Oxford Health Trust has written to all its employees to prepare them for changes after a review found that its finances posed a greater risk to its ability to continue to provide services in line with its Foundation Trust licence.
The trust, already one of the most efficient in the country, reported how it is treating 30% more people in Community Hospitals - a great boon to moving people on from general acute services. The trust reported improvements in patient safety, activity and outcomes of psychological therapies, plus extended services to cover evenings and weekends to support local health and social care work better.
The problem is that it has a forecast deficit of £4.2 million by April 2015. £1 million comes from work it isn’t being paid for and £1.7 million employing agency to fill gaps in staffing caused by poor retention and recruitment.
The trust also announced it is working on a new financial plan with a view to preventing formal action by Monitor, the regulatory body for Foundation Trusts. It will be looking at how it can get more out of it’s resources - reshaping services in the process. This raises the spectre of more disorientating organisational change, possible redundancies, and greater workloads for staff - driven by the need to make cuts rather than patient needs. Yet without a rise in wages, recruitment and retention are likely to remain significant problems, as will not being paid for all it’s activity - even if it does find new ways to deliver services with less cost.
Oxford Health is not unique in having these problems. Monitor reports that half of Foundation trusts, the best performing of all hospitals, have moved into deficit for the first time due to pressures on finances and workloads. The Guardian reports that across the whole NHS up to ¾ of NHS trusts are expected to be in deficit by March 2015 - to the tune of £1 billion - unless there is an urgent bail-out. England health Boss Simon Stevens has warned that the NHS needs funding to fill an £8 billion “black hole”. However the actual projected shortfall to 2020 is £30 billion. Stevens thinks £22 billion of this can be covered by “efficiency savings” and by reducing demand by getting people to look after themselves better - though one of the main increases in demand is an ageing population.
Yet a third of the efficiency savings since 2010 have come from attacks on wages - causing recruitment problems and driving up the bill for agency nurses. It should come as no surprise that further “efficiency savings” will comprise in part of further attacks on NHS pay.
The growing financial crisis in the NHS, increased waiting lists and waiting times, cancelled operations and delayed discharges, are putting pressure on all political parties to announce plans to solve the problem in order to win votes in the next general Election. At the same time the mass disaffection of NHS staff striking over pay has elevated the pressure to a whole new level.
It is in this context that the Chancellor George Osborne has grabbed the headlines with the announcement of a £2 billion “lifeline” for the NHS - though this falls far short of the £8 billion Simon Stevens is asking for. Labour has gone a little further, promising £2.5 billion. Neither amount will be enough to save the NHS. Health Secretary Jeremy Hunt has demanded the NHS “saves” £10 billion a year.
But there is a solution if the next government can be convinced it has no alternative but to adopt it. Efficiency savings based on stripping away the wasteful bureaucracy of the market would offer an alternative to squeezing staff and services harder. If it is combined with substantial additional funding based on getting the rich and big business to pay their fair share of tax towards public services this could solve the problems of providing decent healthcare for all.
All of us who care about the NHS have an opportunity in the run up to the election to pile on the pressure for the next government to cover the £30 billion shortfall and bring in proper efficiency savings by abolishing the hugely wasteful internal market. The pay strikes are a vital component in keeping up the pressure to bring these changes about. Mass disruption by healthworkers and their supporters can save the NHS from crisis.
We need to argue that more strikes are called and that support for the strikes is built stronger in the run up to the election.