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Saturday 4th
posted by Morning Star in Features

But managers are beginning to point out the health service is breaking down, says JOHN LISTER

AS THE financial stranglehold on the NHS is tightened, there are signs that senior NHS managers are beginning to speak out about the damage done by seven years of frozen budgets alongside increasing cost pressures.

The pace has been set by NHS England’s chief executive Simon Stevens. He told the management union Managers in Partnership (MiP) that Jeremy Hunt’s insistence on staff pay rises being dependent upon improved productivity was “an own goal of the first magnitude.”

Stevens argued for an end to the pay cap and for the government to give the health service the extra money needed to cover the cost of whatever award is finally made — or admit that any pay increase would necessarily result in cutting staff numbers.

Stevens has been on record all year challenging government claims to have generously funded the NHS. In January he brandished a copy of the Daily Mail headlining shortages of doctors, beds and scanners compared with other comparable countries to the Commons health committee.

He rejected May’s claim that the NHS was getting “more money than it asked for,” and pointed out that under current plans real-terms spending on health would actually fall in 2018-19.

Throughout the year NHS Providers — the body representing NHS Trusts and Foundation Trusts — has warned that the planned limits on spending made management’s task of seeking to maintain services and quality of care a “mission impossible.”

Think tanks including the normally docile King’s Fund, the Nuffield Trust and the Health Foundation have since the election published increasingly devastating critiques, showing the real-terms cut of over 20 per cent in payment per treatment in hospitals, the desperate shortages of beds and the growing crisis of staff shortages.

Now four chief executives from hospital trusts in Birmingham and north-west England have broken the usual silence and posted comments on Twitter warning of the consequences if the current cash squeeze continues.

Echoing some warnings from this column, one points to the fact that all of the improvements made in the NHS from 2000 are now being rolled back. Another warns that waiting times could increase to levels not seen since 1999.

In response Theresa May’s robotic ministers at the Department of Health and its armies of press officers and spin doctors churn out the same old discredited phrases, claiming the NHS has plenty of money, pointing to increases in spending that take no account of inflation and costs, and endlessly reannouncing previous minimal allocations of “extra” money and decisions to recruit thousands of extra staff by 2020.

But every senior NHS manager who has any contact with front-line services knows that the opposite is the case.

Far from enjoying extra staff, the NHS is struggling to cope with a soaring number of vacancies, as EU nationals — as yet promised no security as part of Mrs May’s disastrous Brexit bargaining — depart en masse from vital NHS posts.

The number of nurses and midwives coming to work in Britain from Europe has plunged by 89 per cent since Britain voted to leave the EU, while there has been a 67 per cent increase in qualified European medics leaving the Nursing and Midwifery Council’s (NMC) register.

As if to bang home the point that migrants — health workers or not — are not welcome in Brexit Britain, the government has insisted, on the basis of specious arguments and largely fraudulent figures on so-called “health tourism,” on imposing charges for overseas patients accessing treatment.

Since October 23, all NHS trusts in England have been forced to check the residency and immigration status of patients and demand up-front payment for care from those who can’t prove their “eligibility.” This covers all secondary care and a large proportion of community and mental health services. It does not include GP services or A&E… yet.

Predictably — as Nye Bevan warned almost 70 years ago when he rejected any such restrictions on the NHS — British-born patients are also being obliged to produce passports and go through the same oppressive bureaucracy.

But for health workers, it’s as bad as US medics having to check a patient’s insurance or credit card before proceeding with treatment.

The campaign Docs Not Cops are right to argue this means “the NHS is now the front line in the government’s attempts to create a ‘hostile environment’ for migrants.”

NHS workers should not be forced to police the people they treat: overseas staff caught up in this will clearly be drawing the conclusion they are no more welcome here than other migrants.

But at the same time, increased stress and workload in under-staffed departments, along with the pay cap, bullying management and demoralisation mean thousands more Britain-trained nurses and midwives are also leaving the register, and applications from mature students for training as new NHS professionals have predictably slumped after the axing of bursaries.

The pressure on NHS Trusts to slash spending to meet impossible “control totals” (cash limits) means that far from flexing every muscle to fill the vacant posts, managers are trying to keep costs down.

Many are retreating from the increases in staffing levels that were introduced in the aftermath of the 2013 Francis Report on scandalously poor care in Mid Staffordshire Hospitals a decade ago.

The danger signs are flashing to warn that one or more ghastly repetitions of the horrors of those under-staffed services could again trigger similar public outcry.

However, ministers just shut their eyes to all this, stick their fingers in their ears so they can’t even hear senior managers, and tell us everything is looking great.

A delusional or cynical Jeremy Hunt has even begun trolling on Twitter, professing his pride at his achievements as Health Secretary, spouting spurious numbers on staffing.

But as NHS performance plummets, BMJ articles warn we are headed towards a staggering five million on the waiting list for treatment, having just recently breached the unprecedented four million mark.

Almost all A&E units are routinely missing the four-hour target to see and treat or discharge not only minor cases but also the more serious and demanding Type 1 patients, many of whom require hospital beds. Targets for swift access to cancer treatments are also being missed.

Mental health, despite endless rhetoric, is still being relentlessly cut, with one patient revealed to have spent a week sleeping on a chair in an assessment unit for lack of beds.

We have seen acute beds in some hospitals full to capacity in August and September, well before the winter crisis which almost all but ministers are expecting to be bigger and worse than last year.

Social care remains fragmented, dysfunctional and underfunded. GPs are struggling to cope with rising workload.

An escalating “omnishambles” in our most popular and universal public service comes at a time when May’s already weak and wobbly government is reeling from revelations and resignations over sexual exploitation by MPs and ministers.

This gives campaigners the most favourable circumstances to challenge local cuts and government cash allocations, linking up with health unions to demand the pay cap be scrapped, and putting pressure on local politicians — MPs and councillors — to take sides in defence of local services and openly press ministers to inject more cash immediately and every year to prop up an NHS struggling to survive to its 70th birthday.

As upwards of 350 campaigners and trade union activists from all over England gather in Hammersmith Town Hall for a major conference organised by Health Campaigns Together, it’s clear the main concern on people’s minds is combating the cuts, and the related Sustainability and Transformation Plans.

We will be looking to develop regional networks and step up the pressure on politicians wherever services are threatened by cuts or privatisation.

It’s our NHS, and we will defend it. We have already seen important retreats on local cuts in the face of sustained political pressure.

But now, with public opinion and even senior management increasingly taking our side, we need to crank up the pressure to force the biggest retreat of all: the abandonment of the seven-year spending freeze and plans for a real-terms freeze till 2020.

This policy is irresponsible, has delivered none of the promised economic benefits, and is now lacking any serious support. The Tories are wobbling — we can push them over.

Let’s make it happen.

The Health Campaigns Together Campaigners conference will take place today from 11am to 4pm at Hammersmith Town Hall, London, W6 9LE. For more details visit: