The Black Hole
The NHS in England alone is facing a £30 billion deficit over the next five years, as demand in just about every area outstrips both the supply of services and the funding for them. Ed Miliband’s extra £2.5 billion a year would plug the debt for 2015-2016 but not cover it subsequently, leaving nothing to pay for 36,000 more staff he has also promised. He is right that the NHS is hitting the wall now, with over two-thirds of acute hospitals in England failing to balance their books this summer and five of the key waiting times standards missed, including the maximum of two-month waits of urgent GP referrals for treatments. David Cameron’s promise of a marginal year on year increase does nothing to address this. The bottom line is that if no party is prepared to fund care for a population living longer, patients will have to wait longer for care, accept brief, poor quality care or not get it at all.
NHS England has allowed the £400m normally used for ‘winter’ planning to deal with this backlog, and is doubtless praying for a warm January. But NHS England has very little control over what devolved Foundation Trust hospitals do to balance the books. On August 26th, Andrew McKirgan, Executive Chief Operating Officer of University Hospitals Birmingham NHS Foundation Trust sent a blunt letter to the chiefs of Clinical Commissioning Groups (CCGs) who are just outside their area.
‘I am writing to inform you of a change to how the Trust manages GP referrals from your Clinical Commissioning Group. Unfortunately due to an unprecedented year on year growth in GP referrals to our local district specialties we are no longer in a position to combine patient choice with a guaranteed maximum 18 week waiting time. Following discussion with our local Clinical Commissioning Group we have taken the reluctant decision to no longer accept referrals into a number of our clinical specialties from GPs that reside outside our local catchment population.
Those specialties initially affected are Pain, Dermatology and General Surgery. As a result these specialties will be removed from Choose & Book and any written referrals received by the Trust will be returned to the GP immediately for referral to an alternative hospital. In addition a letter will also be sent to the patient explaining that we are sadly unable to accept their GP referral with a request to them to contact their GP regarding a referral to another hospital. We are unable to confirm at this stage how long these measures will remain in place however we will continue to monitor our waiting’
The freedom of Foundation Trusts to fiercely protect their own finances was pushed through by Tony Blair against the wishes of English MPs but passed with the backing of careerist Scottish Labour MPs who’s own country and constituents do not have a corporatized NHS. The result is that NHS England the Department of Health and CCGs have much less power to deal with NHS debt, leaving the market and the media to decide which services continue to be funded. Mental illness has never attracted the same kudos or funding as cancer and heart disease, even though it costs the economy £70 billion a year and those with mental illnesses have much worse physical health. Mental illness also tends to start in adolescence, and yet Child and Adolescent Mental Health Services (CAMHS) across the NHS are in crisis (Eyes passim), as this consultant told the Eye:
‘We get on average 17 new referrals a day of young people with serious mental health issues. We are so overloaded and the staff are so stressed that many of them have gone off sick, making it even harder for those of us who remain. We simply have to refuse many referrals even though I know young people need us and they will get worse without us. I may have to choose between seeing a young person who has self-harmed for a year, and a young person who has done it for a week. The person who has self-harmed for a year will be absolutely desperate, but I will be more likely to achieve a positive outcome for the person who has only harmed for a week. Who should I see? How do I allocate these precious NHS resources? Do we have to wait until a young person we’ve turned away commits suicide before somebody sits up and notices how we are struggling to cope? And we’re struggling to cope because the communities our young people live in are struggling to cope. There is a very, very big mental illness iceberg out there and it’s showing no signs of melting.’