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A&Es and hospitals face closure in NHS funding crisis

Published 26/08/2016

The NHS is drawing up plans to close services including A&E departments and district hospitals amid a dire funding crisis.

Experts warned there could be a "glut" of hospital services shut down as providers face a £23 billion national funding deficit.

An investigation commissioned by campaign group 38 Degrees uncovered 44 Sustainability and Transformation Plans (STPs) being drawn up across England to meet significant cuts.

The revelations come after Stafford County Hospital suspended its A&E service for children on Thursday after senior staff said it was not clinically safe.

38 Degrees said the analysis, carried out by health policy experts Incisive Health, "reveals far-reaching plans to close services, which appear to have had little input from patients and the public".

It found that, in the Black Country, there are proposals to shut the A&E department at the Midland Metropolitan Hospital and to close one of two district general hospitals as part of a planned merger.

In Leicestershire and Rutland, there are plans to cut the number of hospitals in the area from three to two, w hile in Suffolk and North East Essex there are plans to "reconfigure" acute services within Colchester Hospital University Trust and to close GP practices.

Hospital beds are at risk in Dorset, while there are proposals to close the equivalent of five wards in the Leeds Teaching Hospitals Trust.

Director at 38 Degrees Laura Townshend said the findings show the NHS is "dangerously under-funded".

She said: "These proposed cuts aren't the fault of local NHS leaders. The health service is struggling to cope with growing black holes in NHS funding. These new revelations will be a test of Theresa May's commitment to a fully-funded National Health Service.

"The NHS belongs to all of us - so local people should get a say in any changes to their local services."

The findings come as Chris Hopson, chief executive of NHS Providers, which represents frontline NHS leaders, warned that a "glut" of hospital services could shut down.

Mr Hopson called on Health Secretary Jeremy Hunt and NHS England boss Simon Stevens to admit there is a disparity between what the NHS is being asked to achieve and the money that is available to do it.

He said: "Our members tell us that they are struggling to keep services open because of workforce shortages and they therefore face really difficult decisions about; do you close down something either permanently or temporarily because you cannot staff it safely?"

He added: "NHS Improvement, when asking our guys to improve their financial position, one of the places they have been asked to look at is 'Please identify your marginal acute services where you are trying to prop up what is really an unsustainable rota'.

"So we would expect to see a bit of a glut of those kinds of decisions going forward because our guys have been specifically asked to identify them."

Mr Hopson warned that tough decisions lie ahead on what care the NHS can afford.

He said: "We have now reached the point where we cannot do everything - we cannot provide the required quality of service to the required performance standards for the money available.

"What you can't do is ask us to do the impossible and then beat us up when we fail to deliver it."

He said "NHS leaders must agree what is going to give", adding: "Is it about reducing the size of the workforce? Is it about rationing access to care? Is it about letting waiting times slip? Is it about letting the deficits go up?"

A spokesman for NHS Improvement said: "It is an essential part of the planning process for local areas to identify which services could be unsafe, under-used or unsustainable.

"It is absolutely right that decisions on the future of health services are taken locally in consultation with the people who use those services. That planning process is still going on and no decisions have been taken."

And commenting on the Incisive Health investigation, the Department of Health said it had protected the NHS "by giving it an extra £10 billion to fund its own plan to transform services".

A spokesman said: "Changes to local services will only go forward where they are designed by doctors and in the clear interests of local patients."

Labour leadership challenger Owen Smith said: "The true scale of the Tories' plans to cut the NHS have finally been exposed.

"Plans being drawn up behind closed doors are going to see A&E departments shut, the closure of hospital wards and damaging cuts to other essential frontline services.

"Jeremy Hunt calls these 'efficiency savings', but they are in fact another hammer blow to the very fabric of our NHS; and with a weak opposition the Tories think they can get away with it.

"I will not allow the NHS to continue bearing the brunt of the Tories' failed austerity policies. That is why I'm calling on Theresa May to bring a halt to these plans and support my proposals for new taxes on the wealthiest to inject an extra £60 billion into the NHS over the next five years."

Labour's shadow health secretary, Diane Abbott, said: "This analysis is a damning indictment of this Government's underfunding and mismanagement of the NHS.

"It reinforces all the concerns highlighted by the recent NHS providers report and the King's Fund survey of Trusts' NHS finance directors. Emergency closures of vital units across the country testify to a real crisis.

"The Government needs to properly fund the NHS and cut out the waste of PFI, agency staffing and inflated drug prices. These resources should be ploughed back in to frontline services."

Natalie Beswetherick, director of practice and development at the Chartered Society of Physiotherapy, said: "Bringing together local NHS commissioners, providers and councils to plan health and care services for their communities is a much-needed step forward.

"Given the financial challenges, it is vital that STPs focus on delivering measures that both improve services for people and deliver savings.

"For example, falls prevention services save £4 for every £1 invested. And putting physiotherapists into GP surgeries as the first point of contact for conditions like back pain reduces pressure in primary care and means less onward referrals to hospitals.

"NHS staff and patients must have the opportunity to offer their views on local plans through full consultations."

Tory chairwoman of the Commons health committee, Sarah Wollaston, said the NHS needed more funding so it could put greater resources into prevention.

"The trouble is that the money that was put into this so-called sustainability and and transformation programme is mostly being sucked into plugging the provider deficits, and relatively, a very, very small amount of it is left for the so-called transformation - that's to say, investing in new premises in the community that allow you to make those changes.

"I do think that there is a very strong case for saying that the health service now needs more money," she told the BBC.

Ms Abbott said the NHS could make billions of pounds' worth of savings by ending the private finance initiative arrangements, and getting a better deal on drug supplies.

Richard Murray, of the King's Fund health policy think-tank, told the BBC the NHS may have to look at expanding charging from current areas like prescriptions.

Lib Dem health spokesman Norman Lamb said: "The original intention of Sustainability and Transformation Plans - bringing NHS services together with a stronger focus on prevention, early intervention and community care - makes sense as a principle.

"However, it would be scandalous if the Government simply hoped to use these plans as an excuse to cut services and starve the NHS of the funding it desperately needs."

NHS Confederation chief executive Stephen Dalton said: "These local plans are being made when funding is very tight but they are not about cuts - they are about modernising services to match people's changing care needs.

"It is inevitable during such important changes that some services will be moved, reduced or enhanced. It is too simplistic to focus only on what appears to be lost. It's also important to look at what alternatives are being provided.

"We are seeing an important shift in which local NHS leaders are starting to get beyond the anxiety of making tough decisions and are working closely with local government and others to reshape services, reflecting changes in public need.

"People will want more information and this is on the way. Leaders in the NHS and local government in each of these 44 areas will do their best to reflect local needs and will want the wider community to be involved in the conversation."

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