24 Jan 2012

MPs criticise government’s NHS reforms

Health and Social Care Editor

NHS managers are “salami-slicing” services as they struggle to cut costs at the same time as the government presses for reform, MPs warn, as a top NHS figure tells Channel 4 News of “financial chaos”.

In a critical report, the health select committee said hospitals were resorting to short-term “salami slicing” as they try to find £20bn in efficiency savings by 2014/15.

And in a criticism of Health Secretary Andrew Lansley’s reorganisation of the NHS, it said the process “continues to complicate the push for efficiency gains”.

There was a “marked disconnect between the concerns expressed by those responsible for delivering services and the relative optimism of the government” over achieving cuts, the committee noted.

The attack could be particularly damaging for the government’s aspirations for the health service as the committee is chaired by one of Mr Lansley’s Tory predecessors, Stephen Dorrell, and is dominated by Conservative and Liberal Democrat MPs.

It comes days after all the major health unions – representing doctors, nurses and midwives – stated “outright opposition” to the health and social care bill. The bill was already “paused” last year to take into account “concerns” voiced by the professions and elsewhere, but after changes were made, its progress through parliament continued. The House of Lords will examine the bill again on 8 February.

The British Medical Association (BMA), the Royal College of Nursing (RCN) and the Academy of Medical Royal Colleges are also holding a summit on Thursday evening to discuss the Bill.

The threats to the standards of patient care are now being realised. Unite union

For the MPs’ report, a detailed investigation by the committee found “disturbing evidence” that cost-cutting measures being implemented “could fairly be described as ‘short-term expedients’ or ‘salami slicing”‘.

NHS bodies were “making do and squeezing existing services simply to get through the first year of the programme” rather than looking for long-term reforms to practices, it found.

Health Secretary Andrew Lansley today denied that there were cuts happening across the NHS, writes Health and Social Care Correspondent Victoria Macdonald. But there are many examples where there is the salami-slicing that the health select committee refers to. Indeed, the chair of the committee, Stephen Dorrell, mentioned physiotherapy services and the Chartered Society of Physiotherapists backed this up with an example in Nottingham of patients being restricted to just two sessions and only after they have visited their GP twice, six weeks apart.

Evidence gathered by Pulse Magazine last December revealed cuts in chlamydia screening, HPV vaccination and schemes for refugees and the homeless. Last August, we were told that waiting times of over 18 weeks from referral to treatment rose nearly 50 per cent over one year. And the Royal College of Nursing said 48,000 posts had been earmarked for cuts.

The obesity organisation Mend said that it was now being affected by cuts. In 2009 it ran 806 family programmes to help with exercise, nutrition and diet. But this year that has falled to 697. Paul Sasher, from Mend, told Channel 4 News: "In some of the areas where our programmes have been running for a number of years, where we have had great outcomes, great success, we have seen contracts not renewed. We have also seen contracts for two or three years now being reduced to one year. Cuts across the board, really."

All this is at a time when childhood obesity is growing. It currently costs the NHS £4bn a year and is expected to reach £6.3bn by 2015. Mr Sasher said it was a sad fact that public health programmes like this one or those for sexual health often suffer in order to protect front-line services. He said childhood obesity can lead to diabetes, high blood pressure and some types of cancer.

Disruption and distraction

The MPs warned that it was “far from certain whether the targets… will be met, even with trusts stretching themselves”.

The tough task was being made harder by the fact that the government was pushing through its major shake-up of the entire health service structure at the same time as trying to make savings, the MPs said.

“Although it may have facilitated savings in some cases, we heard that it more often creates disruption and distraction that hinders the ability of organisations to consider truly effective ways of reforming service delivery and releasing savings,” they concluded.

The Department of Health also came under fire in the report for giving NHS bodies only weeks to prepare bids for £300m of capital funding over the Christmas period.

“At a time when all NHS bodies are being required to make efficiencies and need to plan strategically to reshape services, it is unhelpful for the Department of Health to require them to make bids for capital funding to short deadlines and without adequate preparation,” it said.

As part of an examination of the state of social care, the committee said there was “precious little evidence of the urgency” required being given to integrating health and care services.

It expressed “deep concern” that £116m of £648m earmarked to improving the link between the two had been spent simply “sustaining existing eligibility criteria”.

It called for urgent investigation of the possibility of “passporting” more NHS funds directly to the sector – and warned that more vulnerable people were losing out on state-funded help.

“In spite of government assurances, local authorities are having to raise eligibility criteria in order to maintain social care services to those in greatest need,” it said.

Long-term benefits

However, the committee chair, Stephen Dorrell, said all of the problems voiced by the MPs were not down to the reforms. He said the NHS was “well used to management change” and that efficiencies were the “key issue”.

“The fact that there is another bill going through parliament changing the management structure of the NHS means that there is a tendency for every comment about the NHS to be framed by the debate about the bill,” he said.

“But the NHS is well used to management change. In reality, the key pressures which are building in the system arise from the fact that demand is continuing to grow at a time when health and social care budgets have stopped growing.

“The NHS funding challenge can only be met by rethinking and redesigning the way health services are delivered now, in order to deliver lasting long-term benefits.”

In response, Andrew Lansley said: “We all know the NHS faces challenges from an ageing population and rising costs of new treatments.

“Our plans for modernisation are essential if we are to put the NHS on a sustainable footing for the future. As the report acknowledges, our modernisation plans allow us to make significant savings, not least in reducing the needless bureaucracy.

“We know the NHS can meet this challenge – we have already made £7bn in efficiency savings over the last 18 months as performance has improved: record low infection rates, mixed-sex wards down by over 90 per cent and people waiting over a year reduced by half. Labour failed to push through reform of the NHS in their time in government. That is why we are having to act now.”

‘Financial chaos’
David Stout, deputy chief executive of the NHS Confederation, which represents more than 95 per cent of the organisations that make up the NHS, told Channel 4 News that one of the major problems with the NHS bill is that it does not address the financial constraints the health service is under.

The NHS has to make £20bn in efficiency savings over the next four years, mainly because healthcare costs continue to rise faster than inflation – but the bill itself looks at different areas for reform. The “pause” in the bill’s progress has not helped managers plan either, leading many to look for quick wins like cutting some services, just to balance budgets.

“In quite a lot of ways, the bill really doesn’t make any difference,” he said. “In the long term it could, but what is needed is in the short term. Even in the best case scenario, we get the new structures in 2013, they take a while to bed in, and everyone knows it gets worse before it gets better. So realistically we’ve lost two years, if that’s all we do. And by then we’ll be in financial chaos.

“There are aspects of the bill which are good – but the question is whether the bill is in itself a distraction from doing the task [of making efficiencies while providing quality services], rather than an enabler.”