Last updated:

Government in denial about funding crisis says BMA leader

The leader of the UK’s doctors, Dr Mark Porter, has said that the government is in denial about the state of the funding crisis facing the NHS.

Addressing the BMA’s annual representative meeting (ARM) in Belfast, Dr Porter said that year-on-year funding cuts have left almost every acute trust in England in deficit, with trusts facing a deficit of more than £2bn, a 20-fold increase in two years1.

Dr Porter highlighted the fact the UK spends less of a share of its wealth on healthcare than the EU average and that cuts of £200m to public health have affected many services locally, including sexual health services and smoking cessation services2.

This follows a BMA public survey which found that only a small minority (13 per cent) believe the government is giving the NHS the money it needs and that three in four people (75 per cent) were worried about public health funding3.

Highlighting the pressure on NHS services, Dr Porter pointed out that there are more health ministers in England than there are major emergency departments that recently met the government’s four-hour waiting time target4.

In his speech to the BMA’s ARM, Dr Mark Porter, BMA council chair, said:

“…the government is in denial. The chancellor says he has a ‘fully funded’ plan for the NHS. But while he announced £10bn of new money in November, our funding report4 showed the real increase in health spending is less than half that. As for the rest, for the largest part of the unmet need, the plan relies on what he laughably calls ‘efficiency savings’.

“We’ve seen those before. They are neither efficient nor are they savings.

“They are cuts.

“Year-on-year cuts to funding that have driven almost every acute trust in England into deficit. In total, more than £2bn in deficit, a 20-fold increase in two years.

“And this pernicious effect permeates every part of the United Kingdom.

“This, from a government which promised to ‘cut the deficit, not the NHS’, from a prime minister who assured us that the NHS was safe in his hands.

“You don’t make an organisation more efficient by paralysing its ability to invest, to adapt and to recruit. You don’t make hospitals better at caring for patients when they are forced to care more about their financial survival.

“Here’s a curious fact. There are more health ministers in England than there are major emergency departments that met the four-hour waiting target. And elective waiting lists are at their highest in almost 10 years.

“When those hospitals look for support, they are told by their regulator they should cut staff numbers to help balance budgets.

“The Francis report told hospitals that staff numbers should be based on safe care, not about meeting financial targets. We know what can happen when this advice is ignored.

“Other cuts are made through a shoddy sleight of hand. The government said it wouldn’t cut health spending in real terms. But it took £200m from the public health budget by saying that promise only applied to the NHS, having put public health outside it.

“The chancellor says he is cutting the Department of Health’s ‘Whitehall budget’ as if he were talking about paper clips.

“We’ve looked into what that budget actually pays for. A successful smoking cessation service in the north-east is now under threat. In Brighton, the council says cuts to sexual health may lead to increased HIV prevalence. In Leicestershire, in Somerset, in east London, in Surrey and in Darlington, we have found similar stories. You can’t trade a public health policy for an e-cigarette and crossed fingers.

“Health spending is a political choice, but it’s a choice from which our government is hiding.

“We know that investment in healthcare mitigates health costs for individuals and improves the overall quality of life. It supports the provision of universal access to a comprehensive healthcare service. If health needs are not met by public health services, the costs do not disappear. Instead they have to be borne by the population as a whole.

“And yet, our country spends a smaller share of its national wealth on healthcare than the European Union average.

“We know what kind of NHS we want for patients. Now the government needs to make the same choice. Does it really want to be remembered as the government where the waits got longer, the excuses got thinner, and the debts started to pile up? Or will it finally invest in the health service it promises – the one our patients rightly expect?

“The public no longer believes in that shiny fiction of a health service that gets rolled out on budget day and during elections. An independent survey we commissioned found almost 80 per cent are worried about the future of the health service, and three quarters think the government is fuelling discontent amongst NHS staff.”

Notes to editors

The British Medical Association (BMA) is the voice of doctors and medical students in the UK. It is an apolitical professional organisation and independent trade union, representing doctors and medical students from all branches of medicine across the UK and supporting them to deliver the highest standards of care.

The full text of the speech is below:

 (check against delivery)

Welcome on this first day of the ARM. And in their surgeries and wards, in their clinics and laboratories, let’s acknowledge the thousands of doctors for whom this is not the first day of their working week, but the eighth or the ninth.

They’re in work, Jeremy.

