Everyone is yelling the same warning – healthcare professionals, commissioners, providers, even independent think tanks are contributing to the din. The NHS cannot maintain standards of care, and meet patient demand and expectation within its resource allocation. It just isn’t possible.
The words ‘rationing’ and ‘cuts’ must not be forbidden.
Admission of this defeat hasn’t come easily to the most cost-effective health system in the world. There has been a culture of scapegoating CEOs and finance directors of local provider and commissioner organisations who have been unable to spin straw into gold and balance the books. The practice of ‘lifting and shifting’ scapegoats out of their jobs has been seemingly justified by expensive management consultant reports that conclude that local financial challenges can be overcome. The authors rarely have responsibility for delivering proposed solutions – an enviable position.
With most providers and commissioning organisations in deficit, the scapegoating approach has become farcical. Despite independent experts declaring that ‘overspending in the NHS is largely not attributable to mismanagement’ but evidence of systemic problems, there seems to be failure of our Government to accept this reality.
Our Government is still pressing ahead with manifesto promises for the NHS, despite warnings from independent experts that it ‘must review its priorities’, both new and existing, and that new commitments ‘may not be feasible’ .
At a time in which the NHS is increasingly struggling to deliver safe healthcare to those with need, it is telling that in last year’s Conservative Party manifesto, ‘We will make the NHS more convenient for you’ was their second promise for the NHS, sitting above ‘We will offer you the safest and most compassionate care’. Interestingly the ‘seven-day NHS’ is stated under convenience not safety.
In 2013, NHS England called on staff, public and politicians to have ‘open and honest debate’ about the future shape of the NHS. It stated that cuts would not be considered. So much for openness and honesty.
The NHS was beginning to topple then; it is falling now. GPs are handing back contracts, 80% of acute providers are in deficit, health inequality gaps are wide, performance has declined, the list goes on. In the name of quality improvement and productivity, some steps were taken to improve the financial situation, such as shifting un-resourced care into general practice and disinvesting in community services. We have had cuts to services, and some service restriction policies, once in place to avoid funding interventions of limited clinical value, have veered into blatant rationing.
Surely the truly honest and open debate about the future shape of the NHS is long overdue. But the debate must be informed. Everyone must understand the implications of prioritising ‘want’ and ‘convenience’ at the expense of meeting population need. Unless funding is to increase significantly, the words ‘rationing’ and ‘cuts’ must not be forbidden. There needs to be appropriate expectation of what can be delivered safely with the resources available and open acknowledgement that inadequately resourced demands have safety implications for patients and staff.
The warnings must be heeded urgently. When will the din be heard?
Dr Lisa Harrod-Rothwell is a GP in Essex and lead medical director at Londonwide LMCs
