NHS Providers – the Association of Foundation Trusts and Trusts – has written to the Chair of the House of Commons Health Select Committee asking the Committee to hold an inquiry into how to get NHS Providers out of the impossible situation they are now in, as a result of NHS underfunding. The letter says this this is set to continue for the rest of this Parliament, since the additional Sustainability and Transformation funding is not enough to solve the problem.
Their proposed solutions are mostly chilling, requiring an explicit, nationwide end to the NHS as a comprehensive health service that provides treatment that is free at the point of clinical need.
Both South West Yorkshire Partnership Foundation Trust (the mental health trust) and Calderdale & Huddersfield Foundation Trust are members of NHS Providers. What are they doing signing up to such proposals?
The letter points out that this is already happening on piecemeal basis but where Trusts and CCGs are making such changes this is met with opposition, since many of the cuts and changes are “inconsistent with the overall NHS policy framework” – which does not allow the NHS to simply cut services, as local authorities have been able to do in response to the savage funding cuts imposed by central government.
The NHS Providers’ solution? Change the NHS policy framework.
This is truly a race to the bottom. They complain that social care is no longer available as a result of local authorities’ funding cuts – but they want to remove the NHS policy framework that makes sure that this doesn’t happen to health care services. The NHS Foundation trust and trust boards should fire the bosses who have signed up to this letter. The NHS Providers’ website says that as of November 2015 94% of foundation trusts and aspirant trusts were members.
It is notable that NHS Providers do not at any point recommend an inquiry into ending and reversing NHS marketisation and privatisation, which is the biggest waste of money in the NHS: depriving frontline patient care and vital NHS staff training of anywhere between an estimated £4.5bn/year to an estimated £30bn/year.
Surely this should be the first and most obvious issue for the Health Select Committee to consider in any rescue package for the NHS.
Instead, the “stark choices” that NHS Providers are asking the Health Select Committee to investigate are only “stark” for the public, patients and frontline staff.
They are far from “stark” for the army of NHS bean counters and regulators who owe their livelihoods to NHS marketisation and privatisation; for the accountants, management consultancy companies and lawyers who feast like vultures off the NHS; and for the private companies and voluntary and community sector companies who are increasingly profiting from NHS privatisation.
So it’s clear – and shameful – whose side are the Association of Foundation Trusts and Trusts are on. But hardly surprising since they were set up as independent businesses and Foundation Trusts are legally able to earn 49% of their income from private patients.
Here are the “stark” choices the NHS Providers are asking The Health Select Committee to inquire into this autumn:
“Providing additional funding is the most obvious. If, however, there is to be no more funding, the NHS must now make some quick, clear, choices on what gives, however unpalatable these choices may be. No trust Board wants to depart from the key principle of NHS care being available to all based on clinical need not ability to pay. But, faced with this clear, national level, gap the logical areas to examine would be:
Reducing the number of strategic priorities the NHS is currently trying to deliver. Our members tell us that they are inundated with new initiatives they “must implement” ranging from seven day services and mental health and cancer taskforce recommendations to moving to a paperless NHS and a raft of new patient safety related initiatives. Whilst these are perfectly sensible individually, collectively they are impossible to deliver in the current environment;
Formally rationing access to care in a more extensive way;
Relaxing performance targets;
Closing or reconfiguring services;
Extending co-payments or charges; or
Reducing / more explicitly controlling the size of the NHS workforce which accounts for around 70% of the average trust budget. But, clearly, controlling the size of the workforce would have to be linked to some form of reduction in what the NHS is being asked to deliver.”