Theresa May’s launch of the NHS Long Term Plan this morning should fool no-one in Liverpool. Despite the mild weather, the Royal Liverpool has been on Red Alert at least 25 times since 1 December. Bed occupancy is 92.3%, against a safe level of 85%. In December, 495 ambulances waited over 30 minutes to discharge their patients, and 135 of these waited over 60 minutes. Last week, some patients waited over 3 hours to be seen in A&E, and some in A&E waited 24 hours for a hospital bed.
Why? The half-built Carillion PFI hospital was designed with fewer beds and capacity at the Royal was cut to match the plans. The Trust justified the cuts, claiming that Care in the Community would reduce demand. May’s plan, written by NHS England Chief Exec Simon Stevens, will replicate this all over England, shifting resources out of hospital, promoting digital technology and telling patients to look after themselves.
Last winter, former Health Secretary Jeremy Hunt suddenly postponed all elective (planned) operations to ease the pressure on hospitals. Now, an NHS England document “Preparing for 2019/20 Operational Planning and Contracting” intends to ensure that “as much of” [sic] “inpatient elective activity occurs in the first half of the year, before winter”. The document also includes a rationing plan for 17 NHS treatments no longer to be commissioned by CCGs. Trusts are also urged to “grow their external (non-NHS) income” and “work towards securing the benchmarked potential for commercial income growth.” They must set up systems to raise money by charging patients for treatment (“overseas visitor cost recovery”) – a policy recently denounced by several medical Royal Colleges because of its impact on individual and public health.
Long Term Agenda
The 44 discredited Sustainability and Transformation Plans, re-branded as Integrated Care Systems, will hold the regional budgets to control NHS Trusts. “Planning assumptions” in each STP area are to be agreed by 14 January. Neither the STPs, nor the ICSs, nor the Long Term Plan has been mandated by an Act of Parliament, let alone by patients or healthworkers. The private sector could gain control of individual ICSs through long term contracts to manage the entire health system within one region.
Real integration of health and social care can only take place when the profit motive is taken out, with care fully staffed and resourced, publicly accountable, funded through general taxation, and provided free at the point of need.