Friday, 9 January 2015

Private providers not the answer to NHS problems

The doctor's organisation the British Medical Association says today that the government's  top-down reorganisation of the NHS was 'unwanted'. It also says that private provisions is not the answer to the problems of the NHS.  General practice the BMA says is struggling to keep pace with rising demands in the face of cuts in funding.

There is a tendency when the NHS is under strain to refer to an ageing population and the demands on the NHS. But this crisis is of the government's making.  If you cut resources it is going to have an impact on frontline services.  The Tory leadership promised there would be no 'top down' reorganisation of the NHS. They reneged on that and imposed a complex reorganisation which is causing problems. The coalition said that the NHS would be ring-fenced from the cuts. It has not been. Calling cuts efficient savings does not mean they are not cuts.  These cuts amount to  £20 billion over the five years of coalition government. You cannot take that out of the system and expect no consequences. Add on top of that the cost and problems or a major reorganisation, under funding of GP practices, and you have the recipe for the current crisis in A&E.  As the BMA rightly say problems at the hospital front for of the NHS are linked to shortages at the back door and in social care services that block beds and increase waiting lists.

What is unforgivable is that the government have been repeatedly warned over the last five years of the consequences of their policies and cuts.

Responding to the publication of weekly figures which show pressure on England's A&E departments is getting worse, Dr Mark Porter, BMA council chair, said:

 “Patients should be treated on the basis of need, rather than arbitrary targets, but these figures show an NHS under extraordinary pressure, trying to cope despite inadequate resources.

“What’s happening in Hinchingbrooke today shows that the responsibility of running a critical public service can never be handed over, and so the insistence on private providers as a potential solution to problems facing Hinchingbrooke was always misguided. It also shows that even private providers are not immune to the extreme financial pressures on NHS services, because of government underfunding.

“It’s important to remember that, while there may not be weekly performance figures for other parts of the system, what’s happening in our A&Es is reflective of, and linked to, wider pressures across the NHS.  You can’t address problems in A&E, without looking at the system as a whole.

“Problems at the hospital front door are often linked to delays at the back door. A shortage of social care beds creates ‘exit block’ in hospitals, meaning patients can’t be discharged because there is simply nowhere for them to go. This, coupled with a shortage of hospitals beds, leads to patients waiting for hours on trolleys or admitted to an inappropriate ward for their needs, affecting the quality of care they receive. This is just one example of pressure in one part of the system spilling over into other parts.

“Outside of hospitals, general practice is struggling to keep up with rising demand, carrying out 40m more consultations a year than in 2008. Investment in general practice is declining while demand is on the rise and more care is moved into the community - this simply isn’t sustainable.

“In the last week there have been lots of promises made and blame thrown around. What we need now is action. To address pressure on A&Es politicians need to look at the NHS as a whole. Investment needs to keep up with demand, every part of system - from our GP surgeries, to hospitals, to community care - needs to be supported and working well, and we must also address the acute shortage of A&E staff and GPs.

“We also need to reverse the harmful effects of Government's top down reorganisation without another NHS-wide restructure. These unwanted changes have made the delivery of joined-up care more difficult by valuing competition over integration of services, leading to care being fragmented at a time when the NHS needs to be delivering more joined up care, not less.”

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