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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