Monday, 11 April 2011

The NHS budget is growing - so why are they sacking nurses?

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Nothing, absolutely nothing makes the case for NHS reform better than this piece of shroud-waving from the nurses' union, the RCN:

Last November the RCN identified 27,000 likely NHS job losses during the next three years – but has now raised the estimate to 40,000.

Based on 9,650 posts at risk across 21 NHS trusts, 54 per cent of looming job losses involve clinical staff such as doctors, nurses and midwives.

The proposed job cuts analysed were a mere ‘snapshot’ of Britain as a whole, the RCN said.
Its chief executive, Dr Peter Carter, said: ‘Cutting thousands of frontline doctors and nurses could have a catastrophic impact on patient safety. Our figures expose the myth that frontline staff and services are protected.’

This reduction comes at a time when (along with international aid, for some bizarre reason) health spending is the only part of government spending not facing budget cuts. Here are the figures for resource 'departmental expentiture limits' from 2010/11 to 2014/15 (i.e. the budget excluding capital spending):

2010/11    £98.7bn
2011/12    £101.5bn
2012/13    £104.0bn
2013/14    £106.9bn
2014/15    £109.8bn

So the effect of an increase in funding for health care is the sacking of 40,000 employees (a suspiciously round number, by the way, so probably nonsense), half of whom according to the RCN will be from the clinical and medical staff. Part of the problem may lie in inflation but most of it can't - the NHS is incompetent, wasteful, inefficient and poorly led at every level. And the reason for this is that the consumers of healthcare - that's us the population of the UK - cannot exercise that consumer power. The various health unions - RCN, BMA, RCP and others - direct their attention to government. These organisations have been enormously successful:

NHS expenditure on doctors has doubled in the past five years. In 1999 the NHS spent £3 billion on their pay, increasing to £6 billion in 2004. The pay rise has not been matched by any significant increases in productivity.

And this has continued:

The figures show that, in 2000, the mean earnings of a consultant were £71,900. But by 2009 this figure had risen to £120,900 – an average yearly increase of 5.9 per cent. In contrast, across the whole of the pubic sector salaries rose over the same period by 4.5 per cent. For the private sector the rise was 3.7 per cent.

Staffing accounts for around half the total NHS budget and about 70 per cent of hospital costs. The Office for National Statistics recently estimated that productivity across the NHS as a whole fell by 3.3 per cent between 1995 and 2008, an annual average decline of 0.3 per cent. This was partly due the huge influx of new money in the early 2000s.


It seems to me - and the evidence supports this contention - that huge increases in "investment" have not brought the intended improvements in healthcare. Not that the NHS is always bad - thankfully around 64% of people surveyed are "satisfied" or "very satisfied" with the service rising to 80% with GP services. But this still means that nearly four in ten people aren't satisfied with the NHS and one in five are less than pleased with their GP.

Reform is needed - not moving procurement responsiblity about within the NHS family but shifting power to the consumer, to the patient. The last government set in train a fundamental shift in social care for adults - moving commissioning from bureaucrats to users through what is called 'personalisation'. While medical interventions are different there is a great opportunity to apply this principle to healthcare. At the same time the process of giving institutions - hospitals, clinics and so on - independence need speeding up. The lessons from the academies programme in education - real improvements from granting schools greater local autonomy - need to be learned and we need to stop viewing the NHS as a single monolithic service provider.

But most of all, we have to kick the BMA, RCN and RCS out from any positions of influence - these are simply trades unions and have no interest in the public. As with all trade unions their job is to secure the best deal for their members - nothing else. The government and health management should deal with them on that basis.

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2 comments:

Phil said...

If you move procurement responsibility closer to the patient by say, off the top of my head, giving it to their GP, this would seem to me to represent shifting power closer to those who matter.

Polleetickle said...

Wow, you present the details very clearly and makes shocking reading.

The unhindered financial largesse of the last LAB GOV seems to have had no boundary. But continued consternation of many is now seeing their denials crumbling into overdue apologies.

I, however, need convincing about the need for patient choice which I regard as wasteful. When, essentially, what I regard as the priority is standardised availability of high level care. Especially when it appears that NHS cost to the taxpayer equates the fee's for private health treatment.