East Surrey placed in special measures – we need to be debating the ethics and ideological compromises in each method of rationing

As the failures mount, the government will change it’s own rules. Waiting time and other targets and penalties are being ditched, and standards are falling. Doctors and nurses are leaving or retiring early. Many Nurses have cheated to get their dubious qualifications, and the European Working Time directive still applies….  we need to be debating the ethics and ideological compromises in each method of rationing instead of risking a knee jerk response that seems inevitable ..

Josh Searle reports in the Surrey Mirror 21st July 2016: East Surrey CCG placed into special measures and in the same paper Debbie  King writes “Warning NHS “rationing” means treatment charges”… (Not on line)

Dennis Campbell in the Guardian reports: NHS bosses launch ‘reset’ plan to tackle £2.45bn deficit

Five hospital trusts and nine CCGs in England will go into financial special measures as campaigners voice fears for patient safety

NHS bosses have launched a plan to “reset” the health service’s broken finances that will see overspending hospitals taken into financial special measures, as part of a crackdown to tackle a £2.45bn deficit.

Five hospital trusts that are set to overshoot their budgets by a wide margin this year, and nine GP-led local clinical commissioning groups (CCGs) that are facing acute financial problems, are the first NHS bodies to be forced into special measures. Their bosses have been given weeks to devise an action plan to reduce overspending or risk being replaced.

The initiative was unveiled as it emerged that the Department of Health avoided busting its £118.3bn budget in 2015-16 only because it received £417m more than planned in extra national insurance receipts because of an “administrative error” for which it will not be punished.

However, the health secretary is likely to face a parliamentary inquiry into his department’s figures after the Commons public accounts committee accused him of “underhand” behaviour in publishing his department’s figures on the last day before MPs leave for their summer break.

The Labour MP Meg Hillier, who chairs the committee, wrote to Jeremy Hunt on Thursday, saying: “I write to express dismay that you published your department’s accounts today – the day that parliament rises for summer recess. This does not allow MPs to consider the accounts before recess and smacks of an underhand attempt to cover up the poor state of finances in your department.”

The National Audit Office also criticised Hunt’s department for its failure to come up with “a robust, credible and comprehensive plan to move the NHS on to a more sustainable footing”.

The tough action by NHS England and NHS Improvement (NHSI), the service’s financial regulator, is intended to reduce overspending by trusts from a record £2.45bn last year to nearer £250m by the end of this year.

Trusts will be given money from a £1.8bn “sustainability and transformation fund” to help balance their books only if they agree to make significant savings by the end of March 2017 by signing up to a “control total”. The five are among 17 trusts in deficit that have so far refused to agree their total with NHSI.

The five trusts going into financial special measures include Barts Health NHS trust in London, which is both the NHS’s biggest trust and the one that ran up the biggest deficit last year, at £135m. The others are Croydon Health Services, which overspent by £39.8m, Maidstone and Tunbridge Wells (£22.9m), Norfolk and Norwich (£31.1m) and North Bristol (£48m).

“This suite of measures will help ensure that the providers facing the greatest financial challenges are supported to bring about rapid financial recovery, while maintaining or improving quality. This plan is intended to restore financial discipline and ensure ongoing financial sustainability across the whole NHS,” said Jim Mackey, the chief executive of NHSI.

Critics said the plan would fail and lead to job cuts in an already under-staffed health service and the loss of beds or entire units.

“Simply loading up providers with savings targets and exhorting them to try harder won’t work,” said Saffron Cordery, the head of policy at NHS Providers, which represents hospitals. Singling out heavily overspending trusts would simply stigmatise hospitals that were struggling the most, damage staff morale and make it harder for them to recruit new personnel, she said.

There are also serious concerns that cost-cutting on the scale envisaged under the plan could damage patient care. Jennifer Dixon, the chief executive of the Health Foundation thinktank, said the strategy risked a repeat of a care scandal of the scale of that seen at the Mid Staffordshire NHS Trust between 2005 and 2009.

“Getting the balance right between carrot and stick is critical, as history tells us,” she said. “The Francis inquiry, published only three years ago, describes how radical steps by one NHS hospital – Mid Staffordshire – to improve its financial position had terrible consequences for patient care.”

Nigel Edwards, the chief executive of the Nuffield Trust thinktank, criticised the singling out of NHS bodies that were struggling to live within their means. He said: “With almost nine out of 10 acute hospital trusts in deficit at the last count, the idea that this is a problem caused by ‘a few bad apples’, where the management simply doesn’t try hard enough to balance the books, is long gone.

“I fear that in order for hospitals to virtually eradicate their debts, as NHS Improvement and NHS England want, the next steps could be a series of brutal service reductions and bed closures – which will shock an unprepared public.”

The nine CCGs that will also face intense scrutiny of their financial performance and intervention in their running by the two NHS bodies include those in Croydon, North Somerset, Vale of York and Walsall.

NHS Clinical Commissioners, which represents CCGs, said some were ending up in the red because the NHS was receiving too little money. “We urgently need a cross-government review into the overall financial position of the NHS and an open debate about what can be realistically delivered within the current level of funding,” said Julie Wood, its chief executive.

The “reset” is part of a longer-term strategy to show that the NHS can put its house in order as a way of persuading ministers to give it more than the £8bn extra by 2020-21 already planned. However, experts say fast-rising demand for care and continued reliance on agency staff means the NHS is unlikely to get back into the black soon.

  • This article was amended on 21 July 2016 to give the correct number of clinical commissioning groups (CCGs) that will go into special measures.
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This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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