Professor of Health Policy Peter Bradshaw talks about the reasons for the #OurNHS march which saw tens of thousands of people take to the streets of London to protest against ‘hospital cuts’. Their aim was to draw attention to the plans which could see hospital services in nearly two-thirds of England cut back.
GPs plan for patient charging
“A rally comprising 250,000 NHS staff, Union representatives and left wing MPs protested outside Parliament at the weekend. Their claim is against “yet more austerity” in an NHS whose services “are on their knees” – in an impassioned appeal for more cash aimed at the imminent Budget Statement by Chancellor Mr Hammond (BBC, 2017a)
Predictably the Department of Health holds the claims spurious and extols the additional £4billion investment during this fiscal year – denying that the proposed recovery strategy – Sustainability and Transformation Plans (STPs) are just poor camouflage for further reductions in service – or a device to introduce patient charges.
The source of the perceived problem is evident. We have outstripped our ability to afford all the care and treatment available. The plain answer is that services must be rationed and this happens historically through several well-known mechanisms (Kings Fund, 2016):
- Renunciation – whereby treatments are not provided because of their assumed ineffectiveness
- Selectivity – when patients are only chosen by certainty of outcome
- Delay – where patients wait their turn to be treated
- Dissuasion – where available services are just not publicised
- Deflection – the GPs favourite – where complicated cases are referred elsewhere
- Dilution – when services are offered using fewer or less qualified staff
In truth, we spend ten times more on the NHS now than we did when it was instituted and even allowing for inflation there have never been cuts as the campaigners claim. 30p in every £1 of public spending is currently invested in caring services (BBC, 2017b). But we know also that STPs are guesswork and will reduce hospital provision by two thirds in England in the hope that like Mr Micawber, something will just ‘turn up’ to treat us safely at home – on which the protestors have a very valid point.
Herein resides their grouse – that the Government is ducking the real question of exponential demand. We keep breathing in and out 13 years longer than we did when the NHS was conceived; lethal infectious diseases are almost no more and mortality from cancer means that 50% survive a decade or more. So, with the major killers controlled it is no revelation that the NHS sees 1 million people in any 24hour period and needs 1.7 million staff to do so – due largely to inflictions from the over 65s who cost 2.5 times than the average 30year old to treat and the over 85 year olds who cost five times as much.
Unlike the three devolved UK countries England’s biggest problem is affording adequate personal social care by helping older sick people to be cared for at home to avoid hospitalisation.
Hence the activists claim that unless Mr Hammond has suddenly acquired a hearing aid – his persona and effectiveness on social care thus far have been analogous historically, to inviting Jimmy Saville to be keynote speaker to a conference on Child Protection!”
BBC (2017b) 10 charts which show why the NHS is in trouble
Kings Fund (2016) Six ways in which NHS financial pressures can affect patient care