Finance: We can't get any slimmer

If the Government fails to increase its health budget, the NHS will have to cut services or relax policy targets. Paul Gosling reports

"The NHS is going through a very difficult year. If we are to retain public confidence, we must recognise that some service reductions will occur, and must manage them in advance to avoid criticism of crisis and confusion in the NHS - because in election year problems won't remain local difficulties any more."

So says Richard Jones, chief executive of Gloucester's Severn trust, who sees himself as an objective observer in the great NHS funding debate. His trust is adequately funded to see out this year without the trauma that is growing in a number of trusts. But he is worried on behalf of the NHS as a whole.

"The NHS will remain the best free health care service anywhere in the world, so it would be a shame it this damaged public confidence," adds Mr Jones.

The current financial year saw a tough financial settlement for the NHS. While the average allocation to health authorities gave them an extra 1.1 per cent, many trusts received much less. Even a one-off extra pounds 25m grant to some of the worst-affected health authorities has not solved the problem.

"It is not just a tight settlement," explains David Bell, treasurer of the NHS Trust Federation, who is also finance director of the St Helier trust in Surrey. "We have had a heavy rise in emergency admissions, double- digit percentage increases year on year for the past couple of years. We are trying to keep a cool head, but the winter never ended for us.

"Growth money from the Treasury is not coming as heavily here as in other areas. Our health authority is deemed to be above target for capitation, and so got a 0.5 per cent grant increase."

Crisis might be too strong a word for St Helier's situation, but it is certainly in a tight fix. It has responded by putting in makeshift extra beds in the accident and emergency admissions area, where patients await beds becoming available in proper wards.

"We can open beds that are not in an ideal situation, and not increase costs," says Mr Bell. "We don't have to take on extra staff. We have been muddling through, but that can't go on any longer. It is not unsafe, but it is not the best treatment."

The hospital needs to open more wards, but can do so only if allocated an additional pounds 500,000. "We are still trying to persuade the health authority it can afford to pay for it - it can't afford not to," Mr Bell argues. "We are not quite at breaking point, but resources are at a point where they can't stretch much further."

St Helier's problems may be worse than in many trusts, but they are common enough. It has a population that is increasingly elderly, becomes ill more often and stays in beds longer once admitted. Patients continue to occupy beds even when they no longer need them, but the breakdown of the traditional family can mean there is nowhere for them to go to.

GPs, worried by possible legal actions for negligence, are more inclined to refer patients to hospital. And heavier pollution and climate changes are adding to the number of respiratory illnesses.

Many health professionals believe that the Government has become complacent because of the success of its own reforms. For years it has made the NHS use its existing resources more efficiently - until now, when they will go no further.

Indeed, some elements of the reform process have greatly added to the pressures. In years gone by St Helier's would have cancelled elective operations, extending waiting lists, in order to cope with the unexpected demand from emergency admissions. But the Patient's Charter, combined with fines where operations are cancelled, mean this is no longer an option. The reformed NHS is more efficient but also less flexible than the old NHS.

Health authorities and trusts are having to consider radical solutions. More are looking to rationing, including the limiting of cosmetic skin operations and fertility treatments. Some want the Government to review its policy on non-emergency operations, allowing waiting lists to grow again.

Chris Ham, health services professor at Birmingham University, says: "The situation is very serious. A lot of trusts are running deficits, which they can only pick up through non-recurring funds. I don't think it is possible to keep within budgets and also meet all the objectives of the NHS. The Government will have to put more money in, or accept some relaxation of policy targets."

Until now the worries of NHS managers have been more anecdotal than proven. But both the NHS Trust Federation and the National Association of Health Authorities and Trusts (which are in negotiation to merge) are conducting surveys of members which they believe will provide hard evidence of the damage caused by the funding shortfall.

Philip Hunt, director of Nahat, says: "I don't think it means long-term problems. The rule of thumb is that we need 2 per cent extra money per year in real terms. I am convinced that if you give this to the NHS, it will continue to provide a first-class service."

