BRITAIN: AN ALREADY HOPELESS PUBLIC HEALTH SYSTEM TO BE CUT BACK FURTHER

But they are not cutting back their gigantic clerical staff, of course

The NHS is facing an autumn round of cutbacks and economies across England as trusts struggle to deliver "efficiency savings" worth at least £1.6bn to balance their books by the end of the financial year in March. Although the health service received a 7% increase in budgets this year, the money came with strings attached, requiring economies which are causing confusion among managers and doctors due to the complexity of NHS finance.

Evidence about the extent of the problem has emerged from board papers posted on the websites of most of the 28 strategic health authorities over the past few weeks. They identified 29 hospitals and mental health trusts that have to find savings of at least £10m each to avoid going into the red. Another 22 have to trim their budgets by at least £5m to avoid deficit. Many primary care trusts are also being required to make large savings to compensate for growing spending on drugs and GP services.

The figures were compiled by the union-funded pressure group Health Emergency, which interpreted them as evidence of a cash crisis that is about to cause major dislocation of health services. It cited examples of bed closures in Suffolk, Worcestershire, West Yorkshire, Hertfordshire, Lincolnshire and London as evidence of local distress.

The charge was rejected by Sir Nigel Crisp, the NHS chief executive. "These figures are totally misleading. They appear to be a mixture of projected efficiency savings and projected deficits. Any suggestion by Health Emergency that the NHS is facing cutbacks on such a scale is scaremongering of the worst order," he said.

Health Emergency said its information was extracted from papers presented to NHS organisations' boards during the summer and published under the freedom of information scheme. They suggested authorities and trusts may have been engaged in financial gaming to get permission from the Department of Health to end the financial year with a deficit.

Finance directors accepted a 7% real-terms increase in NHS budgets, but - more than three months into the financial year - were still arguing about efficiency savings that were demanded as part of the 2005-06 settlement. In many cases it was not clear at July board meetings how far the accounts could be squared by cuts and how much the trusts would be allowed in extra financial support to cover a deficit. This late decision-making made it harder for the NHS to manage its affairs prudently.

In June, the National Audit Office and the Audit Commission said the NHS in England went into deficit last year, with a provisional overspend of £140m. Audited figures to be published shortly are expected to show an even higher figure. The audit bodies found about a quarter of NHS hospital trusts failed to break even in 2003-04 and the outcome for 2004-05 was likely to be worse. Auditors were concerned about the financial standing of a third of all NHS bodies, they said.

The Health Emergency figures showed north-west London was the area with the biggest savings target, with economies worth £189m required to balance the books. Its spokesman said no closures of hospitals or wards were envisaged at this stage and economies could be made by bringing down patients' time in hospital closer to the national average. Other health authorities requiring big cost reductions include Avon, Gloucestershire and Wiltshire (£175m), County Durham and Tees Valley (£152m) and Hampshire and Isle of Wight (£125m.) The trust needing the biggest saving to break even was Brighton and Sussex University hospitals. According to the Surrey and Sussex health authority board papers, the trust will be required to save £37.5m after being provided with extra support worth £10m to avoid deficit. The savings amounts to about 12% of its annual income. The trust said it was hoping to meet part of the target through sale and leaseback of property.[Funny money!]

John Lister, information director for Health Emergency, said the picture emerging across England was of beds, wards and some well-loved smaller hospitals closing and jobs being axed. "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 health authorities have yet to be identified as we head into autumn and another potentially cold winter. "Ministers have clearly been adopting an 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."

Sir Nigel said: "All areas of the country have seen significant improvements in services as a result of the highest level of growth in funding in the history of the NHS. Funding will have grown from £40bn in 2000 to nearly £93bn in 2008. "All NHS organisations - including those with a surplus - need to make efficiency improvements every year, regardless of their financial position."

But Jonathan Fielden, vice-chairman of the British Medical Association consultants' committee, said: "The Health Emergency figures confirm reports we are getting of widespread and intense financial pressures throughout the NHS

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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