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.
NHS hospitals will postpone thousands of operations and appointments in an attempt to ensure that the health service continues to function through the winter months.
Government plans have already been initiated which will see contingency measures put in place to safeguard emergency care.
Details have already been provided to the Commons Health Select Committee, with concerns that the NHS will suffer even more serious bed-blocking in the winter months than previously experienced.
Each hospital trust will be tasked with creating its own specific plans to cope with the winter workload, with the new concept of Accident and Emergency delivery boards to be set up in the next couple of weeks.
Evidence provided by the Royal College of Nursing suggests that hospitals are already buckling under the strain of rising demand, and in the busiest health service period it is obvious that this will worsen still.
The Royal College of Emergency Medicine believes that both numbers of doctors and beds are falling far short of what is required.
Dr Cliff Mann, RCEM president, commented that an extreme set of circumstances could render the NHS impotent this winter.
“What is really worrying is that when you look at last winter, the NHS came under very heavy pressures despite mild weather and little flu. All it would take is a bad flu outbreak this winter and we would be poleaxed.”
David Behan, chief executive of the Care Quality Commission, opined at a recent board meeting that he would rather see waiting times increased as opposed to witnessing an overall slump in care quality.
However he said the public “and politicians in particular” place a high value on the waiting targets.
Mr Behan told colleagues that “it would be silly to deny that care quality could be at risk due to the current financial constraints, with a record £2.45bn deficit declared last year. I see the evidence of waiting times increasing, times in A&E increasing, where people are trying to hold on to quality and doing their best to balance money. If I was trying to run a trust at the minute I think that is the balance I would be trying to strike.”
An NHS England spokesman defended the approach of the health service, indicating that provisions are already in place to deal with an upsurge in demand.
“The NHS again proved resilient this winter despite further increase in demand, with fewer trusts reporting serious operational issues and a significant reduction in trolley waits. We are already preparing for the upcoming winter with hospitals, GPs, social services and other health professionals coming together to work out the best way of responding in every area of the country.”
Accident and Emergency has recently missed requisite NHS targets, as the A&E system struggles under the weight of an increased patient demand.
Dr David Wrigley has been elected BMA deputy chairman; and it is notable that the incumbent is a staunch critic of NHS privatisation who has made strong criticisms of government policy.
The GPC member takes over the role from retired Manchester GP Dr Kailash Chand.
Wrigley has gone as far as accusing the government of starving the health service of funding, and causing the existing crisis in the NHS.
Indeed, speaking at LMCs annual conference in May, Wrigley had spoken very strongly on Government policy and the existing financial situation of the NHS.
“Our politicians are starving the NHS of funds and destroying it. Direct your anger to the politicians. The BMA should be shouting from the rooftops about this.”
The Lancashire GP indicated his delight to have been elected to the role by the BMA council, describing it as an honour.
Wrigley is also chairman of the Doctors in Unite / Medical Practitioners Union.
It is notable that this prominent individual in the British healthcare system had been re-elected to the council of this organisation having campaigned strongly against the health reforms put in place by the existing Conservative government.
Additionally, Ridley has even been critical of the failures of the British Medical Association to prevent what he perceives to be the slashing of funding for the health service.
Commenting on his appointment, Wrigley indicated that he would place a particular emphasis on uniting the profession, and discuss the relationship between the British Medical Association and the NHS.
“The NHS and the profession are under great strain with funding cuts. It is very important that the BMA protects and defends the NHS.”
Wrigley also indicated that he would strongly support junior doctors in the ongoing contract dispute with government, and was explicitly critical of the conduct of the Health Secretary Jeremy Hunt in this matter.
“It is quite clear that the contract isn’t acceptable for the majority of juniors, and Jeremy Hunt needs to hear that.”
The incoming deputy chairman also believes that the BMA council should do more to support the General Practitioners Committee.
Wrigley identified the current time as being a critical one for general practice, and suggested that the council of the British Medical Association must show more solidarity with general practitioners in this challenging climate.
The new deputy chairman has co-authored two books about the NHS, namely “NHS for Sale” and “NHS SOS”, with BMA council colleage Dr Jacky Davis and others.
BMA Scotland has announced a new chair of its medical academic staff committee.
Dr Paddy Mark, a Clinical Reader and Honorary Consultant Nephrologist working at the University of Glasgow, has been appointed to this position.