Independent Partners; request a free guide on NISAs from Hargreaves Lansdown

News
Russell Brand was in typically combative form during his promotional interview with Newsnight's Evan Davis
peopleReports that Brand could stand for Mayor on an 'anti-politics' ticket
News
The clocks go forward an hour at 1am on Sunday 30 March
news
Arts and Entertainment
The Doctor finds himself in a forest version of London in Doctor Who episode 'In the Forest of the Night'
TVReview: Is the Doctor ever going stop frowning? Apparently not.
News
Voluminous silk drawers were worn by Queen Victoria
newsThe silk underwear is part of a growing trade in celebrity smalls
PROMOTED VIDEO
Sport
footballMatch report: Real fight back to ruin Argentinian's debut
News
Candidates with surnames that start with an A have an electoral advantage
newsVoters are biased towards names with letters near start of alphabet
Arts and Entertainment
Isis with Lord Grantham (Hugh Bonneville)
TV
Arts and Entertainment
Jay James
TVReview: Performances were stale and cheesier than a chunk of Blue Stilton left out for a month
Finacial products from our partners
Property search
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
Independent Dating
and  

By clicking 'Search' you
are agreeing to our
Terms of Use.

ES Rentals

    iJobs Job Widget
    iJobs Money & Business

    Compensation and Benefits Manager - Brentwood - Circa £60,000

    £60000 per annum: Ashdown Group: Compensation and Benefits Manager - Compensat...

    Data Analyst/Planning and Performance – Surrey – Up to £35k

    £30000 - £35000 Per Annum plus excellent benefits: Clearwater People Solutions...

    IT Systems Business Analyst - Watford - £28k + bonus + benefits

    £24000 - £28000 per annum + bonus & benefits: Ashdown Group: IT Business Syste...

    Markit EDM (CADIS) Developer

    £50000 - £90000 per annum + benefits: Ampersand Consulting LLP: Markit EDM (CA...

    Day In a Page

    Wilko Johnson, now the bad news: musician splits with manager after police investigate assault claims

    Wilko Johnson, now the bad news

    Former Dr Feelgood splits with manager after police investigate assault claims
    Mark Udall: The Democrat Senator with a fight on his hands ahead of the US midterm elections

    Mark Udall: The Democrat Senator with a fight on his hands

    The Senator for Colorado is for gay rights, for abortion rights – and in the Republicans’ sights as they threaten to take control of the Senate next month
    New discoveries show more contact between far-flung prehistoric humans than had been thought

    New discoveries show more contact between far-flung prehistoric humans than had been thought

    Evidence found of contact between Easter Islanders and South America
    Cerys Matthews reveals how her uncle taped 150 interviews for a biography of Dylan Thomas

    Cerys Matthews on Dylan Thomas

    The singer reveals how her uncle taped 150 interviews for a biography of the famous Welsh poet
    DIY is not fun and we've finally realised this as a nation

    Homebase closures: 'DIY is not fun'

    Homebase has announced the closure of one in four of its stores. Nick Harding, who never did know his awl from his elbow, is glad to see the back of DIY
    The Battle of the Five Armies: Air New Zealand releases new Hobbit-inspired in-flight video

    Air New Zealand's wizard in-flight video

    The airline has released a new Hobbit-inspired clip dubbed "The most epic safety video ever made"
    Pumpkin spice is the flavour of the month - but can you stomach the sweetness?

    Pumpkin spice is the flavour of the month

    The combination of cinnamon, clove, nutmeg (and no actual pumpkin), now flavours everything from lattes to cream cheese in the US
    11 best sonic skincare brushes

    11 best sonic skincare brushes

    Forget the flannel - take skincare to the next level by using your favourite cleanser with a sonic facial brush
    Paul Scholes column: I'm not worried about Manchester United's defence - Chelsea test can be the making of Phil Jones and Marcos Rojo

    Paul Scholes column

    I'm not worried about Manchester United's defence - Chelsea test can be the making of Jones and Rojo
    Frank Warren: Boxing has its problems but in all my time I've never seen a crooked fight

    Frank Warren: Boxing has its problems but in all my time I've never seen a crooked fight

    While other sports are stalked by corruption, we are an easy target for the critics
    Jamie Roberts exclusive interview: 'I'm a man of my word – I'll stay in Paris'

    Jamie Roberts: 'I'm a man of my word – I'll stay in Paris'

    Wales centre says he’s not coming home but is looking to establish himself at Racing Métro
    How could three tourists have been battered within an inch of their lives by a burglar in a plush London hotel?

    A crime that reveals London's dark heart

    How could three tourists have been battered within an inch of their lives by a burglar in a plush London hotel?