Most people value and depend on the NHS in the most fundamental way – to look after them when they are sick. Most people are also aware that the NHS is in crisis. Especially in York at the moment. But they are not clear why.
‘Defend our NHS York’ is a group of people who have been working to keep the NHS public for the last 7 years. In that time we have been able to form a clearer picture of what has been going on in the NHS, which we would like to share with the general public. We will link the overall picture to what’s going on in York now.
The NHS is complex. It has to be in order to do all that it does, for the whole population, ‘from cradle to grave’ whatever complex conditions we present it with.
It is one of the largest institutions in the world, covering the whole population, urban and rural, for both routine care, critical care and emergencies, carrying out research and amassing data, both activities of tremendous use in understanding human health needs and introducing new forms of health care. The NHS leads the world in this respect, because it is a comprehensive service available to everyone.
Of course, the NHS has always had problems. How could it be otherwise? But it has been able to deal with them and improve its service and our health care within the initial framework and maintaining its original public service ethic. Amazingly, it has managed to do this while continuing to be one of the cheapest and most efficient health organisations in the developed world.
The Conservatives, knowing all this and the significance of the NHS to most people, promised, before the 2010 election, that there would be ‘no top-down’ reorganisation of the NHS. The subsequent 2012 Health and Social Care Act then introduced the biggest changes ever imposed on the NHS. Despite Section 242 of this Act requiring consultation before any major changes we now find this is done badly if at all…
In 2016 we face another ‘top-down’ reorganisation of possibly even greater proportions – but without further legislation, as responsibility for the NHS was delegated to the head of NHS England in the H&SC ACT in 2012. The current head (Simon Stevens) was responsible for early privatisation developments during the Labour Government. He then worked in Private Health care in the USA.
The new development is known as ‘STP’ – ‘Sustainability and Transformation Plans’. Here in York it means joining a ‘Footprint’ called ‘Humber, Coast and Vale’ stretching from North Yorkshire to North Lincolnshire taking in Hull and Humberside en route. (The whole country is being split into 44 ‘Footprints’). Put simply, the aim is to ‘rationalise’ services and reduce hospital use by integrating health and social care. And make savings of £20 billion.
- Here in York, underfunding has been a longstanding problem, long before the Health & Social Care Act – so the Vale of York CCG (set up in 2012) inherited a deficit from its predecessor, the PCT (Primary Care Team). The Vale of York CCG was put into ‘Turnaround’ Measures earlier this year because of a £7million deficit – the result not of overspending, but of the funding cuts the government is making as part of its ‘austerity’ agenda – reducing public spending to balance the budget as a result of the costs of the banking crisis of 2008 – but bankers were the culprits not the public sector!
- Over the last year, the closure of Bootham Park Hospital has caused outrage. Public attention is at last being paid to the shocking underfunding of Mental Health Services (in a City that was a pioneer in this field).
- Another recent closure (of Archways) has caused further outrage. When so-called ‘bed-blocking’ in hospitals is a major concern, the removal of a rehabilitation centre to allow a staged return home for those who cannot cope alone immediately on discharge seems madness. The alleged savings will be eroded by expensive re-admission to hospital in many cases. Improved ‘back-up’ community services show no sign of happening, as Local Government cuts mean overstretched budgets. This issue highlights the problems of STPs and the need for better funding – not devising ways of reducing spending still further which will only cast more in the long term.
- The recent (and quickly reversed) announcement about withholding medical care from ‘the obese’ reflects Simon Stevens view in his Five Year Forward View (2014) that the NHS faces new and unnecessary demands as a result of new health problems ‘that are largely of our own making’ eg obesity. But when overweight and obesity are as widespread as they are, they cannot be seen as a ‘personal’ issue – there is a ‘public‘ issue here- the things people are being pressured to eat through advertising, marketing ploys etc. But the government made a decision recently not to control these activities. Clearly profits matter more than public health, even when they put more strain on health services.