When NHSreality began, the first about page read “My prediction is that the financial imperative, the dominance of “emergency” medicine to trump all other needs, will mean slowly but surely the softer areas of the health services, such as dementia, psychiatry and disability will be downgraded. Covert rationing by knee-jerk decisions will increase and only when there are sufficient numbers of the public with stories of failure that the politicians have to act, will something happen… ” The subsequent wriggling on the hook with repeated rule and structural change will continue, beyond the Nuffield Trust debates and conference in early March, until the politicians are convinced of the need for “overt rationing” in The Information Age.
Patient care has taken a back seat to cost-cutting in watershed NHS guidance that dumps the government’s main health reforms, experts have warned.
Health chiefs are telling hospitals to focus on cost control as they panic about overspending, prompting warnings of a repeat of the Mid Staffordshire scandal as bosses cut staff to meet financial targets.
In a retreat from controversial reforms introduced by Andrew Lansley, the former health secretary, competition, choice and NHS autonomy have all been sidelined as officials revert to top-down central planning to deal with a cash crisis.
Jim Mackey, the chief NHS regulator, said competition was “absolutely not centre-stage” as he admitted to a “change in tone” on finances, telling hospitals: “Don’t just think the only job is how many nurses you can employ.”
In a blizzard of guidance issued over the past month, hospitals have been told failure to balance the books is “not an option”, after years in which the government has been relaxed about overspending to keep staff numbers high.
Hospitals are on course for a £2.2 billion overspend this financial year and Whitehall is terrified that the Department of Health will be forced into a humiliating bailout by the Treasury.
Chris Ham, chief executive of the King’s Fund think-tank, said recent guidance “brings to an abrupt end the post [Mid Staffs] era when leaders of NHS organisations saw failure to ensure safe staffing as more serious than failure to balance budgets. Financial control is king.” He added: “Andrew Lansley’s ambitions to liberate the NHS by devolving responsibility for decision-making have been abandoned.”
Government sources conceded that cost control had moved up the agenda, saying that after sorting out immediate safety problems, hospitals had been set the more difficult task of maintaining good care while saving money.
Officials insisted, however, that the NHS would not be allowed to return to the situation in Mid Staffs, where bosses were allowed to get away with unsafe staff cuts to meet financial targets. Professor Ham said this was a “major risk”.
Katherine Murphy, chief executive of the Patients Association, said: “I don’t think we should be under any illusions that Mid Staffs was unique. It’s very difficult to deliver high quality safe care at the same time as you’re reducing staffing numbers, especially nursing.”
Jeremy Hunt, the health secretary, is less convinced about the power of competition to improve NHS standards than his predecessor, Mr Lansley.
His reforms aimed to reduce Whitehall control over the NHS, putting GPs in charge of organising care and making it easier for them to contract out services to the private sector.
Mark Porter, chairman of the British Medical Association council, said: “The Lansley reforms were a pointless distraction that never delivered on their avowed aim of devolving clinical decisions or policy making.”
He said the Lansley vision had been replaced by heavy-handed management “caused by a clear desire to cut costs and staffat every turn. Patient care is taking second place to finances once again.”
A spokesman for the Department of Health said: “Hospitals must balance their books but our best hospitals do this at the same time as making sure patients get the very best and safest services — we expect trusts to do this across the country.”
- The NHS has failed to plan its workforce effectively, with a shortfall of 50,000 clinical staff, the National Audit Office has warned. A report from the spending watchdog also said government plans to cap agency staff rates to get soaring temp costs under control, were unlikely to work.