of its ‘fair share’ funding target.
It’s shocking that two of Shropshire’s MPs, Philip Dunne and Daniel Kawczynski, have welcomed this development. Which services do they think should be cut, then? You might want to ask them!
NHS structures are ridiculously complicated these days, but Clinical Commissioning Groups (CCGs) are the most important bodies around. They control most of the NHS budget. It’s CCGs that plan and buy healthcare from hospitals and other organisations. The decisions taken by Shropshire CCG determine whether we have one A&E or two; whether our community hospitals flourish or are closed; whether we can get hip or knee replacement surgery when we need it, effective district nursing care, mental health services that work… In Shropshire, there’s just a façade of local decision making now. The high level decisions on ‘financial recovery’ will be taken by NHS England, by remote bureaucrats with no knowledge of or interest in the needs of local people. It is now NHS England that will determine the level of cuts to Shropshire’s NHS.
Events have moved quickly in the last few days. Last Wednesday, on 30th March, Shropshire CCG met to agree its Operational Plan. This was a plan for extraordinarily damaging cuts. They nodded through ‘opportunities’ for savings of between £3.6m and £5.1 on community hospital beds, saying that more patients will be supported at home; savings of over £1m on hip and knee replacement; and of £3.6m on care for people with mental health issues, learning disabilities or acquired brain injury, particularly those with complex needs requiring care out of county. In a separate but overlapping list, they proposed £10.1m of cuts, including palliative nursing care and end of life care. These are the cuts that do not appear to have satisfied NHS England.
That meeting on 30th March was disgraceful, with profoundly damaging cuts nodded through almost without discussion. We now know why they wanted to drive through the cuts paper with such undignified haste. Shropshire CCG had been informed of the NHS England takeover the day before, on 29th March. Board members knew what was coming, and presumably wanted to get the public out of the room as quickly as possible – so they could move on to discussing the escalating crisis in private.
The public announcement was made this week, on Monday 4th April. The news release from Shropshire CCG and Telford and Wrekin CCG is here, and the Directions from NHS England are here. David Evans, formerly the Accountable Officer of Telford and Wrekin CCG, has been appointed by NHS England as Accountable Officer of both CCGs: Telford and Wrekin and Shropshire. There is to be a joint management team across the two organisations, although each CCG will continue to have a separate GP committee. The challenge of course is that NHS England will call the shots and determine the scale and speed of NHS cuts. Local decision making will be limited to the question of which services to slash. This is akin to rearranging the deckchairs on the Titanic.
What’s going on with money? Is it about financial mismanagement?
There’s a bit of a game being played – a pretence that Shropshire’s financial problems are all about financial mismanagement, and that the new broom of NHS England or David Evans can sort everything out. This is of course nonsense. The NHS nationally is badly underfunded, with a shortfall of £22 billion across England as a whole. This is why almost every NHS hospital in England has ended the year in deficit, despite frantic attempts by regulators to make them cut costs by slashing services, leaving staff vacancies unfilled, and even reporting finances in a ‘skewed’ way to make them appear more positive! The NHS as a whole is in financial crisis.
There’s an even bigger problem for Shropshire, because NHS funding policy discriminates against rural areas and areas with an older population. That’s an obvious double whammy for Shropshire. There isn’t enough money coming into the NHS – so there isn’t enough money available to spend on providing decent healthcare. This isn’t about financial mismanagement from the outgoing Accountable Officer, or from the Accountable Officer before that. And the only ‘solution’ available to NHS England or David Evans, as the man doing the bidding of NHS England, is to cut spending.
Last week we were told of a deficit in the ‘local health economy’ (all NHS organisations combined) of a staggering £40m. A lower estimate of £30m was given in a meeting last night. For Shropshire CCG alone, last year’s deficit was around £14m, and the gap between anticipated income and expenditure for 2016/17 was reported in February to be in excess of £19m. One of the ‘directions’ from NHS England is that Shropshire CCG operates within its budget for this year – and that implies cuts to services of £19m. New Accountable Officer David Evans says “I am hopeful we will get to a position that we do not need to cut services”. Mr Evans cannot believe for one second that this is actually possible. Look back at the cuts that the CCG has already accepted – the ones that NHS England thinks aren’t deep enough. Those cuts alone would be devastating. The cuts we are headed for now will be worse.
It’s not all plain sailing in Telford and Wrekin either. Telford and Wrekin CCG is set to make cuts to NHS services of £5.2m. This isn’t good news for Telford and Wrekin residents. There are already attempts to portray this terrible situation as ‘Telford good, Shropshire bad’. The reality is of a crisis in NHS provision in both areas. CCGs can only achieve significant cost reductions by passing on their cuts to other organisations, and particularly to the hospital trust (SaTH) and to the Community Trust serving Shropshire and Telford. The Community Trust has been transformed overnight from an organisation that was doing OK in difficult times to an organisation that is now in complete crisis – through no fault at all of senior managers, the Board, or the incredibly hard working staff who keep services going. It’s just that the Community Trust is set to be the loser in a grisly game of ‘Pass the deficit’ – and we’ll end up with cuts in a whole series of unglamorous but vital services that give people a decent quality of life. This is no way to run a health service.
NHS staff have been contacting this campaign over the last few days to tell us they are terrified of what the future holds. We need to get organised. We need to move heaven and earth to stop the closure of one of our A&Es and the downgrading of one of our hospitals. We need to work together to stop the major cuts that are set to inflict irreparable harm on our community hospitals and other NHS services. It’s becoming increasingly urgent that our local MPs and Councillors wake up to the sheer scale of the threat faced by our NHS. If the NHS is dismantled on their watch, they will be held accountable.
Two meetings to get to if you can
Last Thursday, the hospital trust signed off a document called a ‘Strategic Outline Case’ – the blueprint for closing an A&E and running down a hospital. It looks very much that the plan is to make the Royal Shrewsbury Hospital the target for cuts and closures, although they say that no decision has been taken.
Whichever A&E closes, and whichever hospital is downgraded, it’s a disaster for ALL of us – in Telford and Wrekin, Shropshire and Powys. The plans are against national guidance, and have been sharply criticised by regional experts – and the evidence shows that A&E closure kills. The fight to stop this nonsense MUST continue.
The next stage in the process for A&E closure is for the blueprint to be approved by two separate meetings. These are public meetings, and you can just turn up. We need NHS bosses to know that they’re closing our A&E without the support of the people they’re meant to serve. Can you attend either or both of these meetings?
Meetings to Close an A&E:
- Telford and Wrekin CCG: Tuesday 12th April at 1.30 pm, Park Lane Centre, Woodside, Telford, TF7 5QZ
- Shropshire CCG: Wednesday 13th April at 9.00 am, Room K2, William Farr House, Mytton Oak Road, Shrewsbury SY3 8XL