Kings Fund report: ‘Ready ammunition for service closure’

The UK government is proceeding with its plans to abolish the NHS and is implementing its new system in advance of the highly controversial Health and Social Care Bill becoming law. This is profoundly undemocratic and combined with demands for £20bn worth of efficiency savings represents a looming catastrophe for public health care.

The efficiency targets are without precedent, according to the House of Commons health select committee. No country in the world has acheived a real terms decrease of £20bn in its health budget in just five years. Nevertheless, the government is allowing chief executives and finance director to press on with a policy of service, ward and hospital closure.

It is also continuing a policy of hollowing out the NHS as the Government allows CEOs to use the excuse of deficits to offload services on to the private sector and risks of not being treated onto patients. Hinchingbrooke Foundation Trust Hospital has been contracted out to Circle, private patient bed numbers increased in Maidstone, Kent, and US health care company, United, allowed to run primary care trust commissioning along with other companeis.

These measures will add to, not reduce costs to the tax payer because scarce resources will be squandered on redundancies, market administration, billing, management consultants and payments to owners and lenders. As a result there will be growing disparities in access to health.

Grist to the mill

This is all grist to the mill so far as the government is concerned. It hopes that NHS disinvestment and public expenditure cuts will force through the market changes they want.

The Kings fund report today provides ready ammunition for service closure and more marketization. Based on interviews with finance directors who make a case for cuts based on deficits, and inspite of reports of rising waiting lists as a result of cutbacks and local deficits, argue for more service closures. However, what is not reported is that deficits are artificial and the product of an arbitrary market-driven pricing system which is creating winners and losers among trusts. What is not reported is that rising emergency or unplanned admissions are due to cuts in other parts of the system. In fact, services do not need to close; that always has been and remains a political decision.

The real measure of performance should not be waiting lists but the extent to which need is being met and access and equity are being protected. But the government’s NHS reforms consign this approach to history: the Bill repeals the founding duty of the secretary of state to provide comprehensive care to all his citizens.

Easy retrenchment

That will make a lot easier the policy of retrenchment that is even now being introduced. The surgeons this week in The Guardian were reported as writing to Secretary of State for Health Andrew Lansley about how eligibility for surgery is already being changed to exclude those with a genuine need for NHS care. Meanwhile, PCTs continue to draw up lists of procedures that will no longer be funded. Of course, this is one way to tackle waiting lists: if you are not eligible for care you can’t be recorded as waiting for it.

The decision to axe accident and emergency departments, wards, hospitals and community services and make NHS staff redundant because of deficits is part of the same process.

Matters can only get worse if the Bill becomes law. The evidence shows that providers and payers operating under competitive systems must select their patients and services in order to manage the risk of exceeding their budgets. Will the pause simply allow closures and chaos to mount unchecked or will decency and sense prevail? The answer lies in the hands of the Lib Dems and Labour; let’s hope they rise to the challenge.

Allyson Pollock is Professor of Public Health Research and Policy at Barts and the London Medical College, Queen Mary, University of London.