A reminder of the King’s Fund report from August 2016. The predictions by Ruth Robertson include post coded prioritisation, delays, treatment dilutions, withholding or substituting treatments, overspends, and a lack of data for monitoring exactly where the commissioners are!. She singles out Mental Health and District Nursing for particular dysfunction, and is open about the crisis in Primary and Social care. All of us know that, until “what is not available” is allowed to be discussed, that the “open discussion” is a nonsense. The Trusts under special measures in England are below, but most of those in Wales, and I suspect Scotland and N Ireland are in the same financial distress. Reality is not yet here, and “it’s going to get worse”. The King’s Fund promised a follow up report in 2017 but I am not sure which one it is or if it has been published yet..
This intensifies the difficult decisions that commissioners and providers have been facing for some time, about how to prioritise limited funding and balance their budgets in the face of rising demand. While the NHS has always had to set priorities, with these unprecedented financial pressures it is inevitable that some organisations will be forced to restrict access to certain services or dilute quality of care as they seek to curtail spending. In some areas this is happening already.
On an individual level, this is like the bank cutting off the overdraft that you rely on when you have just started a family and your rent has gone up. You are forced to cut spending on non-essentials, but deciding what ‘the essentials’ are is tough.
NHS commissioners are starting to have honest conversations with their local populations about these tough choices…..
….Considering the wider impact of financial pressures on the health care system, it’s important to remember too that it’s not only patients who are affected. NHS staff often act as a buffer, working longer hours or more intensely to ensure the people they treat still receive a high-quality service. This can increase staff stress levels and lead to low morale, something that is particularly worrying given evidence that staff wellbeing can have a direct impact on patients’ experience of care.
The King’s Fund is currently researching how the slowdown in NHS funding since 2010 has affected patients’ access to high-quality care. The findings from this study, which will be published early next year, will provide valuable insight into the impact that financial pressures have had on NHS patients and staff. In the meantime the government should be honest with the public about what the NHS is realistically able to offer with its available funding.