17 Mar 2015

Little prospect of relief for cash-strapped NHS in the budget

The NHS has had a hard year.  The winter saw trusts under more pressure than ever, with many missing that crucial target of 95 per cent of patients seen, treated and discharged or admitted within four hours.

And it looks as if three-quarters of trusts will reach the end of this financial year in debt – cumulatively amounting to an expected £1bn.

So will there by any relief in tomorrow’s budget?  I have spoken to a number of health economists and the general feeling is there’s not likely to be much.

One said there may be a bit for something like free car parking but nothing that will come anywhere near dealing with the overall financial pressures.

Yet all believe something needs to be done. In NHS England’s Five Year Forward View,  its chief executive Simon Stevens has said there will be a £30bn deficit by the end of the decade.

While he expects £22bn can be found by changing the way patients are treated and making savings, that will still leave the NHS needing £8bn a year after 2020.

Anita Charlesworth, the chief economist at the Health Foundation, said the chancellor needs to address the medium-term question for the next parliament: how are we going to square the circle of dealing with the deficit while giving the NHS the additional funding that it needs to sustain services?

Massive repair bill

We have been filming over the past few months at Watford General – part of West Herts NHS Trust. They are an average-sized hospital serving a large population – 90,000.

Their buildings are largely old and the repair bill is massive. They are expecting to have a £14m deficit.

This winter the trust overall did not meet its four-hour target. At Watford, in particular, they had to declare a major incident and divert ambulances on a couple of occasions for a few hours.

Yet their problems are not really any different from other hospitals. A growing elderly population – two-thirds of patients are aged over 65 and one in four has dementia.

They also have staff shortages. Their Chief Financial Officer, Don Richards, said their very location causes problems. They are on the edge of London but do not pay London weighting.

After Mid-Staffordshire and the report by Robert Francis, all hospitals had to increase their staffing levels to improve quality of care. So their agency bill this year is expected to be £30m.

Expensive staffing

It is a lot. But then staffing is expensive. On a trust turnover of £320m, £200m is spent on paying for those needed to run a hospital.

They have managed to recruit 160 more nurses recently and they will go abroad soon to find some more.

And they have been spending in the short term to make savings in the long term. Blue Bell ward for the very frail is a good example – many of the patients have both cognitive and physical problems.

Dr Tammy Angel, clinical director for elderly care, said patients with dementia had been scattered around the hospital. They often needed one to one (or special) nursing.

But having them all on one ward they are able to meet their needs more easily and with fewer staff. Most importantly, the feedback is excellent from patients and families. And you can tell, when you are on the ward.  It is light and airy and it feels calm.

In its Five Year Forward View, there are proposals for different ways of caring for patients – more treatments for instance in the community.

But that will take time – and in the short term – there is, of course, a deficit to deal with.

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4 reader comments

  1. Philip Edwards says:


    A start could be made by abrogating the PFI contracts, which are little more than the ability to print profits for the building contractor.

    Nationalise them with no compensation except in the case of proven need. All of them have already ripped off our economy through profiteering so it’s time to take back what is rightfully ours whatever a rigged legal system says. There is no moral requirement to honour an immoral law or a bad contract.

    The current aim is for Yank style profiteers to “save” the NHS with “needed investment” (read: ripoffs). The same old lies from the same old Jeremy Hunts and Alan Milburns of this world.

    Sooner or later it will dawn on the nation that the NHS is being ever-so-gradually salami-sliced off. Tories, New Labour and the LibDems are all equally guilty. The Tories and their spiv mates hated and opposed the NHS from its beginning, New Labour traitors sold out, and the LibDems will do anything to hold onto the coat tails of power – all of them are equally despicable and without a trace of conscience. Not one of them has the guts to stand up and tell the truth of what was done and at the present rate will continue to be done.

    All the medical care staff who work in the NHS are heroes. They work against a constant drip-drip of lying mainstream media attacks that continue to emphasise defects without reporting WHY THESE DEFECTS EXIST. In many respects, mainstream media jobsworth journalists are even worse than the scoundrel politicians.

    The NHS is not perfect and never will be. No large scale human organisation ever can be. But it is one of the last bulwarks against an inhuman capitalist system that will steal everything….health, education, housing, youth, and even old age. Until that lesson finally sinks into national consciousness the profiteering and lies will go on.

  2. David Henderson says:

    It’s like telling an anorexic to go on a diet?