Twelve months ago, we told the government to get real.

To strive for healthcare not headlines.

To find the funding, not conceal its need.

To learn that dogma is no friend of good government, and evidence, no threat.

But instead, we’ve seen this government waste a year in the aimless, damaging pursuit of a mantra. In needless dispute with a profession. In hapless denial of the truth, the evidence and the lived experience of those who work in the health service.

A wasted year.

A year we’ll never get back, a year we never want to repeat, and yet a year when we stood together as one profession against a mounting and shrill barrage of threats.

It started with a line in a manifesto. A line about ‘a truly seven-day NHS’. A line that will mystify those who look back and ask what kind of government whips up a corrosive dispute on a principle with which doctors fundamentally agree.

So, once again, let’s be clear. We support patients getting the care they need, when they need it.

Of course we do. As doctors how could we not? We don’t need to be told – as the prime minister helpfully pointed out – that ‘diseases don’t work weekdays, nine to five’. And guess what Mr Cameron. Nor do we.

We care for our patients every night, every weekend, when the windows of Whitehall are dark. And we have been leading in the redesign of services for years, long before that manifesto was written.

Two months after the election, the government still didn’t have a clue what the policy was, but the health secretary was absolutely sure that we were a ‘road block’ to achieving it. That was never true.

The ‘road block’ was the £22bn hole in NHS finances, in a service already resourced much less at weekends than during the week.

Last August, we were the first to pose the key questions about this major policy.

How will seven-day services be funded?

How will they be staffed?

How will weekday services be protected?

The government couldn’t miss them – we emblazoned them across national newspapers, we lobbied for answers in parliament. But the government still couldn’t answer them. It still hasn’t.

Instead of getting answers, we got the blame.

Nine months later, the chair of the public accounts committee said: ‘It beggars belief that such a major policy should be advanced with so flimsy a notion of how it will be funded.’ Quite.

The public agrees. Two thirds, in a survey we published yesterday, think the government hasn’t done enough to explain seven-day services.

Just imagine, as a doctor, if you embarked on a radical new course of treatment but were unwilling or unable to justify your decisions. You wouldn’t be a doctor much longer.

Nor would you be fit to practise if you took such a partial and cursory view of the evidence. Please, Mr Hunt, the weekend effect is a serious and complex topic, and not your flexible friend, to wheel out when you need to bash some doctors. Confirmation bias can cost lives. Evidence isn’t there to decorate rhetoric.

It was then that the government crossed the road to pick a fight with the one group of doctors who, even by the standards of our seven-day-a-week, 24-hour-a-day profession, are conspicuous on the wards every evening and every weekend.

Who on earth would launch its onslaught on the medical profession by having a go at junior doctors?

I’ll tell you who.

A government that mistook a soundbite for a policy.

A government always too willing to point the finger, always too slow to offer a hand.

A government, blinded by its own dogma, which made the fatal error of believing its own rhetoric.

Junior doctors have never been told why they were singled out.

Why they should simply accept a contract that failed to protect them and their patients from unsafe hours.

Why they didn’t deserve a contract that treated women fairly.

Strikes are always a last resort, particularly for doctors, but we’ll remember how junior doctors made every single one of those days a positive demonstration of why they cared and what they stood for.

They showed unity in dispute and – just as importantly – a focus on the need for a negotiated agreement to resolve this dispute.

Junior doctors pushed this to the point where they were finally listened to by government. And they were listened to because the government was in no doubt of our unity, our ability to organise, and the support we had from patients and the public.

This was the year when a profession that can sometimes revel in its differences came together as never before. SAS doctors, consultants, GPs and medical students supporting junior doctors, covering their work during the industrial action, and saying, as I did on the Today programme, ‘I would have done the same’.

We are one profession. We must remain so.

Junior doctors now have a contract offer that would not have been conceivable last October. Following more than a hundred BMA roadshows at which the detail of the offer has been set out, and junior doctors’ concerns heard, our members are now making up their own minds.

Whatever happens with any future contract talks, the government has learned it is dealing with a united profession. I hope it has learned how, and how not, to deal with one.

This will be remembered as the year when the government grew obsessed with chasing an empty promise, when it should have been obsessed about a health service in financial crisis.

