With continuing pressure on NHS managers in England to both tighten their belts and privatise, the poor state of the pound and the uncertainties created by Brexit, it’s crunch time for the health service.
Although health is a devolved issue, the NHS is also suffering financially in Scotland, Wales and particularly Northern Ireland as a result of Westminster’s austerity policies.
A key difference between the devolved nations and England is that the latter falls under the Conservative government’s department of health – and at the sharp end of the cuts.
Among numerous deficit-cutting targets, the biggest, and scariest, is the requirement to save £22bn by 2020.
While health commissioners and managers struggle to get their heads around that, UNISON is continuing to warn of the dangers of trying to run services with reduced staffing and through outsourcing to private businesses.
And the union’s concerns have recently been backed by MPs and senior health administrators. The shared message is that if we keep on cutting, it will be the services themselves that are in the red.
The most notable pressure on the service at present comes from its new regulator, NHS Improvement.
The body has just issued guidance to trusts and clinical commissioning groups for what it is calling a “financial reset” of their businesses – effectively telling them how best to live within their government funding.
It specifically outlines action that must be taken to cut the trust deficit for 2016/17, from the predicted £550m deficit to around £250m.
Two of its approaches, on staff costs and merging of services, have attracted particular criticism.
Tackling the growth of pay bills
The guidance on staff pay, which criticises 63 trusts for spending too much on staff and calls for a “dial back” of “excess cost growth”, has left the sector up in arms.
UNISON head of health Christina McAnea says: “Trusts are operating in an extremely tough financial climate. Huge amounts have already been saved across the NHS because staff pay has been frozen and capped over many years.
“Everyone wants an efficient NHS, but if the result of this initiative is to cut jobs in the affected trusts it will only make matters worse.”
Ms McAnea said that staff would be seeking reassurance that “a sensible approach will be taken, not one that further hits morale, leads to even fewer staff on the wards or means a huge surge in the already excessive amounts of unpaid overtime.”
The union’s sentiments have been matched by a number of trust chief executives, who have aired their views to the Health Service Journal.
Karen James, chief executive of Tameside Hospital Foundation Trust, told the magazine: “We haven’t got the workforce to deliver what is required of us and therefore we are recruiting staff to meet the required standards that are set nationally.
“We are not deviating from any national requirements, we are trying to meet them.”
If the trust was forced to save an additional £14m it would have “huge implications,” she said, adding: “The organisation would not be able to operate in its current form to deliver services that are required.”
Mid Cheshire Foundation Trust chief executive Tracy Bullock told HSJ that NHS Improvement appeared not to have considered the trust’s increase in activity or its historic understaffing.
“Reducing staffing costs would be detrimental to the safety and quality of care we are able to provide and as such would simply serve to increase agency usage to maintain that safe care,” she said.
Merging support services and pathology services
NHS Improvement has instructed all NHS trusts in England to produce plans for the merger of support service functions and pathology services with neighbouring trusts.
In doing so, it cites the Carter Review, which it says demonstrates “significant potential savings.” Trusts were given until the end of July to formalise their plans.
UNISON responded immediately to this announcement. Deputy head of health Sara Gorton wrote to NHS chief executives, saying that staff working in support services were “rightly anxious” about the implications of such mergers on their future job security and roles.
The move also raised the prospect that trusts might consider outsourcing non-clinical functions, she said.
“At a time when the NHS is facing huge challenges, this could have a big impact on the morale and motivation of staff working in much-needed non-clinical occupations, and affect the delivery of services to patients.”
NHS Improvement’s inclination towards privatisation is also evident in its 2016/17 Business Plan, where it states its intention “to explore and, where appropriate, facilitate independent sector providers to form NHS partnerships that deliver improvement across the sector.”
In contrast, UNISON’s frequent warnings against privatisation were recently borne out by NHS England, when it decided to close the Strategic Projects Team.
The body noted “real concerns” about the work of the controversial consultancy, which helped to hand over of Hinchingbrooke Hospital to private operator Circle, with disastrous consequences, and was associated with a number of other botched privatisations.
There just isn’t enough money
Whatever the misgivings about any of these specific proposals, UNISON believes that there is a fundamental flaw to NHS Improvement’s cost-cutting drive – there just isn’t enough money in the first place.
In July, the House of Commons health select committee warned that the service was under unprecedented strain and struggling to keep pace with rising demand.
In its first report on the impact of the government’s spending review on health and social care, the committee said that the scale of the funding challenge facing the NHS in England was “colossal”, especially given the timescale for achieving it.
The committee also noted that the funding allocated for the NHS in the spending review “is less than would appear to be the case from official pronouncements.”
As Ms McAnea says: “The best financial planning in the world cannot mask the fact that there is simply not enough cash in the NHS to meet the demands being placed on it.
“The NHS doesn’t have the cash to sustain it until the end of the decade. Ministers claim to be protecting health spending, but the reality is very different.
“The extra money the government conjured up last year won’t make up for cuts to public health and health education now underway.
“What’s worse, the government is storing up yet more problems for the future, through its unrealistic approach to pay and ill-considered plans for training tomorrow’s nurses.
“Limiting annual pay increases across the health service to 1% means the NHS will struggle to attract and keep the right number of staff,” she added. “And government’s refusal to fund the Treasury’s national living wage promise means health workers could get even less.
“Scrapping the student bursary will lead to higher spending on agency staff with too few new recruits to plug existing gaps.
“Either way, the NHS will continue to be in dire financial straits unless the government changes tack.”
What do we want?
UNISON is backing a new campaign, Fund Our NHS, which is being organised by the NHS Support Foundation with the support of the TUC.
The aim is to build support for a new approach to funding the NHS, leading up to the next spending review this autumn. The campaign has a five-point plan for properly funding the NHS:
- Give the NHS an urgent funding boost, to bridge the £30bn funding gap before 2020/1;
- Lessen the pressure for unrealistic efficiency savings, which are causing problems for patients and cuts to services;
- Set out a long- term settlement for the NHS – a commitment of public funding that will improve planning and give it confidence for the future;
- Invest in NHS staff who are the heart of the NHS – through safer staffing levels, pay, training and recruitment and retention;
- Spend public funds wisely, restore the benefits of a collaborative NHS and limit the waste of PFI and marketisation.
What can you do?
Chase your trust chief executives – ensuring that they respond positively to Sara Gorton’s letter on support services.
Recruit around UNISON’s One Team For Patient Care campaign.
Visit the Fund Our NHS site, sign its petition and lobby your MP.