Evidence submitted by Peter Mellor (Def
19)
I am a member of "Save Felixstowe Hospitals",
whose aim is to retain the excellent services of our Community
Hospital for Felixstowe and a Convalescent Hospital for East Suffolk.
For over a decade I have attended most of the local Board meetings
(Suffolk Health Authority (SHA), Suffolk Coastal PCG/T) as a member
of the public (often alone). I have witnessed with dismay the
onslaught of changes from the DoH with which local Boards have
tried to comply and the gradual increase in deficit which began
to dominate the provision of good healthcare in late 2004.
SUMMARY
In my opinion the Department of Health (DoH)
headquarters is the main cause of deficits through their micro-management
and their plethora of changes, each inadequately planned and underfunded.
The DoH insistence on franchising its peripheral and core services
to the private sector is transferring several percent of the NHS
budget to multi-national organisations, many of unsatisfactory
integrity. The Strategic Health Authorities (StHA) are an almost
total and unnecessary overhead (over £4 billion in 2004-05),
without which there would be a significant saving and little effect
on healthcare. The Primary Care Trusts (PCT) are a bit wasteful
through incompetence but they waste more as puppets of the DoH
who demand too many underfunded, ill-considered changes. None
of the above shows any sign of accountability to their patients
or the public. Many rural PCTs (such as my Suffolk Coastal) are
underfunded by more than their deficit, cumulatively. Unlike the
NHS deficit of about 1%, many PCT deficits are around 5% which
cannot reasonably be repaid by April 2007 without serious cuts
in healthcare. Curiously, as clinicians lose out to executives,
the management has worsened so much that healthcare is now being
cut despite the huge increase in NHS funding.
PCT DEFICIT AND
REQUIRED SAVINGS
Suffolk East PCT (unofficial merger between
Ipswich, Suffolk Central and Suffolk Coastal) has made several
cuts during 2005-06 which has resulted in a substantially increased
deficit for Ipswich Hospital NHS Trust (IHT). The resulting deficit
at April 2006 was £20 million £16 million at April 2005.
The DoH funding for 2006-07 is about £390 million. In October
2006 we expect SEPCT to join with Suffolk West PCT (SWPCT) and
the deficits will no doubt be combined (not yet published but
roughly similar) and continue. Even if the new (un-named but may
be SEWPCT) PCT were effective immediately, the savings of over
5% of the total budget by April 2007 will necessitate cuts in
healthcare. It will take over a year for the new PCT to anything
but concentrate on the deficit and cuts to reduce it. Just when
Ipswich Hospital is announcing ever-increasing deficits and bed
closures it is building additional capacity (Garrett-Anderson
centre), presumably with PFI—none of us can understand the
duplicity but perhaps it is an opportunity for the private sector
to gain control of the whole hospital.
REASONS FOR
THE DEFICITS
SEPCT gets about 90% of the national average
allocation. My perception is that an average allocation would
have kept SEPCT in financial balance, despite two big factors:
(a) the debt inherited from SHA in 2002; (b) the high and increasing
proportion of elderly residents for which a 12% uplift was expected.
I have tried to get the PCT to challenge the DoH funding but in
vain. Some of the figures in the funding formula are questionable
but the PCT accepts the allocation, regardless of accuracy or
fairness. In July 2005 I was told that Agenda for Change was employing
70 SEPCT staff (part-time) and that it needed 200 to complete
by the target date (September 2005). The Process, still ongoing,
and additional salaries have been underfunded and therefore contribute
to the PCT deficit. The GP Contract was negotiated nationally
but its consequences have resulted in additional underfunded costs
for the PCT, especially for Out-of-Hours cover. Two years after
the Contract the DoH is now saying that it wants GPs to offer
their services when the public wants them—no organisation
the size of the NHS should twist and turn at that rate. It is
destabilising and wasteful.
The National Tariff has made the use of step-down
beds artificially uneconomic due to double charging of their portion
of treatment. It is a market concept with no clinical justification.
Patient records in Ipswich Hospital continues to cost £600k
pa and the National Computer Records system is still unavailable—a
local cost but the responsibility and fault of the DoH. Choose
& Book is being operated in a fashion by the SEPCT but at
its own expense because the DoH system is unavailable—again
a local cost but the responsibility of the DoH.
Fortunately I don't think our area has yet suffered
major additional costs of PFI (PPP) or LIFT but that will change
in the near future; they are required by the DoH but funded by
local Trusts for the next 30 years. The DoH is determined to reduce
the number of acute and Community hospital beds. Trusts with PFI
commitments are finding the charge per patient rise with consequences
on their deficits and patient care. Probably the largest contribution
to the waste of NHS money is the out-sourcing of NHS services
to the private sector. The PFI programme for hospitals is now
accepted to have cost at least 40% more. The waste of tax-payers
money as the private sector bites deeply into Primary Care is
unknown but likely to be of similar order. Even worse, the dominant
objective will be for profit, not the care of patients.
