An investigation has discovered that NHS bosses have gone to lengths in order to keep proposed cuts secret.
The NHS hierarchy has recently been conducting a review of services throughout the healthcare system.
This process may ultimately involve some A&E departments being closed, with the future of some hospitals also reportedly under threat.
But the full details of this review process are yet to emerge, with NHS England apparently having requested managers to ensure that the plans are kept “out of the public domain”.
This shocking assertion has been made by the authoritative King’s Fund, with managers even provided information on how to reject freedom of information requests, according to reports.
Leaks and plans published include a proposal for south west London to close one of five hospitals, either St George’s, Kingston, Croydon, St Helier or Epsom.
Meanwhile, there is a proposal to centralise specialist services on two sites in North Tees.
Services would be downgraded as a result of this decision, according to the King’s Fund.
A spokesman for NHS England said that by the end of this week, plans for at least half of the reviews would be published – and the intention had always been to consult on the final plans if major changes were going to be made.
“I am sure there are things that could be learnt about the process. But when you are trying to improve care across a whole system, things are never going to be straightforward,” added Prof Sir Bruce Keogh, NHS England’s medical director.
But there will be great concern about the covert nature of the plans, and the potential impact on NHS services.
For example, healthcare bosses in Devon are assessing the closure of A&E, maternity and stroke services.
Merseyside, Central London, and Birmingham and Solihull may also be impacted by the mooted cuts.
However, there has been strong condemnation of the attitude of the NHS hierarchy and the decisions that are apparently looming.
Councillor Izzi Seccombe, of the Local Government Association, which represents councils, suggested the stance was a sham – as the public would in effect be consulted on “pre-determined solutions”.
And Jeremy Taylor, of National Voices, which represents patients, said: “Developing plans behind closed doors, and presenting near-final proposals, does not count as meaningful involvement.”
But the King’s Fund did suggest that centralisation plans had the potential to improve patient care, if implemented thoughtfully.
And it it almost inevitable that such decisions will be made, with the government pushing for over £20 billion of efficiency savings in the coming years.
Hospitals are being instructed to cut staffing levels significantly as the NHS grapples with a growing funding crisis.
The decision made by NHS regulators will leave critical healthcare professionals such as nurses and other frontline medical workers facing unemployment.
NHS regulators have taken the controversial decision despite intense concern among hospital bosses and health unions that reducing staff will hit quality of care, patient safety and staff morale, while increasing waiting times.
Yet Monitor and the NHS Trust Development Authority (TDA) have nonetheless issued the instruction to reduce staffing levels, despite ministers having previously ordered hospitals to do the opposite just three years ago.
Aside from the financial issues, many workers at the coalface in the NHS will wonder how such a policy can be carried out, while also delivering the seven-day culture of which David Cameron has spoken.
With some NHS trusts slipping well into deficit, the new policy rubber stamped by monitor could lead to massive redundancies.
For example, Addenbrooke’s hospital in Cambridge has been losing £1.2m a week during 2015-16 and could end the year £60m in deficit.
To put this into perspective, axing 25 nurses would save around £1 million pounds annually.
But despite criticism, it is evident that the regulators have moved in order to address the spiralling deficits of the NHS, which are projected to be over £2 billion by the end of the fiscal year.
Some of the hospital trusts that are most in the red have been told to use “headcount reduction” to reduce their deficit for 2015-16.
This procedural demand is specifically stated in a letter submitted by Monitor and the TDA to each of the 241 NHS trusts that are supervised by the two regulators.
The letter in question informed trusts that they should be dramatically reducing their financial distress in order to receive money from a £1.8 billion bailout which will become available in April.
It is hoped that this diversion of funding will enable the NHS to stabilise its financial position, while efficiency savings kick in over the next 12 months.
The letter, signed by the TDA deputy chief executive, Bob Alexander, and his Monitor counterpart, Stephen Hay, comments that numerous actions are being considered by the NHS, including enforced redundancies.
“We will be meeting a number of challenged providers this month to agree a set of actions, including headcount reduction, additional to the current plan, with the clear intention of improving the financial position of those individual providers.”
Richard Murray, the King’s Fund’s director of policy, immediately indicated his belief that patients would fundamentally suffer from this decision.
“If trusts do begin to reduce headcount the impact on patients would be swift, through either rising waiting times or reduced quality of care or both. Three years on from Robert Francis’s report into Mid Staffs, which emphasises that safe staffing was the key to maintaining quality of care, the financial meltdown in the NHS now means that the policy is being abandoned for hospitals that have run out of money.”
