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People’s inquiry into the NHS: stop cash-driven closures and attacks on services

From John Lister at Open Democracy OurNHS:

A duty of candour for NHS managers and ending cash-driven closures - those are amongst the recommendations of the People's Inquiry into London's NHS which raises serious concerns of creaking services in the capital. 

Cash-driven hospital ‘reconfigurations’ - so hotly contested across the capital - must stop, say a panel of experts conducting a ‘health check’ into London’s NHS. Instead they call for a London-wide needs assessment to match services to patterns of need across the capital.

The panel also calls for NHS managers to be placed under a duty of candour to stop them covering up for financial pressures and dishonestly claiming that changes are “clinically led”. If the money is not there to run a full range of appropriate services, NHS managers should say so openly, and put the focus back onto the politicians whose decisions on funding are to blame.

The recommendations are amongst 18 made by the innovative People’s Inquiry, which has been conducting a health check of London’s NHS after almost a year of the Health & Social Care Act. The Inquiry’s report London’s NHS at the Crossroads, published last week - reveals serious concerns.

Mental health is causing especially strong concern. Budgets nationally have been cut for the past two years, and the ‘tariff’ paid for treatment next year is facing the deepest cuts of all.

Severe shortages of acute mental health beds mean more patients being placed at high cost in private beds, often at long and awkward distances from their homes, friends and family, said Dr Martin Baggaley, medical director of South London & Maudsley Foundation Trust.

The report gives illustrations of the nonsense of a market in health care. Specialist forensic mental health beds have been commissioned at the notionally lower cost of beds in the private sector.

But the private sector is only cheaper because it is a low-skilled service, with a fee crudely calculated by the day. The lack of professional staff means that patients on average stay far longer – pushing up the actual cost per episode of treatment – and are more likely to reoffend and wind up back in treatment. So any apparent short-term saving is achieved only at the expense of higher real costs and a much poorer service.

In total 95 witnesses, ranging from Trust chief executives and the former chief executive of London’s Strategic Health Authority to individual patients, campaigners and health workers spoke to the Unite-sponsored Inquiry, contributing over 30 hours of evidence at seven public sessions, as well as written evidence. The panel was chaired by health commentator Roy Lilley and included Polly Toynbee, Professor Sue Richards of Keep Our NHS Public, Dr Louise Irvine of Save Lewisham Hospital, senior NHS manager Naledi Klein and trade unionist Frank Wood.

Common concerns included the absence of any strategic body with the scope to plan and organise services across the capital, the fragmentation of the NHS – which can only worsen as Clinical Commissioning Groups are compelled by the Act to put more and more services out to tender - and the massive and tightening financial squeeze on the NHS.

The new competitive health care market opened up by the Act is a problem, say commissioners, providers and the public. In many areas campaigners and the wider public complained of uncommunicative commissioners and desperate cost-cutting by providers which is undermining the quality of care.

Among the 18 recommendations from the Inquiry Panel there are calls for more transparency and accountability, the reversal of the Health & Social Care Act, and the repeal of the controversial “hospital closure clause”, which the Panel warn would simply institutionalise decision making without local consultation or local support from clinicians or the wider public.

Which brings us to the first and possibly most contentious of the recommendations: an end to George Osborne’s unprecedented and tightening squeeze on NHS finances, which has effectively frozen the budget in London and across the country, as demand and cost pressures increase.

Osborne’s plans, confirmed in the Budget, would continue the freeze on funding through to 2021, creating a £30 billion funding shortfall nationally, and a London shortfall of £4 billion.

After the four meanest-ever years for growth in NHS funding, and with many trusts and some CCGs already deep in financial trouble, this would spell disaster.

Deeper problems up to now have only been avoided by the generosity of funding in the years of Labour government.

The panel does not attempt to second-guess how any extra money should be raised for the NHS, but it is quite clear that the Tories and Lib Dems are committed to continuing cuts in public spending – and Labour so far appears to be headed in the same direction.

Let’s get real. Without a resumption of proper funding to the NHS, none of its problems are going to be resolved. And any government that crash-dives the NHS is likely to face the anger of voters. So for Labour it’s a no-brainer: sign up as the party that would once again rescue our NHS from a decade of Tory cuts, or face the consequences.

Unite has declared its commitment to campaigning for the Inquiry’s recommendations in the Labour Party and the wider trade union and labour movement. They could provide an important extra backbone to lend teeth to Labour’s latest policy document on health, and reinforce the campaign for health and social care to be integrated in the public sector.

The marketization and privatisation embodied in the Health & Social Care Act are undermining existing public sector providers, pushing up costs, fragmenting services and failing patients. Lansley’s Act has created an NHS that is unstable, inefficient and increasingly secretive and unaccountable. Services are only being kept going by the dedication of an increasingly weary and demoralised workforce facing non-stop cuts in real pay, relentless increases in workload, and bullying from desperate managers.

The People’s Inquiry offers a formula to address these questions. It’s tailored to the situation in London – but many of the issues addressed and proposals are also relevant to other parts of England.

Transcripts of the Inquiry’s seven hearings and many of the submitted documents can be viewed or downloaded at www.peoplesinquiry.org.

The Full report is also available, along with an Executive summary.

I hope campaigners will find them a useful resource and a weapon in the fight to save our NHS.

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