Helath Services

NHS Q&A: What caused the current crisis and what are the solutions?

RSN and RCCs have a long tradition of lobbying on rural health needs. It takes a while for cuts to fully track through in terms of their implications for rural places. This article offers the views of 5 experts on why A&E is in such a mess there is a common theme here. One particularly relevant for rural communities with a skewed aged demography. The article gives the following sound bites from 5 different experts on the cause of the problem:

1. Poor strategic decisions and budget cuts to care services have exacerbated pressures on emergency care.

2. Cuts in social care funding have contributed to delays in discharging patients back home in a timely way.

3. What’s happening in A&E reflects wider pressures across the NHS. Demand is so great that hospitals are now full all year around, meaning there is no spare capacity to deal with a seasonal spike in demand. This is compounded by the problem of ‘exit block’ where patients can’t be discharged because of a shortage of social care beds and community care.

4. But while we hear a lot about the crisis in our A&E departments, the explosion in demand for GPs is being overlooked or ignored. GPs and their teams are working harder than ever – there are 1.3 million GP consultations every day and GPs are seeing 120,000 more patients per day than we were five years ago. Yet as demand has risen, funding for GPs has fallen to an all-time low of just over 8 per cent of the NHS budget. We have a severe shortage of GPs and there are simply not enough to cope with growing demand.

5. The issues this winter are notwithstanding the £700m additional funding put in by the Government to help address pressures over the winter months. But where this money is being and has been spent is a key question – because GPs and emergency medicine doctors are reporting that it has not been reaching them effectively.

 

The funding timebomb that crippled an NHS healthcare trust

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Having worked for a long time in the local authority sector and been bemused by the whole PFI concept to me this story is about a time bomb that threatens to ultimately undermine many local authority services, especially in the school sector aswell as the health sector. Lets also not forget that local authorities are increasingly drawn into the health arena in terms of the development of their health and wealth-being responsibilities.

Have a good read of the way one deal underpinning this financially challenged trust has played out and then ask some pointed questions in your patch about the levels of risk and financial strain arising from your local PFI deals:

The Princess Royal hospital was one of the first hospitals to be born from the Private Finance Initiative (PFI) – the wheeze invented by John Major’s government to refurbish Britain’s dilapidated hospitals and schools while keeping the outlay off the Treasury’s current account in return for phased repayments to private investors over a period of several decades.

After the tender was put out in 1995 it was awarded by Tony Blair’s first government, which embraced PFI with gusto, in 1998. The winner was a consortium trading under the name of United Healthcare (Farnborough Hospital Ltd) consisting of Barclays Private Equity, developer Taylor Woodrow and Innisfree, a City investment fund with about 20 staff which has quietly become one of the country’s largest PFI players by backing projects to build 269 schools and 28 hospitals costing a total of £6.4bn.

David Metter, the 59-year-old founder and chief executive of Innisfree, is estimated to have made a personal fortune of about £60m from overseeing PFI investments on behalf of local authority pension funds.

There is nothing illegal in anything that these companies have done. But the rates of return on their investment are of an order that would make a pay-day loan company blush.

In return for their initial £118m outlay and the provision of services ranging from power to medical equipment, the consortia will receive payments of £1.2bn over 35 years. According the National Audit Office, the rate of return for the contractors is a handsome 70.6 per cent.