Maths of the impossible

The government’s convoluted maths outlining NHS spending is beginning to unravel, as fresh revelations show the health service achieved only £1bn of its £22bn in planned efficiency savings scheduled for the next five years.

NHS England released on Monday (May 9) the most detailed breakdown to date of how the billions in savings demanded of it by the government will be delivered by 2021.

Local NHS services will need to make an astounding ÂŁ15bn in savings to meet the ÂŁ22bn target.

More than a third of these savings which total over ÂŁ6bn, NHS England maintained, would need to be delivered nationally, including through staff pay freezes being imposed each year.

The Health Foundation noted just how far off NHS England is from reaching its targets to date.

“By its own estimate, the NHS delivered savings of just £1bn towards this last year, confirming that the health system is substantially off target with its efficiency plan,” said Health Foundation director of research and economics Anita Charlesworth.

Unite national officer for health Colenzo Jarrett-Thorpe argued that the savings plan put forward by NHS England has given the public the impression that cuts will be made only “to faceless bureaucrats and not to frontline staff.”

Immense strain

What’s not being highlighted, he explained, is the immense strain public health services are under after their commissioning was transferred to cash-strapped local authorities and no longer falls under the remit of NHS England.

This has allowed health secretary Jeremy Hunt to claim that the health service budget has been left untouched by government cuts, when in reality, so many of the services that are essential in keeping the NHS sustainable – health visiting, sexual health services and smoking cessation programmes, just to name a few – are being squeezed by the backdoor.

“Preventative health services in public health will be cut by 71 per cent between 2015 and 2020,” Jarrett-Thorpe noted.

“And it’s these services that cost far less but deliver the most savings in the long-term,” he explained. “One of the greatest financial burdens on the NHS is managing chronic diseases such as diabetes, but many of these diseases can be prevented by early intervention from public health services.

“Health visitors are also vitally important,” he added. “It’s been proven that the first 1,000 days of a child’s life heavily influence their future health outcomes. And it’s disadvantaged communities which benefit most from these services.”

Health secretary Jeremy Hunt was caught out about cuts to public health this week, when he admitted to a Commons’ health committee that he “recognise[d] that we didn’t protect the entire health budget.”

The government has repeatedly said that it would increase NHS spending by a generous ÂŁ8bn, but vicious cuts to public health will mean the overall health budget will only increase in real terms by ÂŁ4.5bn over the next five years.

NHS England this week also highlighted the short-sightedness of relying on pay restraint to ensure efficiencies are met, noting that pay freezes were “not indefinitely repeatable”.

“As the economy returns to growth, NHS pay will need to stay broadly in line with private sector wages in order to recruit and retain frontline staff,” it said in its document outlining planned savings.

‘Ticking workforce time bomb’

Jarrett-Thorpe went further, saying that the pay freezes are fuelling a “ticking workforce time bomb”.

“This is extremely short-term thinking that’s already caused a major crisis in the NHS,” he said. “If you add in scrapping nursing bursaries, which will turn people off from the profession in droves, we’re looking at massive staff shortages that we simply cannot afford.”

The government is considering forcing nurses to take on up to ÂŁ50,000 in debt in order to train to enter the profession, a move which Unite has said will only further increase the already ballooning agency staff bill.

NHS England said in its document outlining savings that it was basing its projections on an assumed deficit of ÂŁ1.8bn for 2015/2016, but the deficit was in fact nearly ÂŁ1bn higher.

This, NHS England notes, is “in part a product of higher use of agency staff”.

“Therefore as part of plans we are assuming that the NHS can achieve at least a £1.2bn net reduction in agency staff expenditure.”

But Jarrett-Thorpe contends that merely “assuming” that the NHS can reduce agency staff expenditure is wishful thinking.

“The reason the agency staff bill is so high is because workforce planning has been so poor and the low pay and poor terms and conditions have made working in the NHS very undesirable –this hasn’t been addressed at all,” he said.

“Instead, they’re trying to control the cost of agency staff nurses by recruiting from abroad, but an overreliance on recruiting overseas labour is also in itself very costly,” he said. “They aren’t addressing the root of the problem.”

“There’s no doubt that the NHS is facing a funding crisis and efficiencies need to be made where they can be made without impacting on the service,” Jarret-Thorpe went on to say. “But you can’t do that on the back of a low-paid workforce, asking them to live on less but relentlessly do more; nor can you achieve savings by cutting the public health services that actually in the long-term reduce demand on the NHS.”

“Efficiencies are best achieved by collaboration,” he added. “For example by nurses, trade unions and employers working together to determine what their patients and staff need in order to deliver the best possible care.”

Unite head of health Barrie Brown said that the plan to achieve ÂŁ22bn in efficiency savings is fundamentally flawed.

“The one per cent pay freeze is unsustainable as NHS England itself acknowledges,” he said. “What’s more, the plan doesn’t take into account the current review of Agenda for Change, living wage costs and the difficulty facing trusts in both reducing agency costs while also being committed to seven-day services.

“Where are the staff for this when the NHS is already facing staffing problems without the commitment to seven-day services? It doesn’t make any sense.”

Brown fears that a relentless drive to achieve the planned savings will inevitably harm both patients and NHS staff most.

“The reality is that all NHS organisations have had to make huge savings over the past five years,” he said. “What is left for them to do to achieve these multi-billion pound savings without harming the level and quality of patient care and impacting on staff morale?”