NHS funding and rationing: The debate intensifies

Whilst Yorkshire men and women are renowned for their grit, they are also respected for their honesty. Mike Waites in the Yorkshire Post reports: Approved: NHS surgery ban on fat patients and smokers in Yorkshire, and if this is correct it is the first time rationing has been approved so that a whole population know what is “not available” to them. It is important because it is overtly rationing (deserts based), and will punish the poorer members of society more than the richer ones. It is pragmatic and realistic, but regressive… (it increases inequalities). This is the type of decision that needs to be made, and even more so for the high volume cheaper services. Government will hope that the media turns a blind eye to the principle: once rationing is overt we can all plan for what is not available. Is the Y Post in denial, or simply being disingenuous in it’s comment: “The NHS funding crisis is not an abstract issue; it is affecting patients’ fundamental right to treatment. If smokers and obese patients are hit this time, where will the rationing decisions …”?

Hugh Pym reports for BBC News 31st October 2016: NHS funding and rationing: The debate intensifies

It is becoming as familiar as Halloween or 5 November fireworks – a crescendo of demands for more money for the NHS ahead of the Autumn Statement. So is it any different this time and are the financial pressures more intense than before?

In 2014, ahead of the general election, George Osborne, then Chancellor of the Exchequer, conjured up an extra £1.9bn for the NHS in England for 2015-16, after warnings there had been an unbridgeable gap in the finances.

Under the usual funding formula, this became £2.2bn across the UK, on the assumption the devolved administrations spent their allocations on health.

This was unveiled with a hospital photo opportunity involving Mr Osborne, Simon Stevens, of NHS England, and the Health Secretary Jeremy Hunt and was widely welcomed by health commentators and think tanks.

The election came and went, and it was not long into the 2015-16 financial year before hospital trust bosses were warning of mounting deficits and the sums not adding up.

Fast forward to the autumn of 2015, and Mr Osborne was publishing his Spending Review for the years up to 2020.

Chart showing spending rise from 2014/15-2021/22

Once again, a photo opportunity of the chancellor in a medical setting, this time in a GP surgery, was designed to underline the government’s commitment to health service funding.

The 2015 Spending Review allocated £3.8bn above inflation to the NHS in England in 2016-17 – and annual increases beyond that, to reach £8.4bn in 2020.

Once again, this was a cue for applause from the health world, with experts noting there was a significant increase in the first year of the settlement.

A year on, however, and there are renewed warnings about the dire state of NHS finances…….

NHS England is committed to finding up to £22bn of annual efficiency savings by 2020.

NHS trusts end-of-year financial results chart

Across 44 areas of England local health and social care, leaders have been told to come up with sustainability and transformation plans (STPs), to make better use of resources and redesign services.

A poll of local commissioning groups by Health Service Journal has shone some light on the process.

Of those that responded (just under 50%), nearly half had plans to reduce hospital beds and a third intended to close or downgrade accident and emergency departments as part of their STP.

The underlying problem is the same as it always has been.

The NHS has a finite level of resources allocated by governments but has to cope with unlimited demand.

What looks like a good settlement the year before can seem more like a sticking plaster solution as the cash gets swallowed up in the face of unpredictable increases in patient numbers.

The money will be tight across the board in this Autumn Statement.

The chancellor and the prime minister may decide to leave the NHS to make better use of the above inflation increases already awarded.

But in doing so they may have to face damaging headlines as the NHS struggles to cope through this winter.

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This entry was posted in A Personal View, Commissioning, Post Code Lottery, 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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