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Taking the knife to the NHS

The future fate of public services, whoever comes out on top in the general election, is already taking shape in the National Health Service. Cuts thinly disguised as “efficiency savings” are biting already but they are only the prelude to major reductions in spending and the provision of healthcare.

What’s actually happening now is typified by the situation in Basingstoke, where the hospital is already having to cut £6 million, or about 4% of its budget. Alex Whitfield, the associate director of productivity at the hospital NHS trust, admitted:

The financial situation is like nothing we have seen before. We have never had less money than the year before. We have a mountain to climb – it is huge.

Cost-cutting projects include sending matrons back on occasional ward duty and using prescribed drugs left unused by discharged patients. Ultimately, Whitfield admitted, staff numbers will have to be reduced. Basingstoke’s problems flow from the decision by Sir David Nicholson, head of the NHS, to save £20 billion in three years in response to government pressure. Some estimates suggest that a third of hospitals will run out of money by the autumn of 2011, which New Labour is keen to disguise as the election date looms.

The crisis is already hitting primary care trusts, which “commission” operations and services from hospitals. A recent survey showed they are overspent by £130 million this year and will have to reduce spending in 2010-11 as a result. The funding gap has already had an impact on patients, with GPs in Hertfordshire being told to get "approval" for a list of procedures including hysterectomies, removal of "skin lumps and bumps" and tooth extraction. Managers have advised the family doctors that in many cases "it is usually better to wait to see if symptoms resolve themselves".

In London, campaigners say spending cuts being drawn up in secret threaten services such as casualty and maternity units at 13 out of 36 hospitals in the capital. A recent analysis by the British Medical Association warned:

This survey of London’s NHS raises serious questions about the long term viability of many of the capital’s acute hospitals in a complex and contradictory market. For the hospitals, the challenge is to juggle a whole series of pressures in the context of a frozen – but in real terms reducing – budget.

Naturally, the plans are being kept under wraps as far as possible until after the election, although local campaigns are already under way. Some New Labour ministers have felt compelled to support protests as they seek to defend their seats. David Lammy, the Higher Education minister, for example, was on a recent march to save the Whittington Hospital casualty department in north London threatened by his own government’s policies! Hypocrisy or what?

Even before the cuts, health inequality is rising, with life expectancy for poorer households on average seven years lower than those on higher incomes, according to a recent report which declared:

In England, the many people who are currently dying prematurely each year as a result of health inequalities would otherwise have enjoyed, in total, between 1.3 and 2.5 million extra years of life.

Halting the cuts in NHS spending and in other areas is urgent if these inequalities are not to grow even sharper. As a start we should reject the idea advocated by all the major parties that the national budget has to be “balanced” to appease financial markets. The markets cannot be allowed to blackmail society and should be told where to get off. And the same should apply to New Labour and the others as we get down to devising some serious revolutionary solutions.

Paul Feldman
Communications editor
9 March 2010

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