Avoiding another NHS winter of discontent

The coming months will push the NHS to the edge of a crisis without increased investment.

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Last winter, Theresa May’s first as Prime Minister, was a terrible time for the NHS and its patients. With the worst waiting lists on record and with patients stacked up in the corridors of overcrowded hospitals, the struggles of the NHS came to be seen as emblematic of the Prime Minister’s failure to manage her domestic agenda while also juggling the huge demands of preparing for the country to leave the European Union.

This year has to be better. The government has had ample time to prepare, and there’s no excuse for NHS patients and their families to suffer the same chaotic scenes as last year.

So far, the signs are not encouraging. Attendances at large A&Es were running three per cent higher this summer than last year. Overnight bed occupancy rates are at the highest level for 16 years. NHS Providers says that 92 per cent of trust leaders predict a lack of primary care capacity this coming winter and NHS England has warned of a “heavy flu season” requiring extra preparation.

The Royal College of Emergency Medicine says “by all metrics, the months ahead… seem likely to be worse even than last year”. The Royal College of Surgeons warns the NHS will face a “winter of woe” unless hospitals and local authorities tackle delayed discharges.

And it is the figures for delayed discharge that give perhaps the most cause for concern. Delayed bed days due to social care are running 11 per cent higher this July compared to last year, despite the government investing in social care with the aim of freeing up 2,000-3,000 hospital beds. Hospital bosses claim that cash-strapped local councils are failing to put the emergency funding into schemes to help patients get home quicker by improving social care support for them.

Despite all these warning signs the government have, at the time of writing, resisted calls to bring in emergency funding to help the NHS get through the winter months. This looks an unsustainable position.

Labour has argued for the government to put in an additional £500m of funding, focused on three areas: increasing capacity in hospitals to cope the with the seasonal spike in demand; allowing hospitals to secure additional staffing without resorting to costly agency staff; and delivering effective arrangements between NHS and social care to reduce delayed transfers of care.

Up until 2014/15, dedicated additional funding of between £300m and £700m was made available nationally to support and sustain the urgent and emergency care system during winter. However, this funding was pulled into the NHS budget from 2015/16 with an instruction to CCGs to ensure it was passed to providers. Seasonal resilience funding, currently £400m, is now being swallowed by the wider financial pressures on the NHS.

The truth is that the problems over winter are only the most obvious symptom of the catastrophic financial settlement which the Conservative government has imposed on the health service. Seven years of Tory underfunding have pushed NHS finances to the brink.

£2.8bn of capital funding has been used to plug revenue gaps over the past three years. Staffing shortages have left trusts spending more than £3bn per year on agency staff. The Capped Expenditure Process is now stripping millions more from budgets, in year, behind closed doors.

Collectively, NHS trusts ended 2016/17 with a reported deficit of £791 million and, according to NHS Improvement, were already a further £736m in the red after Q1 of this year. The provider sector is planning for a deficit of £496m by the end of 2017/18.

A long-term solution is well overdue. At the election Labour pledged to boost NHS spending, funded by raising income tax for the top five per cent of earners. Investment is essential in the workforce, in general practice, in mental health and in infrastructure. Our proposals would have raised an additional £5.4bn a year, plus £10bn capital from reversing corporation tax cuts, to protect NHS patients. Just as importantly, we had a costed plan to deliver it.

The Tories in contrast only set a vague target to increase funding by the end of the Parliament with no explanation of where the money would come from. Under Labour’s plan, investment to support NHS patients would have been available now – three months on, the Tories have not even confirmed their spending plans, much less when it will be available. Their existing, pre-election spending plan will see spending per head fall over the coming years.

They can’t go on like this. Most of the Conservative manifesto has already been pulped, decisively rejected by an unforgiving electorate. Now is surely the time for Theresa May to see sense on NHS funding and put in place a sustainable, long-term package of support that gives NHS staff the resources to deliver for their patients, not just during the winter, but all year round.