Tag Archives: simon stevens

5 Things You Should Know About STP

The Sustainability and Transformation Plans have divided the NHS in England into 44 local areas, and each has been told to cut services as part of a nationwide ‘financial reset’. But what’s actually going on, and how much of the government’s reasoning is just spin? NHSpace brings you a handy myth-busting guide.

1 – NHS Trusts aren’t overspending

The narrative of STPs is that our hospitals are in debt due to overspending. That would be true if the government had matched the NHS budget to the actual healthcare needs of our country, but they haven’t.

The cost of healthcare increases by 4% each year. In the UK, this is referred to as ‘NHS inflation’. If NHS funding doesn’t keep pace with this inflation, then services have to be cut or closed.

David Nicholson and Simon Stevens have both used their time as NHS England CEO to implement austerity measures, leading to a cumulative shortfall in funding of at least £35bn per year by 2020:

Year Increase Needed Actual Increase Shortfall
2010-2015  £20bn  £7bn  £13bn
2015-2020  £30bn  £8bn  £22bn
Total (2010-2020)  £50bn  £15bn  £35bn

The NHS is underfunded, and is actually spending less than it should on healthcare. That’s quite the opposite of an ‘overspend’!

2 – The NHS isn’t unaffordable

Pundits love to tell us about the new challenges facing the NHS, claiming that we now cannot afford universal healthcare. We are told that hospitals are overspending and that they are in debt.

In fact, the NHS is extremely affordable. Here’s a list of healthcare spending in several westernised countries in 2014:

Country Per person ($) % of GDP
Belgium 4,884 10.6
Canada 5,291 10.4
France 4,959 11.5
Germany 5,410 11.3
Holland 5,693 10.9
United Kingdom 3,935 9.1
USA 9,402 17.1

As the table shows, the UK could easily choose to dedicate an extra percent of its GDP to healthcare, providing the NHS with the funds needed to sustain a modern health service.

3 – Hospitals aren’t overstaffed

The ‘financial reset’ planned for the NHS includes a limit on staff recruitment, the implication being that hospitals need to cut back on excessive hiring of permanent staff. Considering the billions spent on hiring agency staff to fill rota gaps, this is certainly not true.

The underlying issue here is safety. Following the Francis Report into the Mid Staffs scandal, hospital managers decided that they would rather exceed their budgets and hire more staff, than be guilty of manslaughter. Fed up with being ignored, the DoH is now coming down on managers with an iron fist. Anyone caught protecting staffing levels by overspending will be subject to a ‘failure regime’.

4 – This Isn’t About Centralisation 

Centralisation of specialised services can improve outcomes for patients with specific illnesses. But trauma, cardiac and stroke services have already become centralised. For many other illnesses, and for maternity and step-down care, it’s important to have smaller District General Hospitals (DGHs) and Community Hospitals. These provide care closer to home and take the pressure off the big, specialised centres.

So don’t be fooled. Closing A&Es and taking services away from local hospitals isn’t centralisation. It’s un-evidenced vandalism in the name of cost savings.

5 – This Is About Creating A Two Tier System

The level of cuts and closures required by the STPs is such that the NHS will become unable to provide a universal service. Rationing will increase, so that most routine procedures will be refused funding. Once various DGHs have closed, the hospitals still standing will struggle with their increased catchment areas and will be forced to provide essentials only.

This was already envisaged by Simon Stevens, who is keen to separate emergency care from routine care. Emergencies will be handled in NHS hospitals, whilst the routine work will be handled by the private sector. Patients wishing to undergo non-essential procedures will find themselves needing to pay to have their cataracts and hernias treated or their tonsils removed.

Bye Bye, Heidi

NHSpace reflects on the sudden departure of the Labour shadow health secretary.

To be honest, we were hoping this day would come. Meetings involving Heidi Alexander have all ended in disappointment. The shadow health secretary persisted in supporting Simon Stevens and his privatising Five Year Forward View. She was a damp squib when it came to the doctors’ strikes, and she did nothing to support the NHS Reinstatement Bill.

As one NHA executive member puts it:

“I have been in 2 meetings with HA. She refused to go on [junior doctor] picket lines. She refused to even wear a BMA badge. Her stance on health policy supported the ongoing privatisation in the form of Stevens 5YFV. Quote ‘I believe Stevens has the best interests of the NHS at heart’. A former UnitedHealth president here to complete the transition to an American style insurance system has her confidence. That says it all.”

Now that the Blairites liked Heidi Alexander are leaving Corbyn’s cabinet, there’s hope that JC will install someone who truly supports the NHS as his shadow health sec. Someone who will come out strongly in favour of a renationalised NHS, and recognise that things don’t have to be the way that Hunt and Stevens want them to be.

The STP hospital closure plans are already being rolled out, and it won’t be long before A&Es and DGHs start being forced to close in order to pay off local NHS ‘debts’. Labour need to start shouting from the rooftops about these sorts of healthcare issues. With the right MPs in charge, maybe they will.

NHS England and the £30bn Funding Gap

Simon Stevens (pictured) of NHS England will shortly be unveiling an NHS roadmap of sorts for the next parliament. Looming large is the matter of the claimed £30bn funding gap, an artefact of the Tory policy to stagnate NHS funding rather than commit to real-terms growth. As you’ll recall, the coalition government already subjected the NHS to £10bn worth of ‘efficiency savings’, the majority of which came from pay freezes and cuts to staffing and acute beds.

As Dr Clive Peedell puts it:

[Stevens] must make the point that flat funding of the NHS is a policy mistake […] per capita spend on the NHS has fallen under the coalition. Efficiency savings are effectively cuts and they have gone too far. Patient care and patient safety is at risk. The NHS clearly needs more investment and it needs to be at least a 4% increase year on year. This could be funded by addressing the […] internal market, that is estimated to cost the NHS at least £5bn per year.

We know from economic studies that an increase in healthcare funding would have a multiplier effect on the economy. That’s to say that for every extra pound put into the NHS, we’d see the overall economy benefit by several pounds. That’s because healthy people are productive people – investing in preventative measures and treating patients in a timely manner will help our economy recover. With the NHS currently one of the cheapest healthcare systems in the western world, we can clearly afford to fund it properly; in fact, with the benefits to people and to the economy so clear, we can hardly afford not to fund the NHS properly.

EDIT: Here’s further reaction from Clive Peedell to Simon Stevens’ report:

Stevens is a long way from securing the £8 billion extra by 2020 that he admits is needed to make ends meet even after extraordinarily ambitious efficiency savings of £22 billion.

None of the three main political parties is committed to raise NHS spending by anything like as much as £8 billion: the Tories are sticking rigidly to their planned further five-year freeze to 2021, the Lib Dems have offered two related injections of £1 billion from 2017, and Labour has promised £2.5 billion also in 2017 – by which point the financial crisis already brewing in the NHS will be boiling over into cuts and closures.