But the government is in denial. The chancellor says he has a ‘fully funded’ plan for the NHS. But while he announced £10bn of new money in November, our funding report showed the real increase in health spending is less than half that. As for the rest, for the largest part of the unmet need, the plan relies on what he laughably calls ‘efficiency savings’.

We’ve seen those before. They are neither efficient nor are they savings.

They are cuts.

Year-on-year cuts to funding that have driven almost every acute trust in England into deficit. In total, more than £2bn in deficit, a 20-fold increase in two years.

And this pernicious effect permeates every part of the United Kingdom.

This, from a government which promised to ‘cut the deficit, not the NHS’, from a prime minister who assured us that the NHS was safe in his hands.

You don’t make an organisation more efficient by paralysing its ability to invest, to adapt and to recruit. You don’t make hospitals better at caring for patients when they are forced to care more about their financial survival.

Here’s a curious fact. There are more health ministers in England than there are major emergency departments that met the four-hour waiting target. And elective waiting lists are at their highest in almost 10 years.

When those hospitals look for support, they are told by their regulator they should cut staff numbers to help balance budgets.

The Francis report told hospitals that staff numbers should be based on safe care, not about meeting financial targets. We know what can happen when this advice is ignored.

Other cuts are made through a shoddy sleight of hand. The government said it wouldn’t cut health spending in real terms. But it took £200m from the public health budget by saying that promise only applied to the NHS, having put public health outside it.

The chancellor says he is cutting the Department of Health’s ‘Whitehall budget’ as if he were talking about paper clips.

We’ve looked into what that budget actually pays for. A successful smoking cessation service in the north-east is now under threat. In Brighton, the council says cuts to sexual health may lead to increased HIV prevalence. In Leicestershire, in Somerset, in east London, in Surrey and in Darlington, we have found similar stories. You can’t trade a public health policy for an e-cigarette and crossed fingers.

Health spending is a political choice, but it’s a choice from which our government is hiding.

We know that investment in healthcare mitigates health costs for individuals and improves the overall quality of life. It supports the provision of universal access to a comprehensive healthcare service. If health needs are not met by public health services, the costs do not disappear. Instead they have to be borne by the population as a whole.

And yet, our country spends a smaller share of its national wealth on healthcare than the European Union average.

We know what kind of NHS we want for patients. Now the government needs to make the same choice. Does it really want to be remembered as the government where the waits got longer, the excuses got thinner, and the debts started to pile up? Or will it finally invest in the health service it promises – the one our patients rightly expect?

The public no longer believes in that shiny fiction of a health service that gets rolled out on budget day and during elections. An independent survey we commissioned found almost 80 per cent are worried about the future of the health service, and three quarters think the government is fuelling discontent amongst NHS staff.

Our campaign, an Urgent Prescription for General Practice, highlights the disastrous impact of these cuts on the workload of GPs, and the care they can offer patients.

GPs offer millions more appointments than they did ten years ago, yet during this time their funding has been cut from more than 10 per cent of the NHS budget to less than 8 per cent.

It’s a bizarre way to run a health service, attacking its very foundations. More than 90 per cent of GPs tell us their workload has impacted on the quality of care.

No wonder half of practices have a GP with firm plans to leave in the next 12 months.

But, who knows, maybe the massive erosion of funding for general practice isn’t really a cut at all. Perhaps it’s another of the government’s ‘efficiencies’. I doubt, however, that patients find it efficient as they wait longer for appointments, and GPs are driven from the profession.

By misusing the word, by implying that those of us who see patients do so lackadaisically, this government has turned ‘efficiency’ into a dirty word.

GPs have sent the government the clearest possible message, that it must meet the BMA’s urgent prescription and commit to fair and sustainable funding, safer levels of workload and proper staffing.

The government has made a belated pledge to increase funding, but it’s inadequate. It will take far too many years into the future to deliver what is needed now.

The government has to learn that repeating the same old empty claim doesn’t bring about change. They can’t conjure seven-day services out of thin air. And to take another tired old mantra – they can’t convince us that privatisation is good for the health service – however much they repeat it.

It’s the small matter of the evidence again, you see.

All we ask is that they look, listen and learn when millions of pounds have already been wasted on private provision in the health service.

Learn from Hinchingbrooke, where a private company took over a troubled hospital, predicting savings that were – in the words of the public accounts committee – ‘unachievable’. Guess what – they were.

