These are extremely troubling times for our NHS. Across the country, waiting lists are on the rise once again, A&E departments are finding it difficult to cope, people are struggling to access GP services and morale within the profession is at an all-time low.
The creeping privatisation of our health service also continues unabated. The figures speak for themselves. Department of Health (DH) statistics show that the amount of its funding that has gone to “independent sector providers” more than doubled from £4.1bn in 2009-10 to £8.7bn in 2015-16. This is not a big-bang privatisation but rather a gradual, inexorable rise in the proportion of the NHS budget going to firms such as Virgin Care, Care UK and Bupa, with the private sector making ever bigger inroads into several key areas of NHS care, notably general practice, community services and mental health care.
Locally, concerns have been raised about Greenwich Clinical Commissioning Group’s (CCG) decision to award a contract for the provision of Muscular Skeletal Service to Circle Health, seemingly without adequate public consultation and with no impact assessment undertaken by either the CCG or NHS England. I’ve been working with other local MPs to raise questions about the tender, and I recently asked the Leader of the House of Commons for a debate on the adequacy of the procedures that Greenwich CCG followed in awarding the contact and of patient involvement in the commissioning process more generally.
Perhaps most worryingly, our NHS is facing the worst cash crisis in its history. Third quarter figures published by the Trust Development Authority earlier this year revealed that NHS Trusts are facing higher than forecast deficits. Our own Lewisham and Greenwich NHS Trust recorded a deficit of £38.4m in 2015/16 (reduced to £22.9m following a capital to revenue transfer of £15m). NHS trusts collectively finished last year with a record deficit of £2.45 billion. NHS providers and commissioners ended 2015/16 with a deficit of £1.85 billion – the largest aggregate deficit in NHS history.
In response, there has been a welcome recognition that the growing financial problems evident in different parts of the NHS cannot be addressed in isolation. Coupled with the emerging consensus that more integrated models of care are required to meet the changing needs of our ageing population, the result has been a discernible shift toward focusing on collaboration. This shift to “place-based planning” led to the recent announcement of Sustainability and Transformation Plans (STPs), five-year plans covering all areas of NHS spending in England across 44 geographical ‘footprints’ (South East London forming one of the 44). The South East London Sustainability and Transformation Plan (STP) has finally been published and can be found here.
STPs have generated a fair amount of alarm, and we used an Opposition Day debate on 14 September 2016 to raise concerns about the impact they might have. While I have serious concerns about STPs, it is also important to recognise that they were a real opportunity to reverse the damaging fragmentation ushered in by the 2012 Health and Social Care Act and to challenge the assumptions upon which that legislation was based, in particular that competition rather than collaboration could be used to improve performance.
However, there are real grounds to fear that the Government are approaching STPs in entirely the wrong way. If they are to work, STPs must be approached as a means of transforming care. STPs based on a realistic assessment of the services that are required in a given area to meet the evolving needs of its population, an appreciation of the time it will take to reduce reliance on hospitals and strengthen services in the community, and what and how long it will take to transform healthcare provision in any given footprint area would be of real benefit. Instead, it appears that STPs are being used simply as a means of balancing the books. It is striking that £1.8 million of the £2.1 billion earmarked for sustainability and transformation looks set to be used to pay off deficits, with only £300 million allocated for the purposes of trying change the way the system works.