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Is the NHS in a terminal crisis?

This article is over 9 years, 7 months old
The head of the NHS Simon Stevens launched a five-year plan to save the health service last week. But we outline how the proposals offer few solutions for the catastrophic crisis in health care
Issue 2427
NHS terminal decline graphic

The NHS faces a funding crisis so severe that it risks death—and only an infusion of cash offers any hope of recovery.

Until recently this view was accepted only by health workers and NHS campaigners. Now it has official backing from the new head of NHS England.

Simon Stevens outlined the scale of the problem in his Forward View “five-year plan” launched last week.

He said the health service budget has to increase by £8 billion a year during the next parliament. 

Otherwise services will close, drugs will be rationed and hospitals will collapse under the pressure of too many patients and not enough resources to treat them.

The amount needed will be even bigger still, Stevens claimed, if the NHS cannot make “efficiency savings” on a scale never seen before.

Despite his dire predictions, politicians from all three main parties refused to commit to the extra funding.

The Tories say health spending will be “ring fenced”, which means “frozen” if they win the next election. The Lib Dems are offering a paltry £1 billion a year extra. Labour, meanwhile, says it can stump up £2 billion a year by taxing mansions and tobacco companies.

None of their offers comes close to what is needed. They all refuse to consider the one treatment that will work—tax the rich to massively increase health spending.

Despite Stevens’ tangle with the politicians, it would be a mistake to see his report as the NHS’s knight in shining armour.

Among snippets about improving dementia care, mental health and cancer services, his Forward View plan is itself littered with dangers that could destroy the service he says he wants to protect.

More NHS closures 

Stevens wants doctors’ surgeries to form groups that can provide lots of services that are at present based in your local general hospital. Some scans, tests and consultations could be done in new local centres, or “hubs”. 

He says that this will make it easier for patients to get treatment.

Forward View says the NHS should “shift the majority of outpatient consultations and ambulatory care out of hospital settings”. That may help people with relatively minor complaints get seen closer to home. 

But for those with more complex needs, the lack of a general hospital offering a full range of skills will certainly mean long trips to specialist centres. 

They could be hours away from where they live.

In reality, these “Multispecialty Community Providers” are a cash-saving measure that will undermine local hospitals and could put patients at risk. Once core services are moved out of a hospital, 24-hour accident and emergency units, and all the services they draw upon, will be threatened.

That endangers patients who see their health deteriorate while attending their “multispecialty hub”. 

It also means that seriously ill patients face a longer ambulance journey to their nearest fully equipped emergency unit.

Privatisation— no accountablity

The Stevens plan carries the hidden danger of more privatisation. GPs will be expected to commission a range of new services from suppliers, both in and out of the NHS.

The government used its 2012 Health and Social Care Act to transfer most of the NHS budget to “commissioning groups” that were supposed to be run by GPs.

At the time it claimed this meant decisions about health spending were now to be made by groups of doctors, not bureaucrats.

Stevens goes even further down this road insisting these groups should get even more control of the NHS budget.

But most doctors are playing only a small role in running commissioning groups.

It’s the private firms, management consultants and lawyers that will be the real beneficiaries of this move.

These profiteers claim that only they know how to navigate the complex health markets and laws that now govern the health service.

Quite rightly, most doctors have decided that they know more about medicine than they do about contract law.

In the meantime, democratic accountability is shrinking as health ministers already tell us that they no longer have a role in how healthcare is provided. The Health and Social Care Act meant the government could wash its hands of the running of the health service, and plead ignorance as the service declines.

Cuts dressed up as choice

Stevens promises that his plan will “empower patients” by giving them “direct control” over their care.

This radical sounding policy means that patients with complex needs could be given a budget to spend on health and social care services.

They would then be expected to work out what services they most rely on and check the local health care market to see who provides them most cheaply!

This “price comparison website” version of the NHS creates the illusion of choice without telling patients what happens if their budget does not cover their needs. 

And when budgets are set too low to provide proper care, sick people will be told that they only have themselves to blame for spending their allocated amount too frivolously.

More patients fewer staff?

Stevens says that staff with fewer skills should be trained to treat a greater variety of patients. This is because the NHS is so short of highly trained staff such as GPs and hospital consultants.

This could end what some call the “professional ghetto” that surrounds doctors. 

Many health professionals could treat patients with the medical conditions that ordinarily require a doctor. 

And many who work for the NHS would enjoy the chance to develop their skills and help those needing more complex care.

But any such move requires a massive increase in staffing levels and for all to receive proper training. Many health workers suspect this is unlikely to happen.

NHS staff already complain that they barely receive the training necessary to keep up with their own roles, let alone expand into new ones.

With the health service starved of cash, health bosses will doubtless be tempted to push inadequately trained workers to treat those who really need to see a doctor. 

When the inevitable accidents occur, you can guess who’ll get the blame.

More cuts are on the way 

The Forward View plan details three possible funding scenarios for the future—and they all involve massive cuts.

For example, the plan to devolve care to local centres is supposed to free up hospital beds. The nurses and nursing assistants who would tend patients there will, in all likelihood, be replaced by the voluntary labour of family members. 

The freed beds will mean that hospitals are underused and are then closed down and the land sold to developers.The money saved, according to Stevens, is an “efficiency saving”.

He says that stopping the health service from going bankrupt depends on making savings far bigger than the NHS, or any comparable organisation, has ever made before.

Stevens says that this effort must be combined with the radical surgery that he has outlined—and that this surgery will itself cost billions.

Stevens’ demand for more cash may have caused consternation in Westminster. But no one should be under the illusion that his plan can save the NHS.

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