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Commentary: “The political response has been dismal”

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j5 (Published 03 January 2017) Cite this as: BMJ 2017;356:j5
Read all the articles in this series on the NHS in 2017

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Re: Commentary: “The political response has been dismal”

I greatly admire Dr Wollaston for having lost neither her grasp of the facts nor her moral compass. This puts her at some distance from her fellow Ministers and policymakers.
The Nicholson challenge created immediate austerity in the NHS, while funding has been stripped from all areas of the NHS using capital leverage; from GP funding streams, hospital Tariff penalties/deflation, PFI debts, £4.5bn cuts to social care, £5bn annually lost to maintain the NHS external market... The H&SC Act (which took seven years to write) has enshrined this direction of travel for the NHS.
Notwithstanding the inadequate £4.5bn uplift, even the fantasy £8bn or £10bn would still only have supported the Govt’s policy of defunding the NHS of a further £22bn while economic and health inflation outstrip almost static year on year funding until 2020.
Money promised for GP 5YFV and Better Care Fund is not new: it’s to be taken from hospital budgets and involves blackmail over GPs’ extended opening. Hospitals are clearly in no position to cede more funds if they are to continue to function and, like junior doctors, GPs cannot stretch any further.
The promised increased funding for general practice must be openly available to allow GPs to gather some of the ground lost under this govt’s continual reforms, not to be held to ransom for implementation of more “7-day NHS” nonsense. There are fewer WTE GPs in England now than in 2009. Before contemplating additional routine opening, an extra 4,500 WTE GPs are needed now just to bring us level to where we were in 2009, in proportion to population.
Even with a short term Govt plug in funding to prop up A+E performance, there is no salvation by implementing 5YFV STP ‘transformation’ plans, which are a travesty of shrink-to-fit solutions for a national £22bn deficit and a downscaled, downskilled NHS. Once expanded Community services have become a functioning and demonstrably effective reality, only then should any further cuts to hospital beds and services be considered. To proceed as is is reckless and dangerous.
With 60% of Hospital beds in England having been cut since 1987 – including 72% of mental health beds (approx. 90% of which cut by Tory govts) – we now have half the EU’s average number of beds per capita. England now has proportionately fewer doctors and nurses than in 2009, and virtually the lowest per capita health spend of any developed country. Patients will be endangered by cutting yet more hospital beds and qualified staff, with proposed backfilling by ‘assistants’, self-care apps and remote IT.
If the Govt simply chose to raise NHS funding to the EU average, this would mean more than £20bn for the NHS now. Is that a big ask for the “sixth richest economy in the world”? The Govt’s desire to micro-manage the NHS into the ground whilst using smoke and mirrors to abrogate their responsibility for the devastating consequences is akin to corporate manslaughter.
It is diminished capacity rather than any true surge in demand which has fuelled this crisis.
Privatisation of social care has clearly failed; privatisation, competition and fragmentation of the NHS has resulted in the NHS sliding from solvency to bankruptcy in just four years. Which health system in the world could sustain £40bn taken from its operational funding while simultaneously being forced to undergo such massive and costly reforms? And what are we left with, when all the ludicrously over-ambitious reductions in urgent and secondary care activity promised by a swathe of DIY STPs prove to be ill-judged wishful thinking, implemented without proper expertise, evidence, detail or consultation?

Competing interests: No competing interests

14 January 2017
Nick Mann
GP & NHS Osteopath
Well St Surgery (building now owned by Assura, estates arm of VirginCare)