NHS Providers, professional bodies and Royal Colleges have been increasingly forthright in their warnings on the state of the NHS in the run-up to the election and the period immediately afterwards.

It’s clear they are reflecting the growing frustration of their members and of health staff generally caught at the sharp end of a system that is being pushed to the very limits of endurance as demand pressures continue to rise, funding, staff and resources lag ever further behind, and ministers roll out inane and deceptive statements to mislead the public on the scale of the problem.

NHS Providers, which represents NHS trusts, trod a diplomatic line of welcoming statements by Boris Johnson and the Conservatives committing to improve the NHS, while also pointing to the growing gap between the amounts needed and the limited resources available. They urged ministers to get “Back to reality” in a statement following the Queen’s Speech.

Its deputy chief executive Saffron Cordery argued that

“We’ve had a stark reminder over six weeks that in many ways it’s a time of fantasy politics, with policies and promises designed to cut through to voters rather than necessarily address reality.”

The reality is stark indeed:

“Performance in the hospital sector and across the urgent and emergency care pathway reached the lowest point in the 10 years since we have been monitoring the constitutional standards. And we know the pressures are just as great in community and mental health services, although not yet measured in the same way.

“In November, only 71.3 % of patients at major A&E departments were seen within four-hour waiting time target – the lowest on record.

“Bed occupancy, at 94.9%, was much higher than recommended levels. The number of ambulance arrivals over the week breached 100,000 for only the second time ever. You get the picture.”

Limited funding increase

Another statement from NHS Providers points out that:

“While the commitment in the Queen’s speech to deliver a 3.4% annual real-terms increase in NHS funding is very welcome … We need to be realistic about what this funding will buy and what the public should expect.

“This investment will maintain standards at their current level, but the service needs additional real investment to meet the needs of the future and deliver the improvements we all want to see.” 

NHS Providers didn’t just bang the drum for more money for hospitals: instead the demands were for improvements elsewhere in the system:

  • a sustainable solution to the current social care crisis …
  • a reversal of the cuts to public health spending, with investment in prevention services, and
  • a move away from the hospital-centric focus, to invest in mental health, boost primary care and community services.

NHS Providers chief executive Chris Hopson has pointed out that the real terms virtual freeze on health spending since 2010 has meant that current NHS spending in England is £35 billion less than it would have been if previous average increases had continued.

But BMA chair Dr Chaand Nagpaul has pointed out in a memo to ministers that the gap will increase by another £6.2 billion by 2023 if spending is only increased by the £33.9bn cash /£20.5bn real terms increase Johnson’s government has promised to enshrine in law.

The BMA’s calculation is based on their view that an annual 4.1% increase in real terms is needed to keep pace with rising demand and cost pressures.

Still waiting for extra GPs

Meanwhile the Royal College of General Practitioners has opened the new year by calling the bluff of ministers who keep promising implausible numbers of extra GPs. Its Chair Prof Martin Marshall states the service has been “running on empty” for too long, and demands a change:

“The situation in which we find ourselves has not happened overnight, and the College has been sounding the alarm bells for many years. 

“Whilst workload in general practice has escalated in terms of volume and complexity, successive governments have failed to invest sufficiently in the family doctor service in order to keep pace with demand, and one consequence is that we now have a worrying shortage of GPs. 

“We hope that the new Government will take this seriously and that it will deliver quickly on its General Election manifesto pledge of 6,000 additional GPs and many more thousands of the wider general practice team.”

Numbers of GPs have declined by over 1,000, and numbers of GPs per head of population have fallen since Jeremy Hunt infamously promised an extra 5,000 five years ago, and the leading health think tanks warned last year that it was unlikely the shortfall in GP numbers would ever be reversed.

But it’s hospital crises that tend to hit news headlines, and promises of new hospitals to be built have been prominent in ministerial claims to be prioritising the NHS, along with inflated claims to have already built 18 new hospitals since 2010.

As i news has pointed out, at least 11 of the 18 projects claimed by Johnson’s ministers are not new hospitals, but “redevelopments, refurbishments or changes to existing hospital sites, such as integration or relocation”.

