Undermining the NHS:the impact of the government’s cuts

Rachael MaskellHead of Health

Unite

The NHS

5 July, 1948

“not only is it available to the whole population freely, but it is intended … to generalise the best health advice and treatment”

Aneurin Bevin, 1946

Cuts in the NHS to date

1949 – Prescription Charges (in place in 1951)

1974 – Introduction of Regional and Area Health Authorities

1982 – Area Health Authorities abolished and Districts re-organised

1983 – Start of competitive tendering for ancillary services

1989 – White paper – Working for Patients (NHS reforms) – proposes purchaser/provider split in the NHS, GP fundholders and a state-financed internal market. Also an efficiency drive

1990 – Market introduced with new Act1991 – Health of the Nation, white paper –

the patient is a customer1994 – Regional Health Authorities abolished

with reorganisation

1996 – 3 new white papers, Choice and Opportunity, Delivering the future, The NHS: a service with ambitions

1997 – The new NHS: Modern, dependable2000 – The NHS Plan (10yrs) then 2001 Act2001 – Star ratings2002 – Reorganisation – District Health

Authorities replaced by Strategic Health Authorities

2003 – Another reorganisation2004 – Foundation Trusts created and

another white paper – Choosing Health2005 – Commissioning a patient led NHS2006 – Reorganisation and cut in number of

SHAs and Trusts2006 – White paper – Our health, our care,

our say. This was to oversee the expansion of the market in providing services in the NHS

2010 GENERAL ELECTION

Coalition Plans

There will me no top down reorganisation of the NHS

Liberating the NHS?

2010 – White paper (July)

2011 – Health and Social Care Bill (Jan)

‘The Pause’ (Future Forum)

Passage through parliament

Professionals, Patients, Public – against

2012 – The Health and Social Care Act 2012

2013 – Mass reorganisation of the NHS

Some services in meltdown

The new NHS

The Health and Social Care Act

£3bn to reorganise the NHS 175 bodies now expanded to 400 Public health moved to local authorities CSUs not GPs in charge of the system

– Vested interests

Private Patient Income Cap of 49% Any Qualified Provider Fragmentation and constant change Current structures will implode Change in role of Secretary of State

££££ Money ££££

PFI debt Efficiency cuts (savings) Foundation Trust additional savings £20bn Nicholson Challenge, more to come Cost of internal market £20m under last government –

these costs will escalate More demands on the service, with increasing

longevity Collapse of other support services previously supplied

by Local Authorities and charities

The NHS staff

Pay – freeze and capDownbandingPensionsOn CallNRRPPerformance payRemoval of unsocial hours whilst

sickSpot SalariesRemove accelerated progression

1/3rd

cut

Impact on staff

Blamed for being uncaring and cruising

NHS staff survey – 38% work related stressLow moraleWould not recommend job Exhaustion – working unpaid overtime – some

average 8 hours / weekImpact on other wellbeing issues

Impact on services & patients

THE SERVICEReorganisationFragmentationRecord keeping and

continuityInstabilityFinancial considerations

put firstPrioritisation

THE PATIENTPatient choice??Postcode lotteryIncreased risk for patientsTop up paymentsConfusionEmergency care

When you bring this together

Too many conflicting agendas,

too many vested interests, too many people who have control EXCEPT professionals and

patients

At a cross roads

Full insurance-based health system delivered by a range of providers. Postcode lottery and range of entitlements. Assessment on ability to pay

Restore the NHS – publicly provided, publicly delivered, publicly accountable – free at the point of need for all where patients and professionals are at the heart of the service

Change needed for staff

The NHS

When you are sick you need the NHS, now the NHS is sick the NHS needs you

Unite

“The NHS will survive as long as there are folk with the faith to fight for it.”

Bevan

Questions

Rachael MaskellHead of HealthUnite@RachaelMaskellRachael.Maskell@unitetheunion.org0203 371 2009