A sight that all of us will have seen since the Autumn is ambulances queuing at A & E and patients waiting on trolleys in hospital corridors. Some of us will have seen the situation at first hand, waiting with a relative or waiting for treatment. Bed occupancy has been dangerously high in many hospitals, with senior managers and doctors having to take decisions that, in some instances, are literally life or death.
Upsetting as these images are, they show only the tip of a very large iceberg that is threatening to sink an NHS and the social care system unable to cope with demand.
Three reports have been published this week which expose the crisis in other key services.
The Kings Fund’s report “Understanding NHS financial pressures: How are they affecting patient care?” looked at the impact on four services that rarely make the headlines: genito-urinary medicine (GUM) services; district nursing services; elective hip replacement services: and neonatal services. The report states:
The growing gap between demand for services and available resources means that staff are acting as shock absorbers, working longer hours and more intensely to protect patient care. ….
Our findings create a fundamental challenge to the direction of travel set out in the NHS five year forward view ……the NHS appears to be moving further away from its goal of strengthening community-based services and focusing on prevention, rather than making progress towards it.
The Neurological Alliance published a shorter study “Falling short: How has neurology patient experience changed since 2014?”, which shows that, in neurological services (for people with conditions including Parkinson’s and Alzheimer’s)
at every stage patient experience of care is falling short of what we reported in 2014.
A recent report by Young Minds on the crisis affecting CAMHS (Child and Adolescent Mental Health Services) adds to the catalogue of evidence of rationing, although every sensible person knows that reducing CAMHS cuts pennies but costs pounds.
To add insult to injury, the government has decided to impose the Immigration Skills Charge (ISC), which from next month will charge employers, including those in health and social care, who bring in doctors and nurses from abroad on a Tier 2 visa, £1000 a year. This may not seem a large amount of money, but it adds up to £3.5m for doctors, £1.6m for trainee doctors and £0.65m for nurses according to the BMA and NMC. This is money diverted away from the front line and could discourage employers from recruiting essential staff.
All this supports our view that we must find £4bn right away to address the current funding crisis in health and social care. In the budget statement last week, all that we got was the promise of £2bn over three years for social care and a bit extra for A&E. That is no more than a sticking plaster! I look forward to the final report of the independent commission on funding of health and social care, set up by Norman Lamb MP to find a long term sustainable solution. It’s time politicians stopped using health and care as political footballs and started to find a grown up solution to the biggest issue facing our NHS and care system.
* Joan Walmsley is a Liberal Democrat member of the House of Lords
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One Comment
Where to begin?
I seriously doubt that “A sight that all of us will have seen since the Autumn is ambulances queuing at A & E and patients waiting on trolleys in hospital corridors”. Most of us do not hang around hospitals. We might have seen these things in selective TV or newspaper reports and suspended our critical faculties because the report was about the NHS and we believe everything bad about funding of the NHS. We always swallow without chewing reports from interest groups, which are mostly fact free or highly selective in their use of facts or full of so-called anecdotal evidence (which is no evidence at all), making them all the easier to digest and regurgitate in argument and discussion.
The situation in the health service is more nuanced than media and interest group reporting acknowledge. Many “resource” problems are to do with the organisation with trusts and commissioners and the near impossibility of moving resources between specialties and consultants.
Funding of the NHS was protected and increased by the coalition because of Liberal Democrat insistence. Funding for other public services was cut. According to the latest Public Expenditure Statistical Analysis from HM Treasury, health receives £138.7bn, 20% of public spending – nearly four times defence’s funding and public spending share – and welfare (including social care but excluding pensions) gets £174.9bn, 25% of public spending. To give health and social care more, when together they receive 45% of public spending, means giving other public services less after they have already endured five years of the coalition’s squeeze, or raising more through taxes. It would be honest to put the choice to voters, though I can think of no recent election in which they voted for more taxes.
As for hanging around hospitals, a couple of weeks ago a relative was taken to A & E at midnight at a major teaching hospital and from there admitted to a ward. A & E was almost empty. The trolleys in the corridor were empty. Any patients on trolleys in corridors were being wheeled somewhere. My relative did wait hours for admission, while consultants decided whose patient they were and then while a bed was found, but the ward to which they were first admitted had a room with more than six empty beds. That’s anecdotal evidence. Make of it what you will.