It was George Orwell who said, ‘We have now sunk to a depth at which restatement of the obvious is the first duty of intelligent men’. Those words ring in our ears as we ponder on the announcement this week from Monitor, warning hospital Trusts across the country that their spending plans for this year do not add up. Orwell’s clarion call to think for ourselves, challenge prevailing dogma, and speak the truth could hardly be more relevant.
Hospitals across the country are struggling to meet targets set by the Government, with many subject to fines for failure. The notion that they are suffering these penalties while frittering resources on unnecessary activity is absurd. There is no more waste to cut. No fat to trim. The engine of secondary care is spluttering, starved of the resources necessary to do the job required of them. The disparity between the edicts of the central planners and the realities of life on the front line are reaching Stalinesque proportions.
So what will be the predictable response to these impossible pressures? Hospitals, in their desperation to avoid the ‘naming and shaming’ so adored by the ever-present political commissars of the NHS, will respond by pushing as much demand back into general practice as they can reasonably get away with. CCGs will be cajoled into ever tighter ‘demand management’ based on the bankrupt prospectus that much of the demand sitting on hospital waiting lists has been put there by slipshod and lazy GPs. General practice, whose resources have been cut by 13% since 2008 while activity has increased by 15% (a 28% real terms pressure increase), will be forced into managing patients who should properly be referred, and without the necessary resources.
General practice has always been the heat sink of the NHS. It is the sector that has soaked up the surges and spikes in demand and smoothed out the input into secondary care. The problem is that the heat sink is now so hot it is melting. It can absorb no more.
The restatement of the obvious that Orwell demands is quite simply that the current demand on the whole system cannot be addressed within current resources. Trusts are spending every penny of their resources on meeting government targets, yet Monitor declares that those pennies exceed the allocation. In short, Monitor’s message to Trusts is really a message to the government that it cannot expect all their targets to be hit unless they invest significantly more cash in the system. The whole system. Including the 28% more funding required to put general practice back on the even keel of 2008.
The obvious conclusion in the face of the refusal of government to invest enough resource to meet its own definition of reasonable demand is that our politicians must begin a debate with the public about curbing that demand. Yet their political grand strategy is to lecture the NHS on their own made up crisis of the need for seven-day working. In other words, they are pouring petrol on the flames. To reflect the Secretary of State’s own words, it is time for the government to ‘get real’ about the resources required to fulfil its populist agenda.
This obvious doublethink wrapped up in divisive political newspeak is just not good enough. The engine of secondary care is spluttering and the melting heatsink of general practice can no longer protect the system, regardless of the volume of rhetorical bravado coming from the top. Monitor’s declaration is the latest and starkest sign of the need for a genuinely ‘New Deal’ – a sustainable deal between the taxpaying public, politicians and beleaguered NHS staff buckling under the strain. In the absence of the courageous political leadership required to achieve this, the very future of the NHS is in doubt.
Dr Mark Sanford-Wood is medical secretary of Devon LMC