New spending caps that will undermine the NHS to be announced after the General Election

North Lincolnshire,  Vale of York and Scarborough and Ryedale “health economies” –  all “localities” in the Humber, Coast and Vale Sustainability and Transformation Partnership – have been told privately by NHS England and NHS Improvement to consider closing wards and services, blocking choice of private providers, systematically extending waiting times, and stopping some treatments.

Decisions are expected after the general election, and some of the officials involved have been told they will be put to the new ministerial team.

Why not ask your Parliamentary candidates if they would tell their ministerial team to kick out these proposals?

There is no expectation of details being made public until after the election, the Health Service Journal says.

According to the Health Service Journal  this is part of a national programme of a new “capped expenditure process”. The principle of the process, introduced this year, is to “cap” NHS spending in the following targeted areas so that they meet “control total” budgets in 2017-18.

capped expenditure process 14 areas

This is in line with the Humber, Coast and Vale Sustainability and Transformation Plan, which states that from 2017/18 onwards NHS commissioners will  “have collective focus on managing activity levels and reducing cost.”

“Managing activity levels” means restricting and denying care.

The Humber, Coast and Vale Sustainability and Transformation Plan is set to make £420m of NHS and social care cuts by 2020/1.

A rally and march in Grimsby in May protested against the Sustainability and Transformation Plan.

Now the new “capped expenditure process” has required NHS bosses in 14 targeted areas across England to examine “difficult decisions” and “think the unthinkable”. This includes modelling changes which are normally avoided as they are too unpleasant, unpopular or controversial.

According to the Health Service Journal, one chief executive said it was the most extreme and difficult NHS finance process they had experienced, and that some of the options – if pursued – would “challenge the value base” of NHS leaders.

As well as limiting the number of operations carried out by non-NHS providers, so the funding stays within the NHS – which seems like a good idea but will require money to be spent to increase NHS capacity if patients are not to suffer – the Health Service Journal says that proposed restrictions and denials of care include:

  • Systematically drawing out waiting times for planned care, including explicit consideration of breaching NHS constitution standards. Some plan to target delays at specialties/areas where waits are currently lower than average.
  • Stopping NHS funding for some treatments, including extending limits on IVF, adding to lists of “low value” treatments, and seeking to delay or avoid funding some treatments newly approved by the National Institute of Health and Care Excellence.
  • Closing wards and theatres and reducing staffing, while seeking to maintain enough emergency care capacity to deal with winter pressures.
  • Closing or downgrading services, with some considering changes to flagship departments like emergency and maternity – though these would normally take too long to deliver savings this year.
  • Selling estate and other “property related transactions”.
  • Stopping prescriptions for some items, as suggested by NHS Clinical Commissioners earlier this year.

Even before the “capped expenditure” discussions took place, denial of care was already happening in the Humber, Coast and Vale Sustainability and Transformation Plan area, as a result of the government’s swingeing NHS funding cuts.

Pain services are no longer routinely available. A Lincolnshire patient who wishes to remain anonymous said,

“At my Pain Clinic hospital appointment I was told spinal injections are now being limited. The consultant said he would have to put a bid in for funding to do mine.

Until he gets a reply we are trying stronger pain killers – but painkillers have little or no effect as I can only have low strength ones because anything higher knocks me out. I also have heart failure which prevents me from taking a lot of painkillers or any anti-inflammatories.

This feels like the beginning of the end of NHS – I wonder how long it will be before I’m asked if I’d like to go private.”

These Sustainability and Transformation Plans will be the end of the NHS as a comprehensive service.

If we don’t stop them now, soon we will have a two tier system like in the USA. People who can afford it will go private. The rest of us will make do with a limited public service like Medicare in the USA.

Hospital cuts and downgrades are happening. Scarborough District Hospital looks likely to lose its A&E.

We have to continue fighting to save our NHS and restore it as a publicly funded, managed and provided service, through enacting the NHS Reinstatement Bill.  Please ask you Parliamentary Candidates if they will vote to pass this Bill, if elected, and scrap the Sustainability and Transformation Plans (not just halt and review/rewrite them).

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