The NHS is now experiencing the worse financial squeeze in its history, facing on present trends, a shortfall of £20bn by 2020-21. We also now know that the money committed by the government for the NHS is less than was promised (and, of course, the ‘£350m a week for the NHS’ supposedly to be re-directed from our EU contributions post-Brexit was an outright untruth). NHS finances have been looked into in detail by the Parliamentary Health Select Committee, and I have copied details of their most recent findings at the bottom of this letter.
At my most recent meeting with our local hospital trust, Imperial. I learned that their 2016/7 deficit is projected to reach £52m, and in addition, they must find £54m in ‘Cost Improvements’. Our local Clinical Commissioning Groups are deemed to be ‘over-funded’ and will see their budgets fall by 10% over the funding period. Cuts to the community pharmacy budget could lead to many closing. At the same time, local councils, which have faced cuts of up to 50%, have been forced to slash spending on social care- the home and community based services which can help patients be safely be discharged from hospital or even prevent them from having to go in the first place. And all the while needs are rising, primarily, though not entirely, as our population ages.
As you may know, our health services are part of the North West London region, whose structure has been under consideration for some time as part of a process known as “Shaping a healthier future”. This strategic approach is intended to promote better integration of care and the reshaping of the health and social services to increase specialisms in some areas, and build up primary and community care outside hospital. This was the underlying philosophy of the Darzi review under the last Labour government, which envisaged a big expansion of diagnostic and treatment facilities at a more local level, and those ideas to some extent fed in to the ‘Shaping a Healthier Future’ plans we now have before us. There is much that is sound and sensible about the approach. The concentration of London’s stroke services into a smaller number of highly specialist units, for example, has definitely saved lives and led to better outcomes, whilst offering some services that currently need a trip to hospital in an expanded GP surgery is more convenient for patients. It is, in my view, important not to lose sight of this agenda- to accept that not all changes are bad, that the NHS needs to innovate, that funding will never be unlimited, and choices do have to be made.
Yet when these plans were first being drawn up, the financial situation was very different from what it is today. Now we know that necessary improvements have to be funded at a time of unprecedented financial pressure. ‘Shaping a Healthier Future’ for NW London (now effectively turning into our local Sustainability and Transformation Plan) envisaged the closure of a number of Accident and Emergency units even though demand is rising, and alternative community based services are not yet fully developed and tested. Meanwhile, the Better Care Fund, which is shifting some money from hospitals to the community, has also had to plug holes made by cuts in Westminster Council support for social care. We saw all this before, when long-stay hospitals closed in the 1980s without adequate ‘care in the community’ being available- the essence of a good idea undermined in practice. And even though we don’t (thankfully) face the prospect of losing our Accident and Emergency unit at St Mary’s, there are many other risks arising from a full blown financial crisis.
The NHS does need to continue to change- developments in treatment and changes in the population make that essential- but it will struggle massively without considerable extra investment, not only in acute/hospital services but in primary, community, social and mental health care services. We also need to ramp up measures to prevent illness and promote well-being- from tackling air pollution and obesity to better mental health interventions, and give urgent priority to reducing health inequalities. So it is particularly shocking that the public health budget has been raided to offset the funding crisis in the clinical sector, and that council services which play a valuable prevention role (youth, play, advice) have been reduced so dramatically and poverty and homelessness are rising again. The NHS has never existed in isolation from the wider social and economic context.
So I will continue to make the case and my colleagues and I will hold the present government to account- on funding, on the re-organisation, and on other policies impacting on health. Sadly, it is they who determine both funding and policies, but it is important that we expose their record and I am grateful for constituents willingness to join this campaign.