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Rethink healthcare policy in face of financial crisis, say doctors leaders

Doctors leaders have urged the government to rethink its approach to the NHS amid signs of a deepening financial crisis in the health service.

Mark PorterThe BMA has expressed concern at NAO (National Audit Office) findings that some organisations created under the Health and Social Care Act are already facing financial instability while NHS England has warned of a £30bn funding gap by 2020/21.

The NHS England claim chimes with the BMA’s own analysis of last month’s comprehensive spending review, which found the so-called Nicholson challenge of making huge annual efficiency savings would have to continue for at least a year longer than originally suggested.

This would mean that by April 2016 the service will have to make do with only three quarters of the budget it needs to keep pace with demand and technological advances, according to research by the BMA health policy and economic research unit.


Downward spiral

BMA council chair Mark Porter (pictured above) said: ‘It will come as no surprise to anyone to hear that the financial crisis in the NHS is deepening, particularly not to NHS staff seeing the impact of these pressures first-hand. The BMA’s own analysis shows that the service will have to make do with three quarters of its existing budget.

‘The government has spent two years forcing through an unwanted reorganisation instead of giving the service space to address the funding crisis. New organisations are struggling to establish themselves while in deficit from the start.

‘So far, most of the savings found have come from staff pay or cuts in tariffs for services, which is neither sustainable nor likely to deliver the savings needed to protect patient care.’

The NAO report Managing the Transition to the Reformed Health System, published earlier this week, says the Health and Social Care Act reforms were successfully implemented in that new organisations were ready to start functioning on 1 April, 2013.

However, not all were operating as intended and some parts of the system were less ready than others. More than 170 organisations were closed and more than 240 new bodies were created.


Uncertain future

The report says a number of clinical commissioning groups had conditions attached to their authorisation, most commonly because of shortcomings in commissioning and financial planning. The report adds: ‘This raises concerns about their ability to make savings and remain financially sustainable in the coming years.’

The Department of Health said the reforms had cost £1.1bn to 31 March, 2013, 40 per cent of which had been spent on making about 10,000 staff redundant. However, 2,200 staff were subsequently re-employed.

Dr Porter said: ‘The findings of the NAO echo many of the BMA’s concerns about how the NHS reforms were devised and implemented. Introducing radical changes to how the NHS is run and structured during a period of intense financial pressure has been a costly distraction to solving the real challenges facing the health service.

‘To learn that some of the newly created organisations already face financial uncertainty is extremely worrying, particularly as they are still expected to make financial savings in the months, and potentially years, ahead.’

He added that the government’s persistence with embedding competition into the NHS, such as by compelling commissioners to put services out to competitive tender, would create further problems and intensify the instability facing many services.


Running the NHS

NHS England, created as part of the health service reforms, yesterday issued a call for a debate on how healthcare is to be funded in the future.

The NHS Belongs to the People: a Call to Action says the public, NHS staff and politicians must have an open and honest debate about the future shape of the NHS to meet rising demand, introduce new technology and meet the expectations of its patients against a backdrop of flat funding.

Its analysis shows that even if the NHS meets the challenge of saving £20bn, there will still be a £30bn funding gap if the current model of care is not reformed.

Dr Porter insisted doctors could play a vital role if they were empowered to make the necessary changes.

But he said they were being held back by increased red tape and lack of support from the top.

He added: ‘Doctors have worked, and always will work, on behalf of their patients and yet the government has so far brushed them aside, instead proclaiming themselves as the only patient champions.

‘I hope that doctors will be given a real voice in helping to meet the challenges we face.’


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