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The waiting game

I voted Brexit for the NHS – now show us the money

Dr Kailash Chand

Let me confess. I voted for Brexit, on a single issue – the promise of £350 million a week for the NHS made by Brexiteers led by Boris Johnson. The now foreign secretary stated in an article for the Daily Telegraph: ‘Once we have settled our accounts, we will take back control of roughly £350m per week. It would be a fine thing, as many of us have pointed out, if a lot of that money went on the NHS.’

NHS England chief Simon Stevens has now articulated the views of many like me, using an image of the notorious Vote Leave battle bus, saying: ‘The NHS wasn’t on the ballot paper but it was on the Battle Bus. Vote Leave for a better funded health service – £350m a week.

‘Rather than criticising these clear Brexit funding commitments to NHS patients – promises entered into by cabinet ministers and by MPs – the public wants to see them honoured.’

Historically, the service has enjoyed rises of around 4% to cover the cost of the ageing population and new drugs. There is a £30bn gap to fill and we should be increasing the UK’s health spending by at least £10.3bn to match that of other leading European economies.

The health and social care system is a mess. Net expenditure on social care has dropped in real terms from £8.1bn in 2005/06 to £6.3bn in 2014/15, a drop of more than 20%. The Department of Health’s budget will increase by just over £4 billion in real terms between 2015/16 and 2020/21. This is not enough to maintain standards of NHS care, meet rising demand from patients and deliver the transformation in services outlined in Simon Steven’s Five Year Forward View. The pressures on the NHS will peak in 2018/19 and 2019/20, when there is almost no planned growth in real-terms funding.

If Simon Steven’s request is not heeded by the Chancellor, the intense pressures on the NHS and social care services will continue to grow. Already, two-thirds of NHS trusts (65%) and NHS foundation trusts (66%) reported deficits in 2015/16, up from 44% of NHS trusts and 51% of NHS foundation trusts in the previous financial year. The number of CCGs reporting cumulative deficits was 32 in 2015/16, up from 19 in both 2014/15 and 2013/14.

This massive funding shortfall means hospital authorities have no choice but cutting bed numbers and already a third of A&Es are set to close to cope with rising hospital deficits. Vulnerable elderly and disabled people will pay the price for a lack of new investment in social care, according to the Nuffield Trust. The government is asking GP practices to provide more services, including many involving the transfer of hospital care into the community, without the resources required to successfully deliver them. Primary care is imploding faster than people realise and patients are already bearing the brunt of the problem.

A combined financial and staffing crisis could cause ongoing chaos for years and ultimately kill off the NHS for good. It’s impossible to see how the NHS will get through the year 2018/19, when spending per person will fall. Something will have to give, whether it’s ballooning waiting lists, record deficits, or having to refuse patients new drugs.

I echo the statement of BMA chair, Dr Chaand Nagpaul: ‘The promise of extra funding for the NHS was a key issue at the ballot box during the Brexit referendum, and people rightly expect that promise to be honoured.’

‘With the budget only weeks away, bold action to deliver on this pledge, as proposed by Simon Stevens, is urgently needed and has the backing of the BMA. This is vital in order to address the current crisis in our health service, protect and improve patient care and put the NHS on a sustainable footing for the future.’

We have been squeezing the lemon for ‘efficiency savings’ for years. But it is getting to the stage where there is nothing left to squeeze.

Dr Kailash Chand is a retired GP from Tameside and is honorary vice-president of the BMA


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Readers' comments (25)

  • Dr Chand is correct that we do need a significant injection of cash in order to maintain a safe service in the short term, and we have been squeezing the pips for too long. Yes demand goes up and we can do more.
    However this is not the only answer and it is a fact that the NHS is completely mismanaged. So much money is wasted and there are huge numbers of people who are not contributing to productivity at all.

    We need to get back to basics. The greatest expenditure in the NHS is on staff. Management costs as a percentage have increased more than clinical costs. The NHS needs

    1) to reduce management costs
    2) to make clinical staff feel valued and empowered to do their jobs to the best of their ability and management should exist to support clinical staff not to control them.
    3) We should aim to get to a point where we do not have to contract with as many bank staff or locums and we should try and staff to excess capacity allowing for the fact that there will be maternity leave, sickness etc. It is a false economy relying on expensive contracted staff
    4) properly staffed departments will lead to less errors and complaints and therefore less indemnity payouts. A huge amount is put aside from the annual budget
    5) There are far too many processes and tick boxes and dare I say it audit for audits sake. We have become process driven and so much data is collected that is never used. When I first started s a doctor spreadsheets were not in existence and we managed without them
    6) We waste so much and we are also having to pay far too much for much of what we use. If you are practising in the NHS you should be made to buy from a central procurement agency which sources from companies and uses economies of scale for the benefit of all NHS providers
    7) We should be paying reduced rents for NHS properties which are being used by NHS providers - not market rents

    I could go on! I am an ex GP partner who is about to retire from locuming etc. We can't just keep asking for more money without dealing with these problems as well.

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  • "Let me confess. I voted for Brexit, on a single issue – the promise of £350 million a week for the NHS made by Brexiteers led by Boris Johnson."

    Oh dear........I thought it was only the ill-informed who believed this rhetoric

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  • Yes Shaba,many were taken in by the Pied Piper of Hamelin, even the great and the good. But twas always like this if one looks down the ages.

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  • Sad to say but above are right, you were deluded on this point. There never was going to be any money for the NHS.
    The blond one was clearly spouting whatever came into his head at that moment (as usual) to get the masses to support him. Really this was no more sophisticated an approach than offering sweets to kids, except worse as the sweets never even existed.

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  • Oh, dear. You really believed that nonsense. Shame on you. Why don't you apologise to our EU colleagues who will be leaving? Why don't you apologise for the racist language they have suffered? And then apologise for the crap we will all go through in the next few years. And then stop writing this column because your credibility has gone.

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  • Oh dear should have kept that one to yourself!

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  • David Banner

    Voting Brexit to save the NHS is like........
    Voting Communist to save the monarchy
    Voting for Xmas to save the turkeys
    Voting Lib Dem to save Brexit
    Voting Jeremy Hunt to save the NHS

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  • What an idiot!

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  • AlanAlmond

    Excuse me my venerable collegues but the majority of the population of this country voted for Brexit. It is a noticeable characteristic of those who voted with the minority to view themselves as somehow morally and intellectually superior to all those stupid fools who disagree with them. Racist, poorly educated and backward is pretty much the standard take. You were on the loosing side of the debate my friends. Get over yourselves. The country is controlled by people who dont want Brexit..very few publicly articulate a pro Brexit view point and those that do are patronised and insulted. If you feel Brexit was wrong ..fair enough, but I remind you again you are in the minority. Although a very vocal and well connected minority at that.
    ..time for me to exit Pulse comments I suspect..these kind of views aren’t generally tolerated by enlightened remoaners.

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  • AlanAlmond

    ..I voted Brexit because I believe in democracy. The EU superstate is not a democratic entity. I didn’t believe the rubbish about NHS funding but I don’t see any reason not to push for more funding in any way we can. Politicians who suggested we’d get more cash need reminding, even if they are obviously otherwise generally full of sh&t

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