Is the NHS about to be caught in another and lengthy political fire storm?

Written by Tony Millett.

It seems the NHS just cannot avoid the headlines – whether it is being named as the top of the league health service (by the American Commonwealth Fund) or whether it is failing one group of patients on Monday and another on Wednesday.  What is going on behind the headlines and at our local hospital?

First though, the endless run of headlines is partly explained by the NHS’ expected position as a key issue in next year’s general election.  This will put the NHS high up the news agenda of newspapers which back the Conservative party – and they will not be looking on the bright side of the NHS.

Two recent polls may have ensured many months of the NHS’ role as main political football even while the election campaign is still fairly distant.  

A ‘phone poll by Lord Ashcroft (who polls for the Conservative party) found that 31 per cent of voters thought ‘public services like the NHS’ would now be better if Labour had won in 2010 – while 48 per cent thought it would make no difference and 16 per cent said the services would be worse.

Another, wider and independent poll of voters across England by the Health Service Journal (HSJ) and FTI Consulting, revealed a widespread fear for the future of free health care.   

With funding at the heart of the political debate, this poll showed 90 per cent of voters agreeing that spending on the NHS should rise as the economy improves.

When asked to score out of 100 how much they agreed with the assertion “free care is under threat”, one in four said 100 per cent.

The average score was 70 per cent – even though no major political party has actually suggested an end to the principle of healthcare free at the point of use – and they are not likely to do so publicly.  

The results also revealed real concerns about the role of the private sector in the NHS.
Which chimes with the new chair of the House of Commons’ Health Select Committee, Dr Sarah Wollaston MP, telling readers of the Daily Telegraph: “Of course, there are…questions to be asked about whether the increased transactional costs from marketization have genuinely improved choice and efficiency.”

“Did we get more bang for our buck alongside better care because of the [Lansley] reorganisation, or was that outweighed by disruptive fragmentation?”  She already seems well-versed in the language of committee-ese.

In the HSJ/FTI Consulting survey the public’s continued support for the NHS is over whelming: 97 per cent of voters believe it is worth fighting for.

Meantime, the NHS carries on.  And so does the Great Western Hospital which serves the wider Marlborough area as well as Swindon.
Recent headlines have highlighted claims that the winter pressures experienced by hospitals have continued as ‘summer pressures’.  In January 2014 GWH had 6,089 attendances at their emergency department (or ED – formerly known as A&E.)  The figure for May 2014 was 6,634.

GWH is busy all the year round as demands on the NHS grow from long-term illnesses, an older population and increasingly complex and expensive treatments.

Elizabeth Price, GWH’s associate medical director for unscheduled care, told Marlborough News Online: “The emergency department is extremely busy all year and although we are seeing slightly fewer ED attendances compared with last year, this is because we are streaming some patients direct to medical and surgical assessment areas and other services.”

“Overall demand for Trust services continues to increase and emergency admissions to the Trust have actually increased 11% since April 1st.”

In fact efforts to reduce attendances at their ED have begun to pay off: last year from January to May 32,458 people went to GWH’s ED.  The same period in 2014 saw a four per cent drop to 31,278.

GWH have not only re-designed and enlarged their ED (and added a children’s ED) and recruited more staff.  They have also been working with other providers to make sure people who think they should ‘Go to A&E’, actually go to the right place where they will get the most appropriate attention and treatment.

GWH is also working with GPs to make sure patients go to the right department within GWH and  has supported the Choose Well campaign run by Wiltshire and Swindon CCGs.

And choosing well is important since it is estimated that at least one in four people attending ED could be treated more quickly and effectively elsewhere.

In addition there is the new urgent care centre on the GWH site open 24/7/365 to provide advice and treatment outside normal surgery hours.
With pressure still on GWH and another winter looming, Swindon CCG are planning to pilot new walk-in centres to help keep people from clogging up the hospital unnecessarily.

Last winter the NHS England handed out extra money to help hospitals through the winter.  GWH applied for £4.2 million and got nothing.  The Royal United in Bath got £4.4 million.

In a second round of extra money (in November 2013) Swindon CCG got £1.1 million.  None of this money went directly to GWH.

More than half of it went to SEQOL – a social enterprise organisation that provides health and social care services in Swindon. £300,000 went to fund additional beds within nursing homes.

The emphasis was on reducing “unnecessary admissions to hospital”, getting patients out of hospital faster, caring for the frail elderly at home.

Which brings us to the stark warning from Dr Wollaston’s Commons committee that cutting back on hospital services in England before community services are ready to provide ‘care close to home’, is a “recipe for disaster.”

The committee’s warning looks ahead to the Better Care Fund which starts this year, but comes into full effect next year.  This ‘Fund’ takes huge sums of money from hospitals and hands it to social care.

As Marlborough News Online has reported, the process of making this change rings alarms bells and will turn risk registers across the NHS in England bright red for danger.