At least half of the projects were also initiated by Gordon Brown’s New Labour government, including a new Mental Health Unit at University Hospital Birmingham  which opened in June 2010, a new build and refurbishment at Hope Hospital Salford in September 2011, and the new build and reconfiguration at  University Hospital of North Staffordshire NHS Trust.

Will new hospitals mean extra beds?

Among those responding to this spurious claim was Dr Susan Crossland, president of the Society for Acute Medicine (SAM), who also told the i:

Whilst investment in the crumbling infrastructure of the NHS property portfolio is of course welcome … we call into question whether this will ease the current pressures we see and we call on the government to be honest and account to the tax paying public.

“Are there going to be any more beds in the system, or are we going to continue to see further reductions which are unsustainable in the current climate?”

New buildings could mean fewer beds

The SAM has reinforced calls from the Royal College of Emergency Medicine (RCEM), which has been pressing hard for more beds in the system to ease the overcrowding and crisis conditions that threaten safe treatment in A&E departments.

In January the SAM responded to the publication of the latest performance figures, warning:

“We can honestly say that acute care is facing pressures the like of which we have never seen and the huge jump in patients waiting more than 12 hours should be of serious concern to the government. 

“… The target of 95% for the standard was last met in July 2015. There has been too little support, too late and the Society calls on central government to urgently tackle the shortage of beds, the lack of staff and the social care system so that hospital staff can work in a safe and sustainable system, providing world class treatment to those who need it.”

Both SAM and RCEM are also warning that without extra capacity to deal with rising demand the ambitions of NHS England to widen the availability of “same day emergency care” (SDEC) will come to nothing.

The Long Term Plan a year ago suggested rolling out SDEC across the NHS could prevent up to 500,000 overnight hospital stays over the year.

How seriously is the government committed to the long-term plan?

Functioning impaired

However, an audit by the Society for Acute Medicine (SAM) found almost half (45%) of SDEC units had their “functioning impaired” by hospital trusts utilising the space as overflow for admitted patients.

Many do not provide evening or weekend SDEC services, and a report last October showing just over a third of units (35%) were only open five days a week.

“For all its good intention, the NHS’s grand plan to use SDEC to improve care and capacity this winter has been grossly derailed as trusts scrounge for additional beds,” said Dr Susan Crossland, president of SAM. Dr Nick Scriven, immediate past president of SAM, added: “We are increasingly concerned we will never see SDEC fully implemented as desired if units are constantly seen as the ‘easy’ target when under-pressure managers need extra bed spaces.”

The RCEM brought a number of these issues together in its General Election Manifesto, which argued “eliminating crowding in our Emergency departments must be the number one priority.”

“Since 2010-11 attendances to Type 1 Emergency Departments in England have increased by 1,748,283 (12.5%) – equivalent to the workload of 22 medium-sized departments. Every year, millions of people turn to our Emergency Departments as increasing numbers are living longer with a complex range of medical needs. Primary and social care services have not been developed to address this need.”

Recommendations

The RCEM’s recommendations to address the problems in A&E are bold – going much further than Johnson and his ministers have been willing to promise:

“1. Increase the bed capacity in hospitals to maintain flow in Emergency Departments. We estimate that at least 4,000 extra staffed beds are needed in England alone this winter to achieve 85% bed occupancy.

“2. Immediately publish a Social Care White Paper, with the view of expanding social care provision to improve patient flow and address delays in transfers of care in Acute Hospitals. Additional funding must address the £2.3 billion shortfall in social care faced by councils, as advocated by the Local Government Association.”

They want ministers to “Ensure sufficient capital funding is available for trusts to transform the emergency care system at pace to ensure it is fit for purpose.”

Mental health

Far from narrowly focused on hospital care, the RCEM have also pressed for urgent action to improve GP services, expand social care to support frail elderly people in their homes, and also “Build on the commitments outlined in the Forward View for Mental Health and NHS Long-Term Plan and accelerate the expansion of mental health services.”

Thousands of young people rejected by mental health services

The RCEM also want urgent action by ministers to deal with the crisis their government has created with its absurd pension taxation policy, driving consultants to cut their hours.

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John Lister
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