While Labour’s Heidi Alexander, was equally critical. “At the last election, the Tories promised to ensure hospitals had enough staff to meet patient demand. However, less than a year later they’re asking hospitals to draw up plans to reduce staff numbers.”
A Department of Health spokesman defended the plans, and emphasised that the regulators would ensure that staffing levels remain sufficient to deliver outstanding care to patients.
“We expect all parts of the NHS to have safe staffing levels – making sure they have the right staff, in the right place, at the right time.”
The spokesman indicated that the NHS now employed 6,100 fewer managers and almost 30,000 more clinical staff than in 2010.
The GMB union has indicated its opposition to significant cuts in services at Barnsley Hospital.
Members of the union are said to be extremely concerned about the potential risk to patient safety.
And the hierarchy of the GMB union has issued a statement indicating their view that it is “only a matter of time before there is a serious incident”.
The cuts in question are effectively worth £3.5 million of services at the South Yorkshire hospital.
In particular, services related to women and strokes have been targeted.
With Barnsley Hospital attempting to fulfil the decision made by the NHS regulator, the organisational structure of the hospital is currently assessing the possibility of reducing bed numbers.
This has resulted in the Stroke Ward facing a bed reduction from 20 to 14, with the GMB union warning that patients will have less opportunity to gain access to specialists as a result.
Meanwhile, the Gynaecology Ward will go from a seven-day to five-day service, also with a reduced bed capacity from 20 to 14.
Consequently, potential issues such as ectopic pregnancy, miscarriage and emergency surgery on a weekend will be dealt with by general nurses and not a specialised nursing team.
Pregnancy services and a specialised surgical ward are also affected by the multi-million pounds cuts.
Barnsley Hospital has suffered since financial irregularities were discovered by the regulator Monitor last year.
Monitor has already instructed the hospital to disregard the maximum patient waiting time of four hours for accident and emergency, with other cost-saving targets to be employed instead.
Currently on the cuts, Martin Jackson, GMB Branch Secretary and Staff Nurse at Barnsley Hospital, expressed his concern about the level of care in the hospital declining as a result.
“Members are extremely concerned about the risks to patient’s safety and fear it is only a matter of time before there is a serious incident.”
Jackson also suggested that the cuts were indicative of the lack of realism in the government’s highly publicised seven-day NHS plans.
“So much for the Tory claim to be making the NHS a seven day per week service. Staff are under immense pressure to deliver high quality patient care but are at breaking point. To make matters worse GMB representatives are being denied proper consultation with hospital management to address patient care concerns. Senior NHS managers keep informing GMB that the quality of care is their first priority while their actions speak of the reverse.”
Stacey Booth, GMB Lead Officer for the NHS, suggested that there had been a lack of transparency in this process.
“There has been minimal consultation about the proposals. Hospital management is making changes at a time when the Trust is under severe pressure. The hospital is already stretched and has introduced an Escalation Ward to deal with the high turn-over of patients, but the ward doesn’t have a dedicated medical team and this is leading to a lack of consistency in patient care. Lives are being put at risk,” Booth commented.
GMP is opposing the cuts, and could choose to ballot its members on industrial action in the foreseeable future.
GMB, the union for care home staff, has supported a warning from Britain’s biggest providers of care homes for the elderly that cuts to public funding for residents are potentially damaging and homes will close if the situation does not improve.
The warning that the system is in crisis comes from Four Seasons, Bupa and HC-One – the three largest operators in the UK’s £24bn care home market – and has been made amid growing concerns about health and social care funding ahead of the general election in May.
According to data compiled by Age UK (the UK’s largest charity for older people) the Government cut its spending on care homes for the elderly by nearly a fifth between 2010 and 2014.
Chai Patel, chairman of HC-One, said the cuts “risked damaging our health and social care system irreparably.”
However, the Department of Health has said it had taken steps to protect social care services by giving an extra £1.1bn to councils.
“GMB support the warning from the three operators that the system is in crisis”, said Justin Bowden, GMB national officer for social care. The repeated warnings from GMB that Southern Cross would collapse were ignored again and again by government.
“Warnings that the entire care sector is in a slow motion collapse, albeit for different reasons to Southern Cross, are falling on the same deaf ears. If we are not prepared to learn the lessons of history, we are destined to repeat them.”
It is expected that demand for care home places will increase over the next 50 years, with the number of over-65s forecast to rise from 10.6m in 2010 to 16.1m in 2035.