  3. Andrew Dundas says:

    It’s the same old story. Our NHS transfers tax revenues from higher income people to spend on the health needs of everyone, and regardless of their incomes. Which is about promoting greater equality.
    But the Tories don’t agree that State guarantees for their property rights justify paying taxes to pay for poorer people’s good health and education. They don’t want greater equality through public services and progressive taxation.
    The future of the NHS is all about that battle for and against greater equality in our Nation.

  4. anon says:

    Firstly very well done and thank you so much for all your outstanding work and that of Channel 4 News about the NHS, a voice for the voiceless

    Hope ok to post here? If not appropriate may I ask if it might be posted on another blog please

    Could I have the temerity to link the NHS and the problems you report on, with all the issues, life choices etc that we all face in life, and even throw in Richard the third to boot, in an open letter to Mr Clarkson please?

    If not too extremely tenuous may I offer this

    Open letter to Mr Clarkson, why post it here? Please read below

    Dear Mr Clarkson

    this has absolutely nothing to do with me but may I suggest this to you please?

    What has happened is perhaps the best thing that has happened to you for years (maybe)

    after knocking his head on the bottom of a river Augustus John reputedly reputedly came up as a genius, at least that is what the card from the Tea company suggested,

    after being metaphorically kicked in the ‘ead. Ie the big end is gone in motoring parlance, Something similar might happen to YOU?

    This is Easter and the time is Lent when we give things up

    why not give up being Jeremy Clarkson and become…Jeremy Clarkson?

    There are people at the moment who would give up everything they have to live another hour,

    you as far as I know have good health and so much else besides,

    this (might) be your wake up call -please don’t blow it?

    Maybe when boredom sets in, all we get older our general chemistry can affect the way we behave but there is never any excuse to take this out on others, we may seem bigger and others seem the other way depending on how life is treating us?

    (if) you really wanted to turn this around might I suggest that you need to do something totally unconditionally now ie something without genuinely expecting or even wanting anything back in return?

    look at the terrible despicable things happening around us, here and overseas, such pain and sadness, beyond comprehension, such evil where people do not have seemingly to have any choices, how to escape it or save those they love, in so many different ways. Every day ,everywhere, its horrible,

    as an example at home where there are unmet needs and not enough resources to help…. consider A/E (and they really do not need any more patients than those they already struggle to care for), look at the excellent coverage by Channel 4 News on the NHS,

    I think I understand from reports that your contract may be up for renewal (on your side) and that you sold your share of Top Gear a while ago, why not do something like sign the lot, all the money you earned from the sale of the show, every last bit of it over to say the NHS, asking nothing in return? Why not?,think about it

    You would need to ensure that the money was spent wisely, not to allow the government to cut funding they would otherwise make. or for disgusting drug companies to hold desperate patients to ransom by charging even higher prices for life saving drugs (based on monopolies on ideas that the World still foolishly allows greedy people and those that employ them to claim), but all things can and will be achieved and overcome in time, (even as you know, restoring beaten up old cars to be put back on the road as good as new, or programmes I guess, or just about anything, – even me perhaps!)

    I think I recall you made a programme about about a VC Hero you were very proud of and to who you were related?

    Such moments require a person to do something quite ‘daft’ (in wordly terms) for something quite extraordinary to happen. As well as needing a person to be not entirely main stream in the best sense, (what car would you choose for this metaphor?) to be an outsider, a true individual, it also requires a crisis or opportunity to take place to allow them to do this, and such a moment by its very nature may not last very long. For you with the news cycle it may be today or tomorrow at the latest?

    But you have it easy Mr Clarkson, this is could be the beginning, not the end, your spring, not what was it with Richard the third, your winter of discontent? or is this wrong now? I am not sure, but what I am sure about is this could be your moment to shine, to reinvent yourself and you are not even under withering machine gun fire from the old Jerries at where was it? Arnhem?

    Besides… we need the foreign exhange you are earning, look at the dreadful balance of payments figures Mr Clarkson,

    and it would be helpful if you didn’t keep blocking up the news agenda at the expense of stories that are so desperate to be told, beyond life and death, far far worse than that,

    so that is a thought of one person, one of the little people.

    this is your moment, please grab it with grateful open arms,

    my suggestion to make this happen is that you need to do something totally unconditionally and without any though of self as I have suggested above

    then just say sorry to the person you hurt and ask for their forgiveness

    and if the BBC should ever agree to have you back please get back to making a lot of people laugh, and not cry !

    This is your chance, many never people have it, don’t blow it,

    the only health warning I would give you is that once you have done this you can be as ‘unsuccessful’ as I am, but far more successful than you have been before, or could possibly be without taking this step, if you get the drift.

    take care, you have just had diesel put in your petrol tank, it is the best thing that could have happened!

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