Despite record levels of funding at national level, the National Health Service is facing a drastic autumn round of local cutbacks and economies throughout England as Trusts, Primary Care Trusts (PTs) and Strategic Health Authorities (SHAs) attempt to deliver a balanced budget for the current financial year, warns pressure group London Health Emergency.
At least 20 of the 28 SHAs have projected deficits in 2005-6, while four have projected end of year deficits in excess of £70m for their local NHS organisations.
A snapshot estimate from the available figures suggests a total shortfall of more than £1.6 billion across 22 SHAs: the 51 most financially challenged NHS Trusts face deficits and savings targets totalling almost £650 million, while many more are also struggling to balance their books.
A survey of SHA, Trust and Primary Care Trust papers and local press websites has revealed that tens of millions in deficits carried over from the last financial year are now worsening the plight of hard-pressed Trusts and PCTs as they attempt -LO stay within spending limits this year, while meeting stiff government performance targets.
Many Trusts and PCTs are counting substantial "brokerage" and one-off support payments organised by SHAs as a means to prop up their floundering finances and remain within borrowing limits.
One Trust, Mid Yorkshire Hospitals, is seeking brokerage this year of £100m, while others are so deep in the red they are having to defer payments on accumulated debts, and hope to Trusts facing deficits or savings targets over E10 million Trust Deficit/ savings
target (Em) Brighton & Sussex NW London Hospitals Ashford & St Peters Hammersmith Hosps St George's, Tooting Shrewsbury & Telford North Bristol West Suffolk Hospital South Tees West Herts Hospitals Eand N Herts Hospitals East Sussex Hospitals United Bristol Hospitals Royal United Hospitals Queens Medical Centre* Worcestershire Acute University Hosps Leics Mid Yorks Hospitals Hull & E Yorks Hosps Royal Free Hospital North Cumbria Bedford Hospital Leeds Teaching Hosps Ipswich Hospitals QEH, Woolwich Surrey Borders Brompton & Harefield W London Mental H Surrey & Sussex clear their deficits over the next three years.
No fewer than 29 hospital and mental health Trusts have been identified as facing deficits or savings targets of £10m or more in 2005-6, leaving them just six months to push through farreaching cuts and changes. At least another 22 Trusts face savings targets or deficits of £5m or more.
And well over a dozen PCTs face massive deficits across the country, several of them in excess of £10m.
While previously published official figures have set last year's deficits against underspends elsewhere within each SHA, giving an artificially small apparent deficit across the NHS as a whole, it is clear from this 37.0 26.1 24.0 23.0 22.0
"Give it to us straight. How long have we got?" recent survey that the sheer scale of the cutbacks required in the 18.0 overspending Trusts 17.5 and PCIs must have an 17.2 impact on patient care. 16.7 Beds, wards and some 15.8 well-loved smaller hospitals and units are closing, jobs aLC being axed, and PCTs, which 13.0 foot the bill for each 12.7 episode of hospital 12.0 treatment, are seeking 12.0 to cut back the use of
hospital services and divert patients to pri11.0 mary care or to nursing 11.0 homes and social serv10.8 ices - to balance their 10.0 books at the expense of
yawning deficits for
their local provider Trusts.
Publishing the survey,
completed at the end of
August using the most current published figures, Dr
John Lister, Information
Director for pressure group
London Health Emergency
said:
"It's hard to tell which figures are the most worrying:
the huge sums to be saved
through identified spending
cuts, or the fact that tens of
millions of "savings"
assumed by the SHAs have
yet to be identified as we
head into autumn and
another potentially cold
winter.
"Ministers have clearly
been adopting the ostrich
style of management, taking
note only of the carefully laundered and deceptive figures served up by civil servants at the end of a financial year, and ignoring the misery that is taking shape as these cuts start to bite."
Deficits which have been rolled over for years at local level have suddenly become unmanageable without drastic cuts. Local services are paying the price of failed government policies, including:
• ministers' eagerness to tie every last penny of new money to new and tougher targets,
• the introduction of new contracts with more costly private sector providers
• and a new, fiercely competitive market system, to be introduced next spring, in which Trusts will only be paid per item of treatment supplied. To make matters even worse, a BICW round of "reforms" which will merge many existing PCTs and make the NHS even more remote from the local people it is supposed to serve, is now being forced through at breakneck speed. Ministers need to wake up and take action now to prevent these financial pressures forcing major dislocation in health services that the electorate will not readily forgive. Patricia Hewitt in May announced f3 billion was available for the NHS to buy in more services from highcost private hospitals, despite the capacity of the NHS to deliver better value: the money is clearly available to rescue vital services and save our NHS. If she refuses to act it will be clear she is happy for NHS organisations to fail. Which one will they make redundant next?