NHS - the promises are there, but where is the money to pay for them?Amidst all the election and post general election talk about the NHS, so far one thing is missing - the money to back up the promises and the commitments.
Fourteen months ago Great Western Hospital won the agreement of central health organisations (NHS England & NHS Improvement) for the hospital's plan to re-design and enlarge their emergency department (ED - or A&E). The cost was set at £29.6m.
Marlborough.news understands that so far the hospital has seen none of that money. So they are having to pay the costs of getting the development underway from their day-to-day budget - just one reason they will be well overspent by the end of this financial year.
And they are also having to carry the daily extra costs that their existing and overcrowded ED brings with it as it impacts other parts of the hospital.
The agreement for this development of GWH's ED was based on the very belated admission that the hospital is simply too small for Swindon's rapidly increasing population, let alone for the increased demand for acute beds - especially from those living longer and with more complex and long-term illnesses.
In those fourteen months the situation at GWH's ED and the availability of acute beds has become more critical. Their ED is often operating at 300 per cent of its designed capacity and the occupancy of the hospital's acute beds is above the safe level.
In quarter two bed occupancy at GWH was officially at 94.78 per cent. The optimum - or safe - level of bed occupancy is now either 92 per cent (NHSEngland) or 90 per cent (NICE - National Institute of Health & Care Excellence). The 94.78 figure put GWH in 104th place out of England's 130 acute hospital trusts.
Before austerity kicked in, the optimum/safe level of bed occupancy was set at 85 per cent. However, the true current figure for bed occupancy at GWH is 109 per cent - once the extra winter beds are taken into account. Even with those figures being reported, no money has been forthcoming and the re-design and enlargement will be further delayed.
GWH is not alone in waiting for money. During a debate in the House of Commons on January 27, the Conservative MP for Kettering asked the Health Secretary when the agreed money to fund Kettering General Hospital's new urgent care hub would be paid. Matt Hancock answered: "The funding will be paid to the hospitals imminently, but it is definitely coming, so they can get on with planning it."
And another MP asked why Nottingham University Hospitals had not received its promised share of seed funding announced in September. The MP explained: "...there is no certainty, even once it has drawn those plans, that they will be funded and delivered."
During the debate, the Conservative MP for Ipswich asked about his local hospital's new A&E department. He said the business case took a year to approve. He said that every month's delay in starting the construction work is costing the taxpayer 'around £167,000, which is mainly due to inflation and increased building costs'.
Another local development that seems to be taking for ever to get through the Department of Health's byzantine approval process is the new health centre for Devizes. This was an NHS development Devizes MP Claire Perry O'Neill had hoped to see completed well before she decided not to continue as an MP.
In his maiden speech in the House (January 29), Devizes' new MP, Danny Kruger, referred to her work on the scheme: "Thanks to her, we have the promise of a new health centre in Devizes, which is badly needed and, I am afraid to say, quite long overdue. I have inherited from Claire the tradition of posing with the Health Secretary in an empty field outside Devizes, pointing to the spot where the health centre will appear at any moment."
He may have a bit of wait. Last month marlborough.news asked the Wiltshire Clinical Commissioning Group [WCCG] whether all the money for the new centre was signed and sealed. A spokesperson responded: "Plans for the proposed integrated care centre on Marshall Road in Devizes continue to progress well. NHS Property Services (NHSPS) will develop the building with construction expected to start in 2021 and completion planned for 2022."
"The Outline Business Case for the centre has been submitted to NHS England & NHS Improvement (NHSE/I) for approval and development of the Full Business Case has already started. Subject to business case approval, the total cost of developing the new building will be funded centrally via the NHSE/I approval process, with the cost of equipping the building met from CCG ‘business as usual’ allocations that have been ring-fenced for the Devizes scheme."
"The local NHS Clinical Commissioning Group are developing the business cases and leading the project in partnership with NHSPS. Local GPs and other service providers, along with service users and patient groups have been involved with the plans to ensure they meet the needs of the local community."
Which was almost certainly not the positive reply to our question Danny Kruger would like to read. One tricky issue impacting on progress may be that after the end of March the WCCG will no longer exist. Will the demands of the two CCGs with which it is being merged (Bath & North East Somerset and Swindon) have the same priorities for the Devizes project and its ongoing costs?
Between the NHS and the government, is it simply that they have a dysfunctional system of approving improvements? Or is it just that the money is not there?
In the meantime at GWH and other hospitals, the NHS managers and their hard-worked staff struggle on - still caring and still producing amazing results.
This is the first two articles about the funding of the NHS. The next article will look at the government's promises and its new level of funding.