Call to Action!
This an #NHS4All blog post – please support our Call to Action.
You can do this by sending the #NHS4All campaign demands to your Sustainability and Transformation Partnership/Integrated Care System, as they prepare the 2019-2024 operational Five Year Plan that they ALL have to submit as a draft to NHS England by 27th September. This plan has to have local approval. Does yours? Do you know what’s in it? Check it out asap – time is running out! Please also send the demands to your MP, local newspapers, Health and Wellbeing Board, Councillors’ Health Scrutiny Committee, hospitals Trust Elected Governors, etc
This blog post lists our campaign demands for adequate funding for the NHS and an end to the imposition of USA market-based “integrated care”.
It gives background information about the NHS Long Term Plan “extra” funding, announced by the government in the summer of 2018, and the 5 year operational plans 2019-24 that Sustainability and Transformation Plans and Integrated Care Systems have to submit in draft to NHS England by 27th September and finalise by 15 November.
A full explanation of the #NHS4All demands is here.
The issue of NHS capital funding is the subject of another blog post [link coming soon].
Please support these #NHS4All campaign demands
- Much-needed further increases in NHS funding – both for the NHS Mandate (ie the services provided by the NHS England) AND other key Department of Health budgets which are excluded from the NHS Long Term Plan funding settlement.
- The government write-off of all the NHS Organisations’ deficits and debts to the Dept of Health that have accumulated over the last nine years, as a result of sustained government underfunding of the NHS.
- Proper public consultation on the STP/ICS 5 year operational plans and an end to the pretence that local Healthwatch organisations are in any way competent to gain the required “local approval” for the plans.
ALONG WITH an end to:
- The dismantling of our NHS into fragmented accountable/integrated systems/providers – that force local NHS organisations to clear their “deficits” that were incurred through a decade of damaging underfunding, while siphoning £millions of NHS funding to private companies and charities.
- The hugely wasteful marketisation and privatisation of the NHS. An updated NHS Reinstatement Bill must be passed that restores the NHS as a comprehensive, universal #NHS4ALL – properly publicly funded, free of all privatisation and marketisation and directly accountable to the Secretary of State with a duty to provide and promote its services.
- Corporate fingers in the NHS pie and the revolving door between the NHS and corporations.
Background to our demands
Some campaigners are questioning whether there’s any point to extra NHS funding, since increasingly it’s being siphoned off to corporate profits. Others are rubbishing the government’s inadequate funding of the NHS. This blog post tries to address both of these points. First, a few facts.
The new funding settlement Teresa May announced last summer is to be spent on implementing the NHS Long Term Plan (and it’s making Optum rich).
NHS England’s funding is set to grow at 3.4 per cent/year for the next five years. By 2023/24, annual NHS England funding will be £34bn more than in 2018/19. But this is only for the NHS mandate (the bits of the NHS delegated to NHS England). The funding increase omits other elements of the Department of Health budget including workforce training, capital funding and the public health grant to local authorities. All of them have been slashed to the bone since 2010.
The NHS Long Term Plan sets out how NHS England/NHS Improvement intend to spend this money.
We disagree strongly with its recipe for ongoing cuts, privatisation and surveillance medicine that subjects the most potentially costly groups of patients to remote monitoring through wearable apps, while requiring them to take part in large scale behaviour change schemes.
Shambles by design
The Government’s 2019-20 Accountability Framework with NHS England and NHS Improvement lays out the Mandate to NHS England – ie what the quango has to do with the money, along with the annual remit for NHS Improvement. It includes planning for Brexit. There will be another 4 year Accountability Framework once Brexit is out of the way.
It claims that the extra government NHS funding means it’s possible
“to plan for the future with confidence”.
In fact the 2019-20 Accountability Framework is a total pig’s ear.
The government has told all Sustainability and Transformation Partnerships/Integrated Care Systems to produce draft 5 year operational plans 2019-24 by 27th September, to be completed by 15 November. These have to include costed statements of how they are going to implement the NHS Long Term Plan.
