While the chancellor deals in economic optimism, reality in the NHS is tough – and getting tougher

Sunak's plan to cut £4.75bn in “efficiency savings” from the NHS budget is a classic of the “heroic optimism untethered to reality” genre
Health secretary Sajid Javid, PM Boris Johnson and chancellor Rishi Sunak talk to a member of staff on a visit to the New Queen Elizabeth II Hospital, Welwyn Garden City. Photo: PA Images/Alamy Stock Photo

By Andy Cowper

27 Apr 2022

You can always tell when things are getting crunchy in the NHS: people start telling the truth about fictional financial plans.

Many CSW readers may have noted the chancellor’s media-announced plan to cut £4.75bn from the NHS budget for the coming financial year in the name of “efficiency savings”. (You may also know that the NHS has an underlying annual deficit running at about £5bn, as Sally Gainsbury’s work for the Nuffield Trust has shown.)

The government subsequently got round to actually issuing the relevant press release. I commend it to you warmly: it is a classic of the “heroic optimism untethered to reality” genre.

It states: “As part of the renewed drive, the chancellor said the NHS efficiency commitment will double to 2.2% a year – freeing up £4.75bn to fund NHS priority areas over the next three years.

“These savings will be made through a range of programmes including the digitisation of diagnostic and front-line services, which has been shown to reduce cost per admission by up to 13%, improving the efficiency of surgical hubs and developing digital tools to cut time spend by NHS staff on admin tasks.”

This is impressive for three reasons.

Cutting £4.75bn from the NHS budget in the financial year that began just under two weeks later is unlikely to be well planned. Also, this hypothesis that NHS cuts mean more money for the NHS… really?

Only a few surgical hubs yet exist. More are planned, but not yet actually there, in the real world. 
Digitisation costs before it saves, as the Wachter Review inter alia stated.

Economic reality with Mackey

Northumbria Healthcare NHS Foundation Trust chief exec and NHS England’s national director of elective recovery Sir Jim Mackey is noted for his forthrightness, and his statements at the Health Service Journal Provider Summit that the proposed financial savings for trusts “probably aren’t really possible” was a welcome assertion of reality in the fantasy-prone world of finances.

The Treasury Munchkins will hate him for this, which won’t bother Sir Jim at all. Health Service Journal also reported that NHS England’s orders to achieve financial balance are getting push-back from much of the system.

How are things in NHS reality?

There’s no escaping the fact that things are in A Really Massive Mess just now. Indeed, they have been so for some months.

The Health Select Committee’s new report on cancer services is an unsettling read. “Despite the efforts of NHS England to protect services and encourage patients to come forward, 36,000 fewer people in England and 45,000 fewer in the UK began cancer treatment during the pandemic compared to previous years,” it said.

“Neither earlier diagnosis nor additional prompt cancer treatment will be possible without addressing gaps in the cancer workforce and we found little evidence of a serious effort to do this. While our independent expert panel acknowledged the short-term progress made, rating progress against 2021 workforce targets as ‘good’, they rated the appropriateness of these targets as ‘inadequate’ because they are insufficient to address ongoing workforce shortages.

“On the basis of evidence supplied by the government and the NHS, we do not believe the NHS is on track to meet the 75% early diagnosis ambition set by the government. Our independent expert panel has also rated the government’s progress against this target as ‘inadequate’.”

We have had confirmation that since 2015, the number of GPs has fallen every year, and the acute care sector is also feeling the pain. HSJ reported that average ambulance waits in one region have reached two hours for heart attack and stroke patients. The Guardian reported major issues with surging emergency demand in Yorkshire this week, but in truth, it’s almost everywhere now.

Covid-19: like the poor, still with us

The one remaining reliable national survey by the ONS shows that one in 13 people have Covid-19, according to its latest data. The level of people in hospital with Covid (over 20,000) is having obvious effects on efforts to start addressing the backlog.

Covid has really not gone.

NHS Confed’s boss Matthew Taylor continued his outspoken streak, warning that “the brutal reality for staff and patients is that this Easter in the NHS is as bad as any winter. But instead of the understanding and support NHS staff received during 2020 and 2021, we have a government that seems to want to wash its hands of responsibility for what is occurring in plain sight in local services up and down the country.

“No.10 has seemingly abandoned any interest in Covid whatsoever. The Treasury has taken bites out of the already very tight NHS budget, while soaring inflation means the NHS settlement is now worth less. It is now unclear that anyone in the centre of government feels the unfolding NHS crisis is their responsibility

“NHS leaders and their teams feel abandoned by the government, and they deserve better”.

Andy Cowper is the editor of Health Policy Insight

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