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Osborne’s billions are too little, too late



From Dr Chris Hewitt, chief executive of Leicester, Leicestershire and Rutland LMC

Health and social care in our region is in meltdown and the damage could take a generation to fix. If general practice in the area were a patient I would say it is on its last legs, heading for a life support machine with the Government preparing to pull the plug.

GPs and their teams in the region are struggling – many large practices are now down to the ‘last man standing’ with just a single GP running practices of up to 10,000 patients with help from whatever locum doctors and nurses they can find each week.

I believe that the impact of huge cuts to social care since 2010 means that GP surgeries and hospital accident departments will drown this winter under the weight of a rising tide of demand. You get what you pay for, and as far as spending on public services is concerned our region is one of the worst funded in the UK. Even with the £3.8bn now allocated to NHS England from April next year, this is too little too late. George Osborne is very good at conjuring tricks and he has dismantled the funding ring fence to protect public health and NHS education – robbing Peter and Mary to pay Paul. I feel very sad that the deep cuts to social care spending since 2010 will be responsible for the overwhelming of local healthcare services this winter – the talk of seven-day opening is just a distraction, Monday to Friday services have been starved for too long.

I fear there will be large queues of ambulances outside the Leicester Royal this winter as patients will be stuck in hospital beds with nowhere to go to – A&E will be backed up.

We estimate that £3.8bn of additional funding to NHS England from next April will only result in £60 per person in Leicestershire and Rutland (which gets a poor deal compared to most other parts of the UK). With the reduction of acute trust and CCG deficits and the impact of other public health and social care cuts this could account for up to £50 per person. The net result is likely to be just £10 extra funding per person per year across the NHS in our region – of which GP services may just receive 60p per person. From our surveys of members we believe that general practice services receive just 6% of the local health funding and have to deal with 93% of the patient appointments.

Local GPs already offer over six appointments per person per year, in addition to many other services previously only available in hospital, with funding of only £120 per person (less than £20 per appointment) – 60p will be too little too late.

Medical students and doctors in training do not want to be GPs any more as the system is unsafe, unsustainable and can be a very frightening place in which to work. This autumn over 40% of GP training posts remain vacant in the East Midlands. GPs and their teams are taking early retirement, changing careers or emigrating.

I am profoundly sad for patients and carers in the area I have grown up and worked in – I fear that people do not realise just how far down the international league tables we have fallen in terms of how little we spend on looking after each other. If we don’t start to make meaningful investment in our care now we will spend a generation regretting it.

We need new thinking and the brightest minds to review the broken systems in health and social care – the issues are usually very nuanced and complex, and vary from one postcode area to another, and even within the same postcode area. As Einstein once said: ’We can’t solve problems by using the same kind of thinking we used when we created them.’

The main obstacle to solving all of this is that we have politicians, managers and professional bodies continuing to do what they have always done – people appear unable to think or act differently, or to persuade others to think or act differently. This must change and it must change now.