But the government has only produced a 1 year Accountability Framework. So how does that work out?
Ignoring that small problem, the Accountability Framework says that all the “local” plans will be brought together and published as a full national implementation plan at the end of 2019, along with a final workforce plan to underpin it.
How can anyone make a 5 year operational plan in the absence of a national workforce plan? The government are putting the workforce plan cart before the horse.
The icing on the pig’s ear cake is that the government hasn’t published its 2019 Spending Review on all the bits of NHS spending that aren’t in the Mandate to NHS England – ie future funding for workforce, education and training and NHS capital investment, along with social care and public health services provided by local government.
The Accountability Framework shrugs this off by saying that
“The national implementation programme and workforce implementation plan will also take account of decisions made in the forthcoming 2019 Government Spending Review.”
Really why bother? This is a shambles before it’s even started.
Hahahahaha. Informed by needs and wishes of patients and the public – as if
The Accountability Framework (crossing its fingers behind its back) also claims,
“NHS England and NHS Improvement will drive forward implementation of the Long Term Plan and ensure that each stage of delivery is informed by the needs and wishes of patients and the public.”
Remember the game of Hunt the Sustainability and Transformation Plans back in 2016? This is going to be a re-run. Really they think we the public are stupid. They’re wrong.
More cuts in 2019-2024
The Accountability Framework says that in 2019-20, NHS commissioners and providers are to achieve:
“overall financial balance for the NHS and for (NHS England), support[ing] the financial stability of social care through contributing effectively to the Better Care Fund.”
This means further cuts by Sustainability and Transformation Partnerships/Integrated Care Systems. Because of course 2018’s new NHS funding settlement is not enough to make up for the roughly £42bn underfunding since 2010. (Roughly £20bn from so-called Nicholson challenge underfunding 2011-2015 and £22.5bn 5 year forward view underfunding.)
At least 65% of acute hospitals now have “deficits” totalling £1.8 billion, plus long term borrowing from the Department of Health of around £14 billion.
Because of years of savage underfunding by the government, Trusts have not had enough money to pay staff and suppliers. That’s why they’ve had to get interest-bearing loans from the Department of Health.
That “debt” is now bigger than NHS PFI debt. The most heavily indebted Trusts are seeking to renegotiate the loans. But the Department of Health must write them off as these Trusts have no means of repaying them. Even Ian Dalton, former NHS Improvement boss, has said so.
These are the hospitals with the biggest “debts” – ie forced long-term borrowing – from the Department of Health.
The funding constraints on Sustainability and Transformation Partnerships/Integrated Care Systems are worsened because the “extra” funding is backloaded – the biggest increase will be in the last year of the current Parliament – in the unlikely event that it lasts the fixed 5 year term.
But the Long Term Plan is dead set on forcing local NHS organisations to eliminate these “deficits”. It does this by tighter controls on both Clinical Commissioning Groups’ and hospitals’ spending.
The Sustainability and Transformation Partnerships’/Integrated Care Systems’ 5 year operational plans 2019-2024 have to include:
“the financial recovery plans for individual organisations in deficit against specified deficit recovery trajectories (test 1), with actions to achieve cash releasing savings (test 2) including through the reduction of unwarranted variation (test 4) and how they will moderate growth demand (test 3). Plans should set out capital investment priorities for capital budgets being agreed through the forthcoming Spending Review (test 5).”
20 years of cross-party and corporate drive for NHS privatisation and USA-style accountable care
Where is the mainstream political outcry about this demolition of our NHS and the diversion of huge amounts of NHS funding into private profits?
Cross-party and corporate support for NHS privatisation and the imposition of USA-style Accountable Care, built over more than 20 years, makes the NHS Long Term Plan almost unassailable to effective political challenge by Parliament or Local Authorities. You can read about that here.