Thursday, 23 October 2014

Simon Stevens: Unrealistic, And Will Fall On Deaf Ears, by Clive Peedell

Simons Stevens's projected £22bn savings are unrealistic, and his call on political parties to fill an £8bn funding gap will fall on deaf ears.

Despite the swift declarations of political support for the principles of his plan for the next five years of the NHS, NHS England chief executive Simon Stevens is a long way from securing the £8 billion extra by 2020 that he admits is needed to make ends meet even after extraordinarily ambitious efficiency savings of £22 billion.

None of the three main political parties is committed to raise NHS spending by anything like as much as £8 billion: the Tories are sticking rigidly to their planned further five-year freeze to 2021, the Lib Dems have offered two related injections of £1 billion from 2017, and Labour has promised £2.5 billion also in 2017 – by which point the financial crisis already brewing in the NHS will be boiling over into cuts and closures.

The Tories keep banging on about needing a strong economy for a strong NHS.

But only this week George Osborne was shown to have missed his deficit target and their real terms cuts to NHS funding have led to rising waiting times, an A&E crisis and GP surgeries in meltdown.

Meanwhile Labour's plans for a Mansion Tax are already falling apart and won't raise sufficient funds.

The National Health Action Party is putting forward a genuine alternative plan that would break now from the spending freeze and start with an immediate injection of extra funding, if necessary raised through taxation, to be followed by efficiency savings based on stripping away the wasteful bureaucracy of the market​,​ coupled with measures to force the rich and big business to stop dodging £120 billion a year in taxes and pay their fair share towards the public services and health care we all need.

Simon Stevens has totally ignored the grotesque financial waste that is draining billions of pounds from frontline care in our NHS - wasteful internal markets, commissioning support units, management consultancy fees, the cost of procurement of clinical services, profit-taking by private providers, the cost of fragmenting pathways due to outsourcing components to private contractors, and PFI deals bankrupting our hospitals.

We also need to consider the damaging physical and mental health impacts of austerity economics. Poverty and inequalities are the big issues that the government must tackle if good health is to be preserved.

Another striking thing about Stevens's plan, which many reports see as radical, is that few of the ideas are new: most have been at the centre of various attempts at reorganising the NHS over the last 20 years, during which time few of the promised new services outside hospital have taken shape, and far from reducing dependence on hospital services, attendances at A&E and GP referrals for hospital treatment of continued to rise stubbornly each year.

Many of Stevens's proposals to seek ways of reducing demand for hospital treatment by improving public health are quite sensible – even if they cannot be guaranteed to deliver any significant change in hospital caseload in the five-year period.

But it's less clear that some of the proposals for reorganising the delivery of services could generate anything like the scale of savings that are required, especially when some of the proposals in the Stevens plan involve substantial additional new investment:
  • He proposes an end to the continued freeze on NHS pay, which has so far delivered at least a third of the "cost savings" since 2010.
  • He proposes to "radically upgrade" prevention and public health.
  • He proposes to give "resources and support" to the introduction of what he calls radical new care delivery options including establishing "multispecialty community providers" bringing together GPs, nurses, community health services, mental health and social workers, employing hospital consultants and running community hospitals.
  • He promises more NHS support for frail older people living in nursing homes.
  • He also promises to "invest in new options for our workforce, and raise our game on health technology".
None of the costs of these suggestions is discussed.

But the plan for example for "multispecialty community providers" appears to revive Lord Darzi’s controversial "polyclinics", and would inevitably mean capital investment in new, larger buildings, new equipment, possibly including MRI scanners, and the recruitment of professional support staff, some of whom are already in short supply.

It's not clear how scattering the services which are currently provided in specialist hospital centres across a wider network of smaller centres could possibly be more efficient in terms of the time of consultants and professional staff or save money.

Dr Clive Peedell is Co-Leader of the National Health Action Party.

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