NHS services across Yorkshire are facing unprecedented upheaval to make them fit for the future as soaring demands from an ageing population combine with a growing financial crisis.
Increasing numbers of frail elderly are putting severe pressure on hospitals which have been ordered to meet new quality and safety standards.
Latest figures reveal five out of 15 NHS hospital trusts serving the region will be in the red by the end of March and warnings are already being issued about deteriorating finances at another six.
Longer-term prospects for the NHS are significantly worse with a predicted £30 billion shortfall in England by 2021 unless major efficiencies are secured.
Today The Yorkshire Post is launching the latest in its series of Big Debates looking at the future of NHS services in the region amid calls for radical transformations of care. Readers will next month have a chance to take part in a debate what they would like to see from the NHS in years ahead.
Sweeping changes to reduce pressures on hospitals are expected to be implemented to prevent admissions particularly of the sick elderly by treating them in the community or at home.
But the moves will also see some patients travelling further for treatment and could lead to hugely-controversial reconfigurations of hospital care, notably affecting A&E and maternity services.
In a surprise move, NHS leaders in Calderdale and Huddersfield yesterday announced plans for major hospital changes that had attracted a storm of opposition were being put on hold despite warnings delays will trigger worsening financial pressures.
The Yorkshire Post can today reveal hospitals in Leeds are expected to be £42m in the red in 2014-15 despite making more than £50m in efficiencies - one of several NHS trusts which are plunging debt partly due to pressures to increase numbers of doctors and nurses.
Strains in A&E units - traditionally the first parts of the NHS to come under pressure - are being combined with shortages of key medical staff, with bosses at York’s NHS trust likely to be the first in the region to sanction cash bonuses to attract doctors.
But concerns are increasingly focused on the long-term impact of the sick elderly which could overwhelm the NHS without improved care in and outside hospital although there remain major doubts plans to expand community care will save money - and could even increase costs.
Former Yorkshire health boss Rob Webster, now chief executive of the NHS Confederation which represents NHS trusts, said politicians and decision-makers needed to be honest with the public about the challenges facing health and social care.
“We are living longer, and living with conditions that our parents and grandparents might not have survived,” he said.
“Cancer survival rates have doubled since the 1970s, stroke mortality rates have halved since the early 1990s, and many people now live long and full lives with multiple long-term conditions.
“If the NHS is to continue to meet people’s needs, and to meet their needs better, we must find new ways to deliver high quality care within budget. We cannot afford to deliver care in the same way, and we must recognise that doing so will not meet the needs of the millions of people with long-term conditions and ongoing needs.”
Andy McKeon, senior policy fellow at the Nuffield Trust, said growing demand from the elderly and those with chronic illnesses were coming at the same time as pressures to enhance the quality of care and increase staffing.
There was a now a “fair chance” of a cash crisis in the NHS ahead of next year’s General Election.
He said: “It is becoming more difficult to find savings and it’s going become more difficult as each year passes as pressures on services will be just the same if not increasing.”
Patrick Crowley, chief executive at York Teaching Hospital NHS Foundation Trust, said: “There has to be some honesty in the system. I genuinely believe that we will see a growth in hospital organisations getting into extreme financial difficulty in coming months that cannot all be down to incompetence. Some financial relief will be essential in the short term.”
NHS officials in Calderdale and Huddersfield said the delay would allow more time to be spent developing NHS services closer to home before a plans were put to the public for changes to hospital services.
Carol McKenna, chief officer at NHS Greater Huddersfield Clinical Commissioning Group, said: “We are fully committed to a public consultation and this in no way represents a diminution in our ambition to deliver long lasting and extensive change. The timing of public consultation on hospital services is crucial, to attempt consultation now risks losing the opportunity for long lasting change that will ultimately be of benefit to everyone in the future.”
David Birkenhead, medical director at the Calderdale and Huddersfield NHS trust, said: “We are waiting to understand in more detail how the commissioners’ decision will be implemented and how it impacts on the care and safety of patients now and into the future.”
A spokesman for Leeds Teaching Hospitals NHS Trust said the deficit followed a decision by bosses to invest significant sums in extra nursing and medical staff to improve patient care. A recovery plan was being drawn up to ensure its finances and performance were put “on a sustainable long-term footing”.