Learn from mid-Sussex, where a £235m musculoskeletal contract was handed over to the private sector, and only after that did someone figure out the mortal threat it posed to the local hospital.

Learn from Nottingham, where dermatology was transferred to a private provider, but most of the senior staff didn’t follow, harming the service for patients, for years to come.

It’s all in our report on privatisation, and so is another question the government has never been able to answer – why private providers don’t face the same requirements to report patient safety incidents and performance as NHS providers.

There seems to be a blithe assumption that, just by having shareholders, an organisation can care better for its patients.

Well we’ve got a group of shareholders too. It’s every man, woman and child who uses the NHS.

Private companies should be supporting our shareholders. It’s not our job to support theirs.

We are campaigning on many fronts, and with the same unity and focus we devote to the junior doctors, to seven-day services, we have achieved real benefits for our members and our patients.

We have protected children’s health by successfully campaigning to ban smoking in cars where a child is present. This is law in England and Wales, will become law in Scotland, and is being considered in Northern Ireland.

Every bad year for the tobacco industry is a good year for health; I’m sure you will have shared my satisfaction last month when the overwhelming vote by MPs for plain packaging was upheld in the High Court.

We even heard multinational tobacco companies talk about compensation – but of course it was compensation to them for a devalued brand. As if they hadn’t devalued it themselves through peddling death and disability.

In the past, we have been called eccentric or extreme when we have campaigned for smoke-free public places or a ban on advertising. Now these policies are mainstream. More importantly, they save lives every day.

A soft opt-out on organ donation in Wales, for which there was consistent and well-informed BMA lobbying, has already increased the number of available donors. We will continue to promote this policy for other UK countries.

In Scotland, the BMA continues its battle for minimum alcohol pricing, against powerful commercial interests. Surely the most powerful interest in any country should be that of improving people’s health?

Here in Northern Ireland, the BMA has spoken up eloquently on the funding shortfall, the need to recruit and retain its first-class medical workforce, and in the better integration of health and social care.

We have carried out a major project to find out the public’s and profession’s views on end-of-life care and physician assisted dying, and you will be discussing those issues in detail on Wednesday.

The government has at last realised that its chummy and voluntary approach with the food and drink industry is no way to tackle the obesity crisis. The tax on sugary drinks, for which we called in our Food for Thought report, is a welcome start. But, as the report shows, there is much more that needs to be done to tackle this serious epidemic.

We have achieved significant victories for overseas doctors and medical students, winning changes to visa rules that placed unfair burdens on those who want to study here or contribute to the National Health Service.

And in the year ahead, we have major pieces of work on child health, and on the impact of austerity.

That’s why I’m so proud to be one of the 170,000 members of the BMA. Our wins for doctors are wins for patients too.

Colleagues, we meet here in Belfast at a crucial moment in our membership of the European Union.

Or, if you’re watching this on repeat, perhaps at a crucial moment in our membership of the North American Free Trade Agreement.

I hope you have made your voting arrangements because the decision that confronts us on Thursday will have profound consequences for healthcare in the United Kingdom.

We haven’t told BMA members how to vote on this issue. I, like you, have my personal views, and I think we can agree, as the BMA in Europe guide pointed out, on how many ways our lives are touched by EU membership. We were the first national medical association to have an office in Brussels and have lobbied on a wide range of issues for more than 20 years.

Where none of us can be neutral, however, is in condemning the farcical and fatuous claims that have been a by-product of the political campaigns. We’ve warned before about politicians playing games with the health service. Here we see game-playing on a truly continental scale.

That promise of billions of pounds of extra NHS funding if we leave the European Union.

It’s beyond irresponsible. It relies on the unknowable assumption that the United Kingdom’s economy will be the same size, and the money would still be available. It is a promise that has been proven to be based on fantasy figures, but it is maintained as a slogan designed to deceive.

And further, do we really believe that some of the most ardent, fanatical and dogmatic supporters of austerity are suddenly desperate to increase public spending if only they had the chance? That the only thing holding them back from investing in the people’s health before now, has been saving it up as a mammoth bribe?

Instead we have a promise, made by senior politicians, of money they don’t know they can find, and probably no inclination to spend if they stumbled across it.

The NHS deserves better than that. It’s not a logo to misuse on a leaflet or a bus.

Worse even than that, there have been truly unsettling insinuations directed against tens of thousands of our members, and the people with whom we live, work and study, who make the fabric of our NHS and our nation.

