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NHS care squeezed by contrived financial crisis

July 18 2013

by Mike Marqusee

http://www.mikemarqusee.com/?p=1443

The financial crisis threatening jobs and services at the Barts and London Trust hospitals is a scandal and a tragedy – because it is entirely contrived.
Among the main causes of the £2 million per week deficit are “non-delivery of planned cost improvement programme schemes.” In other words, the Trust has been unable to implement the spending cuts it is required to make as part of the NHS-wide £20 billion “efficiency savings” programme.

It’s not that the Trust hasn’t been trying to meet its “savings” targets or that staff have been wanton with resources; it’s that those targets cannot be met without compromising patient care. It’s a paper exercise that is inevitably disjointed from the realities of service provision.

The Guardian notes that “Attempts to cut wage costs are failing because vacancies are having to be filled by agency staff.” What could better illustrate the irrationality of the NHS financial squeeze? Patient needs are non-negotiable; the demand does not fluctuate according to the economic cycle and therefore the supply has to be consistent and continuous. This cannot be done within the “business” model embraced by the Barts bosses. (And the only serious error I’ve suffered in my treatment at Barts was the fault of an agency nurse on a night shift who didn’t understand how to use a new piece of equipment).

The same point applies to the problem of escalating A & E costs. The hospitals are pushing hard for people not to resort to A & E unless it’s absolutely necessary, but in the end A & E demand is out of the hands of the hospitals that have to meet it. Demanding an arbitrary level of savings from A&E is tantamount to demanding an arbitrary cap on A&E demand, which is not possible, unless you’re simply going to deny treatment to people who need it.

The Guardian article notes that the Trust is avoiding mentioning the elephant in the room: the massive PFI re-building programme that costs the Trust some hundred million a year in repayments. These, it appears, can never be renegotiated or re-scheduled.

Muddying the waters is the news that the Barts Trust hospitals are to face inspection as a result of “serious patient safety incidents … poor patient confidence and trust in its nurses; long waits for urgent cancer treatment; excessive rates of Caesarean section births; and too many emergency re-admissions.” Redressing any of these shortcomings will require more, not less, money; and the proposed cuts in staff and departmental spending will surely exacerbate existing problems. But here’s where the current spate of negative stories about NHS treatment plays a dubious political role. Not because the stories are untrue or insignificant (they are neither), but because they are the effects, not the cause, of the NHS crisis.

My own care at Barts over the last six years has been superb. With a few exceptions, nurses, doctors, technicians, receptionists have been expert, efficient, caring, responsive. But it’s quite obviously a service under enormous and mounting pressures. I regularly attend the weekly haem-oncology clinic which is always packed with patients. There’s usually a delay of 40 minutes or more between appointment times and actually being seen by a doctor. Patients accept this because when you do see a doctor, you get as much time and attention as is needed. I’ve never felt rushed or cut short; whatever issues I have at that moment are dealt with in full. This can sometimes take as much as an hour of the doctor’s time – which means people behind me in the queue wait longer. And of course the costs to the Trust rise. So it’s not inefficiency but efficiency – if the measure is to be patient care – that’s making Barts financially “unviable”.

Now there will be pressure on staff to process patients more quickly. At the same time, there will be fewer staff to deliver the service.

The Trust says it wants to reduce “emergency re-admissions”; that will mean staff erring on the side of not re-admitting patients, and thus exercising less caution, less diligence, in ensuring necessary care is provided.

I hope staff at Barts resist this attack on their jobs and on the essential, life-sustaining services they provide. It’s often seemed to me that Barts survives on their good will alone. They’ve already been hammered by a steady fall in real wages and there is a sad fatalism among most, not helped by the patchiness of the union presence across the Trust. What’s vital is that they understand that what’s happening now is not about failings at Barts; it’s a manifestation of the general crisis in the NHS, a crisis brought about by cuts, fragmentation and privatisation, and one that can only be addressed through a mass movement that forces a radical redirection in government policy.

Mike Marqusee
(Barts patient)

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