Cuts ‘risking perfect storm’ in NHS

NHS hospitals will bear the brunt of efficiencies under health service spending plans for 2012-13 announced by the Department of Health.

Overall, primary care trusts (PCTs) will see their budgets rise by more than 2.5 per cent although part of this will be handed over to councils for work designed to reduce pressures on the NHS.

But under a continuing drive by the NHS to save £20bn between 2011 and 2015, all NHS organisations will also need to make cost efficiencies worth four per cent. On top of this, hospitals will also face cuts in the tariffs they are paid for providing services of at least 1.5 per cent.

Amid growing concerns over standards of dignity and basic care in the NHS – and ahead of the highly-critical report into the Mid Staffordshire hospital scandal – there is also a renewed emphasis on improving the quality of services.

In a key development, the plans also foreshadow a sweeping shake-up of services which will see district hospitals providing fewer services.

Already in Yorkshire there are plans to centralise trauma care in regional centres, while vascular surgery will also be provided in fewer hospitals.

But the most controversial changes are likely to cover provision of maternity care and A&E which could see some units close.

Experts predict the coming 18 months will be critical for the NHS ahead of a switch which will see GPs take over spending and the soon-to-be-abolished PCTs are being ordered to make sure they clear their debts.

Sue Slipman, chief executive of the Foundation Trust Network which represents elite foundation hospitals, said the renewed requirement to make four per cent efficiencies could leave hospitals in “a perfect storm this winter”.

“NHS provider organisations are grappling with cost cutting measures, trying to reorganise their services to bring more effective and streamlined care to patients as well as coping with changes across the NHS,” she said.

Judith Smith, head of policy at the health thinktank the Nuffield Trust, welcomed the emphasis on dignity and quality, amid increasing evidence the NHS had failed to ensure humane care for frail patients with complex conditions including dementia.

She said: “The Government is right to be concerned. The financial pressures on the NHS raise the risk that these sorts of failures will multiply and this is a major challenge for new clinical commissioners to grapple with.”

She said new organisations being set up to improve scrutiny of health services would in theory help improve local monitoring of the NHS.

“However, the dangers of warning signals being missed in the transition are real: tragic lapses in care must not be the price of system reform,” she added.

NHS chief executive Sir David Nicholson said recent agreements on significant service reconfigurations showed real change could be achieved where managers and clinicians worked together “with courage and skill”.

Where change was needed “we must be prepared to take on the challenge during 2012-13”, he said. Failure to do so would mean relying on “short-term fire fighting measures” which was why blanket restrictions on procedures or minimum waiting times could not be used.

Sir David added: “This is not a time for the faint-hearted: we must sink our teeth into these issues if we are to have any chance of success.”

Comment: Page 12.

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