Feeling the Squeeze

The Tory conference continued to peddle the delusion that routine NHS services can be safely extended to seven days a week whilst making eye watering efficiency savings. The government has a convenient blame figure lined up in Simon Stevens, the chief executive of NHS England, who calculated that the NHS shortfall by 2020 would be £30 billion, based on an ageing population that demanded more care. He also pronounced that £22 billion of this could be recouped by ‘working smarter’ and encouraging people to take more responsibility for staying healthy. This left the government with just 8 billion to provide at some unspecified time before the next election.

In the first year of Stevens’ ‘five-year forward view’, no efficiency savings have been made at all. Indeed, the NHS deficit will soar to over £2 billion, leaving the NHS to somehow make £24 billion worth of savings over four years. Even worse, the performance of the NHS has nosedived. Waiting times are up across the board, some Clinical Commissioning Groups are rationing NICE approved services illegally and every day 100,000 people aren’t able to see a GP when they want to.

It’s not just Stevens feeling the

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Addenbrooke’s on Fire

The ‘special measures’ meted out to Cambridge’s prestigious Addenbrooke’s hospital by the CQC is a symptom of an NHS struggling to cope nationally and locally. Fifteen NHS trusts are now is such measures, whilst two thirds are in debt and 33 are without a permanent chief executive. Many services are deemed inadequate and unsafe because they don’t have sufficient clinical staff, particularly nurses and midwives, which makes NHS England’s decision to halt and refuse to publish NICE’s work on safe staffing levels all the more inexcusable.

Even if more money was available, failings in workforce planning mean many hospitals and GP practices struggle to recruit staff, and the working conditions and static pay make them hard to retain. A new contract is to be imposed on junior doctors which could mean some specialties – particularly GP trainees – face large salary cuts which is hardly likely to help recruit the additional 5000 GPs needed to keep the NHS afloat. Large cuts in benefits, social care and local authority budgets are pushing up demand in the NHS, as is an ageing population. Clinical Commissioning Groups are also in debt and struggling to cope with their responsibilities. And

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Do you believe in the Care Quality Commission?

Do you believe in the Care Quality Commission? Health Secretary Jeremy Hunt clearly does, pronouncing that a “good” or “outstanding” rating is now the “single definition of success” in the NHS. This implies that something as complex and fast moving as health care can have a single definition of success, and the over-stretched CQC – which often only produces its reports many months after it has inspected a hospital – is up to the task of measuring and monitoring it. The previous badge of excellence for NHS hospitals in England was the prestigious ‘Foundation Trust’ status, but this lost credibility after Mid Staffordshire hospital became an FT despite appalling failings in the care it provided, and it has lost further credibility after the CQC rated 33 FTs as “inadequate” or “requires improvement”. FT’s are rewarded for balancing the books, whereas the CQC rewards the quality and safety of the services provided. So a highly rated CQC trust could be a basket case financially, and a financially prudent trust could be hiding appalling care.

The CQC inspects hospitals, GP practices, ambulance services, care homes, clinics, dentists, community services, mental health services and

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A leadership crisis

On paper, running the NHS seems relatively straightforward. You have to provide universal healthcare (or at least the treatments NICE deems are both effective and value for money), you have to do it a standard that is both safe and effective, and you have to stick to your budget. Yet in the battle to achieve access, safety and affordability, very few NHS leaders succeed, or are given the time to succeed.
The average job span of an NHS chief executive is two and a half years and only one in 10 trusts has had the same chief executive for a decade or more. One-fifth of trusts have no substantive director of finance and one-sixth have no substantive chief executive. It is the same picture for directors of nursing and medicine. The jobs are so tough, and the culture of fear and blame so prevalent, that very few clinical staff want to do them. And yet the NHS will collapse if they don’t.

Between 1948 and 2011, NHS annual funding growth averaged 4%. From 2011-2015 it was 0.9%, and the target growth 2015-2020 is 1.5%. The current budget requires another £22 billion of ‘efficiency savings’ in the

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Medicine Balls

Cradle to Grave

An FOI request from the Observer to the Care Quality Commission has revealed it was notified of 30,000 allegations of abuse involving people using social care services in the first six months of this year. Allegations ranged from physical, emotional and sexual abuse to financial fraud. The rate at which allegations of abuse have been made in 2015 is double that of 2011. In 2013-14, a professional carer was the alleged abuser in care homes in 57% of allegations. In people’s own homes, professional carers were identified as the abuser in a third of cases.

The CQC seems powerless to stop the flow of allegations it receives – 150 a day – and its chief inspector of adult social care, Andrea Sutcliffe, has publically blamed a lack of political leadership and huge cuts in funding. £4.6bn has been cut from social care budgets in the last five years. How to train, motivate, pay and retain a million care workers with less funding is unclear.

Poor care of the elderly gets most media attention because elderly patients are the main users of the NHS and social care. However, the greatest long term health benefits come

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