Losing the power to shock

This seems to be where we have got to with revelations about NHS forward plans.

Using the Freedom of Information Act, a BPV stalwart has obtained important and hitherto hidden NHS papers about the calculations underlying the NW London STP.

These show what is really necessary to achieve “sustainability”, NHS speak for lopping £1.4billion off the budget by 2021. It is to cut out 7,753 staff jobs, have 50,000 fewer planned admissions and 222,370 fewer outpatient appointments than now.

Yet who is shocked by such figures? Not apparently the NHS chiefs and council figures who have put their names to the STP.

One of our colleagues could not believe it meant what it said and speculated that it must imply that many of those affected would be treated by private providers at NHS expense. If that were so the costs would still fall on the budget and the patient numbers would still be there.

We have to recall that the overriding aim of the STP is to eliminate the estimated cumulative deficit of £1.4bn by 2021. This was confirmed by Chris Hopson, boss of NHS Providers, when he appeared before the Health Select Committee before Christmas.

Most of this reduction can only be achieved by cutting staff so what our FOI investigation has stumbled on are the staff numbers whose removal enables the sums to add up.

There is no evidence that anyone in the system knows the type and grade of personnel involved.

If as rational humans we were to draw up a forward plan for the local NHS we would be looking at the trends in acute admissions for various types of cancer, heart disease, strokes, abdominal disorders, gynae cases and so on over the last 10 years and working out in which of these areas we could expect reductions either absolutely or because the patients could be treated safely and more cheaply in a non-acute setting or without becoming in-patients. There is no sign of any analysis like this.

We just get odd bits and pieces of information indicating increases in a number of categories of acute admissions such as cancer. The Delivery Areas of the STP are mostly aspirational and all assume better outcomes for less cost without any consideration of demand numbers or the availability of alternative facilities. Look at it another way – if demand for acute was not growing overall our major hospitals would have headroom to park post-op cases until community care was available. There is no such headroom – see the performance stats in CCG Governing Body papers or watch BBC2 “Hospital” about St Mary’s and Charing Cross.

One clip on the latest Hospital episode showed a model of Charing Cross and said there were 10 operating theatres on one of the floors. Is it conceivable that we can lose these in the next 10 years without huge damage to patient care? If there is something we don’t understand why does not someone in the system just sit down with us and explain it? Then we could all go home and stop torturing our little brains with these conundrums .

A personal view from BPV Chair, Robin Sharp

One Comment:

  1. As we approach 2021 it is my firm belief the proposed savings will also prove to be largely aspirational and NHS Capital budgets will continue to be raided in order to support Revenue budgets .Finally the Government will have to increase public sector borrowing (currently standing at £2 trillion) in order bale out the NHS.
    Of course an alternative would be to cancel HS2 or the Trident refit and the Government may well be forced to cancel one or both of these projects anyway as the full impact of Brexit affects the economy.

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