It has been implied that those who come to this country take from us, or threaten us. ‘Close our borders’ has been the call, keep out the Europeans and while we’re at it, people from beyond Europe’s borders, whether seeking refuge or with much to offer to our society, or both.

In one campaign advert, we see a waiting room in one of our hospitals. It’s calm, half-empty – the suggestion being that’s what the country would be like with fewer immigrants.

Well, in that little England, good luck with finding enough doctors, or enough nurses.

Anyone who attacks the contribution to this country of people from around the world, attacks us all. They attack many of us personally, but they attack every one of us, because the health service we love would not exist without their contribution.

We are one profession. And that means you, who trained in India, you, from Pakistan, you, from Nigeria, from Poland, from Germany, from South Africa, from every single country that makes the world’s greatest health service a health service that the world has built.

The health service would be poorer without you. There might not even be a health service without you.

Colleagues, our unity makes us strong enough to fight for the quality of patient care. It allows us to speak with authority, and to know we will be heard.

It’s what turns a group of individuals into a profession.

One profession.

We can be no other.

Thank you.

1.In 2015/16 the NHS provider sector reported a deficit of £2.45 billion, this is £461 million worse than planned. 157 (65%) out of 240 providers reported a deficit, the majority of these were acute trusts: https://improvement.nhs.uk/news-alerts/nhs-providers-working-hard-still-under-pressure/. In 2013/14 the deficit was around £100 million: http://www.nuffieldtrust.org.uk/node/3504

 

2.Below is a list of cuts to public health services:

West Leicestershire

  • £1.1m cut from quit smoking service
  • Funding for substance misuse service reduced by £625k
  • £340k cut to sexual health services budget

Source: West Leicestershire CCG board papers, April 2016

Brighton & Hove

  • £338k cut from substance misuse budget
  • Funding for in-patient detoxification slashed by 38 per cent.
  • £115k cut from sexual health service

Source: Brighton & Hove Council, impact assessment 2016-17

Bromley

  • Smoking cessation service axed in 2017
  • School nursing service decommissioned
  • Childhood obesity service closed
  • Public health staff roll halved from 32 to 16

Source: Bromley Council, impact assessment, February 2016

North Somerset

  • School smoking reduction programme cancelled
  • Diabetes prevention work put on hold
  • Primary care alcohol intervention contract axed

Source: North Somerset, Public Health Draft Equality Impact Assessment, January 2016

Merton

  • £600k switched from public health to social care
  • £540k cut from substance misuse
  • £200k cut from child public health
  • Befriending service axed
  • Quit smoking budget cut by £300k

Source: Merton Council, Public Health Budget proposals 2016/17

Leeds

  • £100k axed from addiction services budget
  • £375k cut from drug intervention and offender management
  • Staff budget cut by £423k

Source: Delivery of public health budget savings 2016/17, Leeds Council

Gateshead

  • £105k cut to child weight management programme
  • Smoking cessation service budget cut and capped.
  • Nicotine replacement therapy budget wiped out

Source: Gateshead Council budget proposal papers, February 2016

Havering

  • Stop smoking service axed
  • Chlamydia screening service for young people closed
  • Sexual health prevention for young people service decommissioned

Source: Havering Council briefing note, 10 March 2016

Darlington

  • Axing funding to Fresh, an organisation that co-ordinates quit smoking campaigns across the south east
  • Quit smoking cut shrunk from ‘universal’ service to one focused on ‘priority, and vulnerable, groups including pregnant women and routine manual workers’
  • Disbanding of dedicated drug, alcohol and tobacco team

Source: Darlington Council budget proposal papers, February 2016

3. The survey of 1,240 adults in England was carried out between 7th and 9th June 2016 by BritainThinks. The survey data was weighted to reflect the English population in terms of age, gender, region and social class. More information is available here.

4. In April the BMA published a report in NHS funding and efficiency savings. The report is available here.

5. Only four major emergency departments (type 1 departments) in England met the four hour waiting time target in Q4 2015/2016.  The NHS England figures are available here. There are currently six health ministers in England.

For further information please contact:

British Medical Association, BMA House, Tavistock Square, London, WC1H 9JP
Telephone: 020 7383 6448 
Email: [email protected]
Media centre | Twitter | Youtube - BMA TV | Flickr