By Judith Smith, Andy Street and Paula Lorgelly
The Conversation website has just published a piece by HSMC Director, Judith Smith, together with Andy Street (or York University) and Paula Lorgelly (of the Office of Health Economics) about the current NHS pressures and funding. This follows a debate the three took part in at a recent Health Economics Study Group winter meeting in Birmingham.
"There have been many warnings over the past few years about the problems facing the NHS and social care. But the British Red Cross is the first to describe the situation as a “humanitarian crisis”.
The Red Cross is one of the many third sector organisations working alongside the NHS and local authorities to provide health and social care support to people in the UK. In 2015, its volunteers helped almost 85,000 vulnerable people to continue living independently through its support at home programme. And, through its A&E support services, a further 31,000 people were helped to settle back home after being in hospital. So the Red Cross speaks from experience of what is happening on the ground.
In recent weeks, there have been increasingly loud cries for help from both acute hospitals and primary care. The new chair of the Royal College of General Practitioners, Helen Stokes-Lampard, spoke of the relentless pressure under which GPs and their teams are working. This pressure was confirmed by research that showed increases in rates of GP consultations and concluded that the service, as currently delivered, could be at saturation point.
Hospitals are struggling to get through the winter, and many are issuing black or other alerts. Delays in discharging medically fit patients are at a ten-year high with newly arriving patients having to wait on trolleys in corridors. Staff morale is at an all-time low.
Like many others, British Prime Minister Theresa May disagreed that the “huge pressures” facing the NHS constituted a humanitarian crisis. But she refused to accept responsibility for these pressures, instead criticising the head of the NHS, Simon Stevens, claiming that “funding is now at record levels for the NHS”.
The government continues to claim that the NHS will be receiving an extra £10 billion over the course of this parliament. Both the House of Commons Health Committee and the UK Statistics Authority have verified that the real terms increase in NHS funding over the period amounts to £4.5 billion. And annual funding growth for the next three years will be among the lowest in NHS history, falling far below the growth in need, which is also at record levels.
The health secretary, Jeremy Hunt, also downplayed the Red Cross’ claims, only to undermine his case by describing how the NHS is struggling to cope with the rising demand on A&E departments. Such pressure had been predicted by his own department. But instead of acting on timely advice, Hunt has simply blamed mounting pressure on “selfish” people who shouldn’t be going to A&E.
Hunt also indicated that the four-hour waiting time target should be relaxed, given that A&E departments have long been failing to meet the standard. Instead, he says that target waits should reflect how urgently patients need care, as in Australia. But relaxing targets does not address why more and more people are turning up at A&E departments, nor how best to care for them when they’re there.
This leaves NHS staff and organisations in an unenviable position. Hospitals and GPs are acting as shock absorbers in a system under huge pressure, where demand is rising, funding is flat, and politicians seem deaf to calls for action. Inadequate funding of the health service and cuts to social care mean that local services can’t cope. Hospital boards find themselves on the horns of a dilemma: either meet punishing financial “control targets” or prioritise patient safety and fall further into deficit. There is simply not enough time, resource or management capacity to focus on planning and “transforming” into new models of care provision.
Hunt has called for “an honest discussion with the public about the purpose of A&E departments”, but the debate needs to be much wider. Leading NHS clinicians from the Royal College of Physicians have written [PDF] to the prime minister detailing their concerns, while others have asked her to convene Cobra-style meetings to address the situation. The chairs of three Commons select committees have also asked the prime minister to seek cross-party consensus on the future of health and social care.
There is a stark choice. One option is that the government sticks to its funding plans for health and social care. If so, pressures will rise, waiting times will increase, and people in need will be denied health and social care. This is already happening, and the Red Cross’ warning reminds us of the human cost – the humanitarian crisis – of this policy.
The alternative is to increase NHS and social care funding. But the money has to come from somewhere. The obvious source is increased taxes, thereby preserving the traditional way of funding the NHS. The fear is that this government is letting the NHS reach crisis point in order to open the way for increased co-payments and private insurance, shifting funding responsibility onto individuals, just as has been happening for social care."
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