Fully Fund Our NHS. Photo: PA
11 ways Cameron’s cuts are hurting the NHS – #FullyFundOurNHS
David Cameron claims to have protected NHS spending. But this has failed to keep pace with growing demand, or even with inflation. Funding per head of population has actually fallen in real terms since 2010.
Public funding of health as a proportion of GDP is on a downward curve. By 2008, the UK was in line with leading EU nations, we are now falling significantly behind. The recent OECD report on international health care, showed that UK spending was now significantly below the average for leading world economies.
These cuts have led to a growing financial crisis in the NHS which is having an adverse impact on patient care, despite the best efforts of fantastic NHS staff.
Here are 11 ways in which Cameron’s funding squeeze is hitting your services:
1. A & E queues are growing
Just over 2% of patients waited over 4 hours for treatment in A&E in early 2010. Today, this number has risen to around 6%. In January of this year, A&E performance reached its worst level on record, with ambulances frequently queueing over 30 minutes and record numbers of patients waiting for hours on trolleys. Emergency staff are struggling to cope with the demand as the government fails to tackle the crisis in recruitment and retention.
2. Fewer older people get the social care they need
Between 2009/10 and 2013/14, adult social care received a real terms funding cut of 9%. This has led to a fall of more than 25% in the numbers of people aged over 65 receiving community-based, residential and nursing care services. That’s 400,000 fewer older people getting the paid-for care that they need and forced to turn to over-stretched NHS services instead.
3. District nurse numbers are tumbling
District nurses play a crucial role in delivery health care in the community. They help give chemotherapy to cancer patients in their homes, administer insulin for diabetics, give relief to those in their dying days and help keep people out of hospital. This role is even more crucial given our ageing population and the pressure in our hospitals.
Yet numbers are tumbling. Since 2010, we have seen a 28% reduction in the number of district nurses. The Royal College of Nursing fears that district nurses will be all but wiped out by the next decade if things don’t change. And earlier this year, the government announced a further cut of £200m to local government public health budgets, taking more money away from both local authority and NHS providers in the process.
4. Cancer treatment targets are being missed
Cancer waiting time standards, introduced under previous governments, were one of the more popular targets introduced to the NHS and helped to underpin a decade of improved waiting times for cancer treatment from the early 2000s. However, things are now going in the wrong direction. Since 2006, patients have expected to be treated within 62 days of an urgent cancer referral from their GP. NHS providers are expected to meet this target for 85% of patients. The figure has dropped from 86.7% in April 2010 to 82.5% this summer, with the NHS missing the target for six consecutive quarters now.
5. Mental health capacity is falling whilst referrals increase
Mental health has for far too long been a Cinderella service within the NHS family. And there’s evidence to suggest that, despite government assurances, funding actually decreased for mental health services last year. There is a crisis of in-patient provision in mental health, with dangerously high bed occupancy rates and a lack of capacity, with scandalously high numbers of mental health patients being held in police cells as a result.
Since 2009 there has been a 12% reduction in the number of beds available to mental health patients, the Royal College of Psychiatrists said that on one day in 2014 there were no beds available at all in England. ‘Out of area placements’ rose 23% last year with patients facing journeys of up to 370 miles for beds. Alongside the reduction in in-patient care, there has been a reduction in community based services, while referrals have increased.
6. A million more people on waiting lists
There are almost a million more people on referral to treatment waiting lists since, increasing from 2.57m patients in May 2010 to 3.52m today. By contrast, investment in the NHS from 2000-2010 cut waiting lists and reduced waiting times to a maximum of 18 weeks.
7. Shortage of trained nurses means soaring agency staff costs
Cuts to training budgets in 2010/11 and 2011/12 have left us with nursing shortages that have led to a massive increase in the costs of agency and bank staff, with the NHS now spending over £3bn a year on temporary staff. In their annual staffing level survey released in February this year, UNISON highlight some alarming figures on the current state of nursing and the impact on patient care. Of the 5,100 nurses responding to the survey 45% felt there were not adequate staff numbers to deliver safe, dignified, compassionate care, 42% were caring for eight or more patients – the point at which research indicates that harm is occurring, 49% reported not having an adequate amount of time with each patient and 65% reported that there was care left undone due to understaffing.
However despite the recommendations of the Francis report, work by NICE on developing guidelines on safe staffing has been stopped. The thousands of students who had their training places cut in those first two years of the last government would now be newly qualified nurses in wards around the country.
8. Midwife shortages are forcing maternity units to close
Over two-fifths of maternity units had to close temporarily during the last year because they couldn’t cope with the demand – up from around 33% in 2014 to 41.5% in 2015. The number of closures is a reflection of the rising demands on services from increasingly complex births and staffing levels. On staffing levels, around 30% of Heads of Midwifery (HoMs) surveyed in 2015 – said that they simply did not have enough midwives. The shortage of midwives in England remains critical with the country still short of 2600 full-time midwives.
Services are also being reduced as inadequate funding and staffing shortages bite. One in ten HoMs reported that they had to reduce services in the last year, including specialist midwives, fewer parent classes and less bereavement and breast feeding support. And because community-based staff are being pulled in to cover maternity wards, up to a third of home births were affected last year.
9. Most hospital trusts are in financial deficit
One of the most obvious indicators of the financial crisis in the NHS is the state of trust finances. Survey of finance directors suggest that around 66% of all trusts will be in deficit by the end of this financial year, a figure that grows to 89% for hospitals. Back in 2010, this figure stood at around 5%. In five years, NHS trusts and foundation trusts have gone from a £600m surplus to a deficit touching £1bn. One reason for this is the massive reduction in tariffs, prices paid to hospitals for treatments that have gone down by an average of 10% in the last 5 years – with even bigger cuts for many treatments.
10. GP workload is forcing more to leave the profession
While demand on GPs is increasing from communities with increasingly large cohorts of older people and those with complex on-going conditions, the proportion of family doctors per head of population has dropped. Training and recruitment numbers are falling far short of what is required.
No wonder that GPs are increasingly over-worked, with increasing numbers of GPs planning to retire and trainees planning to work abroad. More than 90% of GPs say that their heavy workload has had a negative impact on the quality of patient services.
11. Ambulance response times are missing targets
The demand for ambulance services has been rising by more than 5% for many years. In 2014-15 the number of calls to ambulance switchboards was 9 million, a 6% increase on the year before. It is widely acknowledged that there are insufficient numbers of paramedics, with training budgets cut between 2012 and 2014.
Although numbers of paramedic posts have risen there are a large number of unfilled vacant posts and paramedics report massive increases in workload and stress due to staff shortages. This is affecting performance, the average response time was below target for the most serious cases (Category A) throughout 2014 and the first quarter of 2015, reaching a new low over the winter period.
We need a new funding settlement for the NHS.
On November 25, the Chancellor will set out spending plans for public services over the next 5 years. We need a proper settlement for our health and social care system. We are calling on George Osborne to:
- Provide emergency funding over and above what has already been promised to deal with the current, short-term funding crisis
- Front-load the £8bn promised in the budget in the next two years to avoid further service cuts and staffing shortages
- Establish proper, sustainable funding for local authorities providing and commissioning adult social care
- Ensure parity of funding for mental health
- Commit the UK government to increase spending on health and social care as a proportion of GDP that is line with leading EU nations like France and the Netherlands.