FUNDING FORMULA
I have been unable to check whether the formula
has been correctly applied for our PCT; the Finance Director
considers it a waste of his time to try to understand it because
the DoH would not change their allocation even if a mistake were
found. The DoH simply directed me back to the PCT. I wonder whether
any member of the Select Committee understands the formula and
the resultant allocations to PCTs. The population served by a
PCT is an important factor in the formula but the figures used
for Suffolk Coastal PCT cannot be understood and are questionable;
exactly the same figures are used for succeeding years in the
Financial Report Summaries and yet we know that the population
is rising. I agree that some differentiation between PCTs is necessary
and a formula is justified. However, in view of its crucial importance
to deficits, the allocation of funding ought to be transparent
and fairly implemented. PCT fundings in the constituencies of
notable members of the Government and DoH are above the national
average. Perhaps that is justified—who knows?
CONSEQUENCES OF
THE DEFICITS
To avoid double charging under the National
Tariff and to get money for the building given to the area, the
SEPCT proposes to close the Bartlet Convalescent Hospital and
replace it by Care in the Community, most of which should be provided
by means-tested Social Services. Unfortunately the lack of trained
staff and the big deficit will probably mean that the Bartlet
closure will simply be money saving for the PCT and the loss of
a much-wanted service. Ipswich acute Hospital (IHT) has already
closed about 80 beds and many more are being considered. It has
had a long-standing problem of "delayed transfers of care"
and this must surely get worse, despite an aggressive programme
to keep patients out of hospital, (a) because of closed IHT beds
and (b) because of closed Convalescent Hospitals.
Acute hospitals without deficits will become
foundation hospitals first and their market objectives will favour
the "easy" jobs, not those requiring long term care
who will either use the other acute hospitals or be turned away
completely. It is important but uncertain what will happen when
all acute hospitals get foundation status. Presumably long term
care will be completely excluded from the NHS; as a 68 year old
I fear for my future healthcare and savings. The DoH claims to
support Community Hospitals but they are forcing PCTs to close
them. The PCT deficits are now closing Convalescent Hospitals
and we are promised increased Care in the Community. For
some patients this is good news, even though most will have to
pay for the Social Services care and the army of staff have yet
to appear. For an important minority, care in their own home would
be unsafe and they will have to try to find a nursing home for
their recovery. In all areas with whom I have been in contact,
patients want to retain the NHS Convalescent Hospitals but it
seems that the "Patient-Led NHS" does not mean what
it says. In rural areas Care in the Community will require considerable
car travel and travel time by carers and it looks to be unsustainable
as fuel prices and congestion increase. At that time local hospitals
will be sold and there will be no local alternative. The monitoring
of Care in the Community staff, for their quality of service,
kindness and to prevent the abuse of patients, will be much more
difficult than in hospitals but is ignored.
In 2004 our PCT produced A Fresher Future
for Felixstowe with announcements and commitments made in
public and before our MP. Beds were closed but the rest of the
package was dropped through lack of money. Our PCT has actually
admitted that the local public does not trust them. We used to
trust government departments but now find their words and deeds
are different. As both major parliamentary parties favour privatisation
the cost and quality of healthcare, especially for the longer-term
patients, will worsen until either: (a) a public revolution and/or
(b) a new Beveridge emerges to take the NHS back to its founding
principles.
SOLUTIONS
Instead of reorganising the StHAs I would scrap
them. Apart from the savings it would put the DoH into direct
contact with the Trusts—better understanding and the extra
load would reduce the number of new ideas from the "bright
boys and girls in the DoH". Take a very careful look at the
funding formula and funding allocations, make any necessary changes
and make them understandable. Provide a longer period for the
repayment of deficits if they still remain. Reverse the headlong
slide into privatisation. The British and foreign companies will
increasingly fleece the NHS and grow fat on tax-payers money.
Return control to those with clinical experience. The "un-managed
NHS" was more efficient than it is and will be. Minute accounting
and statistics never cured anyone but give an increasing burden
of administration. New schemes should be much more carefully thought
out before being implemented (eg GP Contract). Computer schemes
especially should be tested much more thoroughly before being
released to Trusts.
I thank the Health Committee for the opportunity
to contribute. You have a heavy responsibility to serve the nation.
Peter Mellor
Save Felixstowe Hospitals
June 2006
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