Mark qualified for he profession back in 1999, and his current duties include heading the Renal Research Group at the University of Glasgow.
He is also employed as a Consultant at the Glasgow Renal and Transplant Unit at Queen Elizabeth University Hospital Glasgow.
Speaking about his elevation to this important position within the British Medical Association, Dr. Mark indicated his pride about the position, but also warned that the NHS in Scotland, and healthcare in general, faced some challenges in the foreseeable future.
“Scotland has long maintained an excellent reputation in medical education and research, but recently the committee has become concerned by the possibility of redundancies in some Scottish universities and changes to pensions, both of which could have serious implications for academic medicine in Scotland,” Mark warned.
Following on from these comments, Dr. Mark also indicated that employment issues within the health service could have a serious impact on the future of the NHS.
“The threat of redundancy may have a significantly adverse effect on academic medicine in Scotland by discouraging doctors from seeking academic careers and raise doubts about the value of research and teaching,” Mark opined.
In the meantime, the new head of the BMA body indicated that he would particularly prioritise fighting against any compulsory medical academic job losses, owing to the importance of such positions within the health service.
But he also warned that there is a risk of academics in Scotland being particularly vulnerable to certain legislative issues.
“Medical academics in Scotland will be disproportionately hit by USS (Universities Superannuation Scheme) plans to reduce pension contributions as they have to move to the USS after eight years, whereas those in England can usually choose to stay in the NHS scheme. This represents a major reduction in the remuneration package available to clinical academics in Scotland and would mean they are paid substantially less than their NHS colleagues,” Mark stated.
Concluding his comments on the subject, Mark pointed out that the potential of recruiting academic and healthcare staff within Scotland would be impacted by these issues, and resolved to play his role in having a positive impact on the issue.
“This would be a serious blow to clinicians in Scotland and a disincentive to young people considering an academic role. In the coming year, the Scottish medical academic staff committee will be pushing for alternative options to be explored to ensure doctors in training are not discouraged from seeking an academic career in Scotland,” Mark concluded.
In addition to the appointment of, Dr Paddy Mark, Dr Rebecca Riddell, a GP and clinical senior lecturer at the University of Aberdeen, was appointed deputy chair of the committee.
Members of the GMB are seeking assurances that managers who submit resignations will not receive compensation.
There are concerns among the trade union that golden handshakes or other forms of pay-off could be offered to resigning managers, damaging trust in the NHS.
The hierarchy of the GMB has made it clear that members believe managers being rewarded for what are deemed “dismal failures” should be considered completely unacceptable.
Speaking on behalf of union members, Gary Palmer, GMB Organiser, pointed out that members were far from happy with current managerial proposals.
“Concerns that any further management who resign could receive golden handshakes, has resulted in GMB members calling for complete clarity around NHS money funding any potential pay-offs in rewarding such dismal failures by those entrusted to manage the NHS Trust on our behalf,” Palmer asserted.
In addition to the concerns about the managerial culture in the NHS, GMB members are also calling upon East Sussex Healthcare NHS Trust to clarify a particular issue.
There have been strong rumours that the Trust will be placed into special measures potentially as soon as later this month.
East Sussex Healthcare NHS Trust includes both the Conquest and Eastbourne District General hospitals.
Should this move come to fruition, it would represent just a six-month gap since the Care Quality Commission (CQC) graded the Trust with an inadequate rating.
The CQC found that there were significant failures in the quality of care offered by the trust, with hospitals failing to deliver adequate service in a number of key areas.
It was noted that hospitals under the care of this trust were particularly culpable with regard to the critical area of safety and management.
And it is thought that this played a major role in the resignation of Chief Executive Darren Grayson earlier this year.
Speaking passionately on this issue, the aforementioned Palmer outlined the strength of feeling on the matter within the membership of the GMB union.
“GMB members and staff are shocked and understandably angry that not only have the Trust management put patients and services at risk to a point that placing the Trust into special measures could be required to finally turn things around, but that those responsible for the troubles at the Trust, namely the senior management team including Stuart Welling, could potentially be recipients of substantial NHS pay offs if they choose to resign as a result,” Palmer stated.
With the issue clearly provoking strong feeling among NHS staff in the region, this would seem to be an issue that will run and run in the coming months.